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Dr. Zorba Paster: Keeping blood pressure on target reduces stroke risk

UPDATED: Wed., April 28, 2021

Dr. Zorba Paster For The Spokesman-Review

I had a patient in my office the other day – hard worker, farm family, likes to fish, in good health, taking his blood pressure medications. Good blood pressure control with two pills.

His dad was a typical Wisconsin farmer, a guy who rarely went to the doctor because, well, just because. But his dad had a devastating stroke sometime in his early 70s, which left him unable to care for himself and which was too much, eventually, for his wife to care for him.

So, the dad spent the last of his years in a nursing home – not the way any of us want to spend our golden years.

Now, I can’t go back and look at the father’s health record, but since his son has high blood pressure, chances are the father may have had high blood pressure, too.

And if he did, and if he had taken medication for it – one, two or three meds, as many types as he may have needed – he would have reduced his risk of stroke by at least 75%.

But getting someone to see a doctor and take their meds, especially men, can be rather, shall I say, problematic.

Women are more likely than men to go to the doctor, seek medical advice and then follow it. Not sure why this kind of testosterone dementia sets in, but clearly that male hormone can lead to some unclear thinking.

I like to discuss family history with all my patients when I’m doing a physical, which is why this came up. So, I told my patient directly that he was doing a great job, and his two meds were working splendidly. I congratulated him on getting his blood pressure checked and then taking action.

His response was that it wasn’t about his health, really. He’d only come in because, in order to get his commercial driver’s license, he needed to get his blood pressure under control. And then he told me, “If it weren’t for that, I probably wouldn’t have done anything.”

It reminded me of the importance of talking about some simple things, like blood pressure, all the time for all of us because we have great, inexpensive generic medications that really work well for this.

According to the Centers for Disease Control and Prevention, nearly half of all adults have high blood pressure, yet only 1 in 4 have it under control. About 30 million adults who should take blood pressure pills are not taking any of them.

Hypertension is a major contributing cause of death for an estimated 495,000 people in the U.S.

My spin: If you have hypertension, treat it to goal. That’s less than 120/80 for younger folks and somewhat higher for older adults. It’s something you should discuss with your doctor.

If you don’t know if you have hypertension but don’t want to get it checked by a doctor, then get a portable machine. I like the ones made by Omron – you can buy them online for about $40.

Check it at home and if it’s elevated, take action. And by the way I only tell patient stories when they give me permission to do so.

Finally, here’s a correction on my recent column on atrial fibrillation. The first line treatment for A. Fib is to reduce the risk of blood clots and subsequent stroke by using blood thinners, such as Warfarin, Xaralto and Eliquis.

They do not affect the fast heart rhythm that some A. fib sufferers have. Beta blockers, calcium channel blockers or antiarrhythmic medications are often used to control that.

Unfortunately, the only drug thinner that’s generic is Warfarin, which requires regular blood tests to keep it in check. I just checked with a pharmacy – Warfarin is $10 month, while Xaralto is $500 month. So, if you don’t have good insurance coverage, then Warfarin is the way to go. Stay well.

Dr. Zorba Paster is a family physician and host of the public radio program “Zorba Paster on Your Health.” He can be reached at askzorba@doctorzorba.com.

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