At least half of the 80 million Americans with high blood pressure don't have it under control. Sometimes poor control stems from lack of trying. A growing number of people, though, have what's called resistant hypertension — blood pressure that stays stubbornly above the target (see "Blood pressure goals") in spite of lifestyle changes and medications.

Persistently high blood pressure is a problem. It is a key contributor to stroke, heart failure, and other cardiovascular conditions.

After a Heart Attack

Questions to Discuss with Your Doctor:

• Have you had chest pain or pressure since you were discharged from the hospital?
• How severe is it?
• How long does it last?
• Does it stay in your chest or radiate to other parts of your body?
• Did you have this pain before your heart attack? What brings it on? How frequently do you get it?
• What were you doing just prior to the chest pain?
• Do you ever get chest pain or pressure at rest?
• What relieves the chest pain?
• If you take nitroglycerin, how many doses do you usually need to take before the pain goes away?
• How often do you take nitroglycerin?
• Do you get short of breath when you lie down or exert yourself?
• Do you awaken in the middle of the night short of breath?
• Do your ankles swell?
• Do you ever feel lightheaded?
• Have you fainted?
• Do you get rapid or pounding heartbeat for no reason?
• Do you know what each of the medications you are taking does?
• Do you know the side effects of each medication?
• Are you having any side effects?
• Are you taking an aspirin every day?
• Are you doing everything you can to modify the risk factors that can worsen your coronary artery disease (cigarette smoking, high blood pressure, high cholesterol, and diabetes are the most important risk factors)?
• Are you participating in a supervised exercise program?
• Are you resuming your normal activities?
• Are you sexually active?
• Have you returned to work?
• Have you been feeling depressed since your heart attack?
• Have you been able to reduce the stress in your life?
• Have you been fatigued?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in your wrist, groin, and feet
• Listen over the major arteries in the neck, groin, and feet (for abnormal noises)
• Look at the veins in the neck to see if there is extra fluid in your body
• Heart and lungs
• Ankles and legs (for swelling)

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests for glucose, lipid panel (cholesterol levels) and C-reactive protein (CRP)
• Electrocardiogram
• Echocardiogram
• Exercise stress test

Heart Block

Questions to Discuss with Your Doctor:

• Have you been dizzy or lightheaded?
• Have you fainted?
• Have you been fatigued?
• Have you had chest pain?
  • Do you get it with exertion or at rest?
  • How frequently do you get it?
  • How long does it last?
  • What brings it on?
  • What relieves it?
• Is this a change from your usual pattern?
• Do you get short of breath when you lie down or exert yourself?
• Do you awaken in the middle of the night short of breath?
• Do your ankles swell?
• Do you get rapid or pounding heartbeats for no reason?
• What medications are you taking (including over-the-counter medications, herbal remedies, and vitamins)?
• Do you have any other medical problems?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in the wrist and feet
• Veins in the neck
• Heart and lungs
• Ankles and legs (for swelling)

Your Doctor Might Order the Following Lab Tests or Studies:

• Electrocardiogram
• Echocardiogram
• Holter monitor
• Electrophysiologic testing

Mitral Valve Prolapse

Questions to Discuss with Your Doctor:

• Have you had an echocardiogram?
• What did it show?
• Does your mitral valve leak?
• Do you get chest pain?
• What brings it on?
• How long does it last?
• What relieves it?
• Do you ever get a rapid or pounding heartbeat (palpitations) for no reason?
• How long does it last?
• Do you feel faint or develop chest pain or shortness of breath?
• Have you ever fainted?
• Do you get short of breath when you lie down or exert yourself?
• Have you ever taken any medications for your heart?
• Did you develop any side effects from these medications?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Heart (sometimes while you are standing, squatting, or performing other maneuvers)
• Lungs

Your Doctor Might Order the Following Lab Tests or Studies:

• Electrocardiogram
• Echocardiogram
• Holter monitor or event monitor

Peripheral Artery Disease

Questions to Discuss with Your Doctor:

• Do you develop pain, cramps, aches, fatigue, or numbness in your leg muscles when you walk?
• At what distance do you develop symptoms?
• Do they go away when you stop walking?
• Do you ever develop these symptoms at rest?
• Do you have decreased sensation in your feet?
• If you are a man, do you have erectile dysfunction?
• Are you doing everything possible to modify the risk factors that can worsen this disease (smoking cessation, treating elevated blood pressure and cholesterol, and controlling diabetes)?
• Are you exercising regularly and at progressively more strenuous levels?
• Are you taking an aspirin every day?
• If you have diabetes, do you practice meticulous foot care (cleaning, applying moisturizing lotions, and wearing well-fitting protective shoes)?
• Do you know when to seek emergency medical care for peripheral artery disease (if your leg becomes suddenly painful, pale, cold and numb)?
• Do you get chest pain or pressure with exertion or at rest? If so, you may have coronary artery disease.
• Do you have sudden brief episodes of blindness (like a shade being pulled over your eyes) or sudden episodes of weakness in an arm or leg, or difficulty speaking? These could be warning symptoms of stroke.

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in your feet and groin, and behind your knees
• Listen with the stethoscope over your carotid arteries in your neck
• Heart and lungs
• Neurologic exam (reflexes and sensation in your legs)
• Muscles (looking for atrophy in leg muscles)
• Skin, looking for changes related to reduced circulation

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests, including glucose and cholesterol levels
• Ultrasound of your carotid arteries
• Doppler Ankle-Arm Indices
• Exercise Stress Test
• MRI/MRA
• Angiography

When it comes to fighting high blood pressure, the average American diet delivers too much sodium and too little potassium. Eating to reverse this imbalance could prevent or control high blood pressure and translate into fewer heart attacks, strokes, and deaths from heart disease.

Normal body levels of potassium are important for muscle function. Potassium relaxes the walls of the blood vessels, lowering blood pressure and protecting against muscle cramping. A number of studies have shown an association between low potassium intake and increased blood pressure and higher risk of stroke. On the flip side, people who already have high blood pressure can significantly lower their systolic (top number) blood pressure by increasing their potassium intake when they choose to eat healthy foods.

"Mini-strokes" have major risks

What's the difference between a stroke and a transient ischemic attack (TIA)? At first, not much. They look the same, feel the same, and stem from the same thing — blocked blood flow to the brain. But a stroke lasts for hours, maybe longer, while a TIA fades away after a few minutes.

Don't be fooled by the disappearance of symptoms. Even after they are gone, danger still lurks in the form of other TIAs, stroke, and even death.

Immediate first aid works to minimize blood clotting triggered by plaque ruptures

How should you take aspirin for a heart attack? You've always been healthy, but you seemed to run out of steam at your wife's 60th birthday dinner last week. And now your chest feels heavy, as if you're in a vise. You take some antacids, even though it's 7:00 a.m. and you haven't even had breakfast. But you get no relief, and the pain is spreading to your jaw and shoulder. You call your wife, who takes one look at you and rushes to the phone. After calling 911, she brings you an aspirin and some water.

Your wife got it right: You may be having a heart attack, and you need to get to the hospital fast. You also need to get some aspirin into your system quickly — but should you chew the tablet or swallow it?

Alternatives to Vioxx if Heart Disease Present

Although the sudden decision to withdraw Vioxx came as a surprise, it wasn't entirely unexpected. Concerns about the cardiovascular safety of this medication were raised soon after it was approved for sale in the United States .

As of this early October 2004 article, hard and fast guidelines for replacing Vioxx haven't yet been published. What many doctors are telling their patients with heart disease is to first try one of the older, more established anti-inflammatory drugs.