Does High Blood Pressure Signal Coronary Disease?

Q:  I have always wondered if high blood pressure is a cause or a symptom of coronary artery disease. If it's a symptom, won't lowering it by medication simply hide the underlying problem (in the same way an aspirin would mask the cause of the toothache)? A friend of mine said his blood pressure returned to normal after his bypass operation.

I am 62, slightly overweight, though I exercise regularly and try to be careful about my diet (some meat, but also lots of fruit, vegetables, fish, grains, etc.) We also avoid canned or packaged foods high in sodium or fat. I've been taking medication for my blood pressure for about three years; the doctor checks me periodically and sometimes changes the prescription. Still I am usually in the 150 over 90 range and sometimes as high as 160 over 100. When I exercise, my ears get burning hot and beet-red. Should I regard this as a warning sign and back off? They also sometimes get hot for no apparent reason at all.

Do alcohol and caffeine affect blood pressure? My doctor has never told me to give up either one, which I enjoy in moderation. I quit smoking quite a few years ago. I know you can't make a diagnosis by mail, but I would be interested in your thoughts.

A:  High blood pressure can be both an underlying sign of existing cardiovascular disease and can also make it worse. Because hypertension is a major risk factor for heart attack and stroke, keeping it lower than 140/90 will help prevent those events and lengthen your life. Excessive alcohol (more than two drinks a day) will raise your blood pressure, but caffeine usually doesn't affect it that much. Caffeine can speed up your heart rate or cause palpitations (skipped or extra beats). Smoking definitely raises your blood pressure, so it's great that you quit.

In addition to medication, there are steps you can take to help lower your blood pressure: weight loss, lower salt intake, increased dietary fiber, stress reduction and exercise will all have a positive impact. Exercise is really important and your red, hot ears probably don't indicate any danger signs. Chest pressure, unusual shortness of breath, palpitations or lightheadedness during exercise are serious signs that should cause you to stop right away.

I think that people over 50 who are at risk for heart disease should have a stress test prior to engaging in strenuous exercise. If you haven't had one, ask your doctor to order one and then get back to exercising!

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.