And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension. Since this development is likely to cause confusion and concern for many, I'm writing this post to help you understand the debate and what this might mean for you and your family. By the way, if you've read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines. The core principles of better blood pressure management for older adults remain the same: * Take care in how you and your doctors measure blood pressure (more on that here), * Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014, * And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control. Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers "diminishing returns" as we treat BP to get lower and lower. Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150). From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120. However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.) According to the above context, choose the correct option to answer the following question. Question: Who should be careful how they measure blood pressure? Options: A. The reader. B. The author. C. not enough information D. The AHA.
A

I was 35 weeks pregnant when I had my stroke. For weeks prior to the event I kept experiencing 'visual disturbances.' I felt when I was reading a newspaper or book a sense that my eyes were crossing. I'd feel aware right before it would occur and I would rush to look in a mirror only to discover my eyes were not crossing. I informed my OB who blamed it on the blood vessels in my eyes enlarging due to pregnancy. Ummm ok. You know more than me. Later I was told by a surgeon what I was experiencing was 'textbook' for the passing of blood clots through my occipital area of the brain! The feeling would eventually subside. I awoke one morning feeling 'kind of fuzzy' headed. Like I had slept too hard. I sat with my husband at the kitchen table for our morning coffee and newspaper and for no reason I could imagine I was unable to swallow my coffee and it dribbled out the left side of my mouth. My husband asked me what was going on and I apparently told him, I was 'stroking' out. He got up from the table assuming I was OK and went off to take his morning shower. While in the shower it occurred to him something might not be right. He came back to the table where I was struggling to lift myself from the chair. I put my hands on the table to lift my body and my left hand kept sliding off the edge. He finally got behind me and tried to lift me under my arms and I crumbled to the floor. He then called my OB and told him he thought I'd had a stroke. My OB immediately expressed his doubt but my husband was advised to call an ambulance to get me to the ER. I never really experienced pain from the stroke. According to the above context, choose the correct option to answer the following question. Question: Who got up from the table thinking that the pregnant woman was ok after dribbling coffee from mouth? Options: A. the doctor B. her husband C. not enough information D. the OB
B

"So, Jenny tells me jury selection is going well," said Buford, puffing small billows of Cuban cigar smoke into the phone with each syllable. "Yes, I think so too." Kyle was speeding down FM-2208 in his new Lexus SC 430, headed toward Coreyville. He could barely make his lease payments, but he had to have that car. It screamed success-- especially with the top down. His wavy head of hair would be easily restored to perfection with a few brush strokes. "Well, you be sure to take her advice. She knows how to pick a jury." Buford figured some of Kyle's attention would be focused on getting Jenny into bed, but he didn't think it would jeopardize the case. "Don't worry, Mr. Bellowin, I will." At only 27, Kyle Serpentine had already developed a successful practice in Longview, defending every kind of crook. Some of them paid handsomely. He idolized Buford Bellowin. Buford had grown up in Coreyville and earned his Bachelor's and Law degree at University of Texas, graduating near the top of his class. Now he was a high-priced, infamous defense attorney headquartered in Dallas. Nicknamed 'The Bell', he had never lost a case. Even in law school, his mock trial team always won. And Buford put on a show in the courtroom. So, the gallery was always packed with those who wanted to see The Bell in action. Occasionally, some hotshot would think he could outsmart him. But Buford was the teacher, and it was his classroom. Before the prosecutor knew what hit him, The Bell would ring, and school was out. "The D.A. really thought she could get a jury out of that pool of forty, didn't she? She thought this was gonna be a cakewalk. They don't get many murder trials in Coreyville. That's good for us. And she'll make more mistakes. Mark my words." According to the above context, choose the correct option to answer the following question. Question: How much money does Buford have in the bank? Options: A. not enough information B. $128 C. $300,000 D. $0
C