Dear Doctors: I just had my yearly physical, and my blood pressure has moved into the upper range of normal. The idea that it may be increasing is worrying me. I prefer not to take medications, so I want to get ahead of this. What can I do to lower my blood pressure naturally?

Dear Reader: Your instinct to take this change seriously is well-founded. Blood pressure is an important metric of good health, and an upward trend, even within guidelines, can be concerning. High blood pressure, also known as hypertension, makes your heart work harder. It also stresses blood vessels. Over time, uncontrolled hypertension can increase the risk of heart disease, heart attack and stroke. It also increases risk for kidney disease, plaque build-up in the arteries, sexual dysfunction and vision loss. More recently, research has found that chronic high blood pressure can play a role in cognitive decline.

The good news is that a range of lifestyle choices can help bring blood pressure into a normal range. These include regular physical activity, a healthier diet, getting enough good-quality sleep and managing stress. No doubt these guidelines sound familiar, which can make them easy to acknowledge and then set aside. But the key to successfully lowering blood pressure is making them into daily habits. Incorporating even a few can lead to meaningful improvements in your health. And -- more good news -- it can happen faster than you might think. Many people begin to see a positive trend in blood pressure within weeks of adopting more healthy habits.

When it comes to diet, limit salt. Dietary guidelines recommend that adults not exceed 2,300 mg of sodium per day. That's close to only a teaspoon. To stick to this limit, pay close attention to added salt in prepared foods. Cutting back on highly processed foods, which are high in salt and low in nutrients, is also key. Replace them with whole, fresh foods, including leafy greens, vegetables, fruit, beans, legumes, grains, healthy oils, seafood and lean proteins. Limit alcohol and quit tobacco.

Although sodium gets headlines when it comes to improving blood pressure, potassium is equally important. This mineral helps the body excrete sodium. It’s part of a biochemical process that relaxes blood vessel walls. For best results, potassium intake should at least match sodium intake and ideally exceed it. Following the DASH diet, the fresh food eating plan we wrote about quite recently, is an excellent way to lower sodium and increase potassium.

It is also important to get moving with a mix of aerobic exercise, resistance training and stretching. The goal is 150 minutes per week in sessions of at least 10 minutes each. Exercise improves sleep, which also helps with healthy blood pressure. Regular exercise has also been shown to help manage stress. Yoga, tai chi, deep breathing and meditation can be useful. And remember, you don't have to do this all at once. Start small, build gradually and give your body time to adjust and to respond.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello, dear readers! Welcome to the monthly letters column. We hope the new year is treating you well, and that those who made resolutions are having a few victories. Forming new habits continues to be a popular topic, and we'll explore new research in an upcoming column. And now, on to your mail.

-- A column about the use of Botox to help manage migraines continues to generate interest. We heard from a reader in Virginia who suffers from this debilitating form of headache. “I get vicious migraines at least eight times per month. They start at the nape of my neck, and the pain moves forward to behind my right eye,” she wrote. “Do either the symptoms or how often this happens mean I can be referred for Botox therapy?”

According to current U.S. Food and Drug Administration guidelines, Botox is reserved for chronic migraine. This is defined as 15 or more headache days per month, with at least eight of those days meeting criteria for migraine. If you were to experience seven more headache days per month on top of the migraine days you described, you would meet the criteria to be eligible for treatment with Botox.

-- The phantom ringing, buzzing and chiming sounds of tinnitus are a challenge for many older adults. A reader from upstate New York wrote to say he had good results from a popular dietary supplement that combines vitamin C, B vitamins and naturally occurring plant compounds known as bioflavonoids. “I got a few friends who have tinnitus to try it, but it didn’t work for them at all,” he wrote. “It did work for me. Any idea why that would be?”

While there are various claims regarding the use of dietary supplements to lessen the sounds of tinnitus, studies have produced inconclusive results. Tinnitus often fluctuates over time, which can create the perception that a particular treatment is helping. We should also consider the placebo effect, a powerful response by the body. Centuries after it was first identified, we still don’t fully understand it. In your case, what matters is that the supplement you are using is not harmful to health, and that the outcome is an improvement to a challenging condition.

-- A column about the benefits of walking prompted a reader to ask for a definition. “I am 80 years old and walk twice a day for 20 to 30 minutes. The advice I always see says to walk briskly,” he wrote. “Just how fast is brisk?” While the term “brisk walk” suggests a certain speed, what you’re really after is a specific effect on the body. The goal is to modestly raise your heart rate without strain or pain. You should feel a bit of exertion but still be able to carry on a conversation. Also, some good news. Your 20-minute time frame aligns with newer research showing cardiovascular benefits from sustained walking.

Thank you, as always, for taking the time to write. We love hearing from you. Our email address is askthedoctors@mednet.ucla.edu. We read all your letters and look forward to hearing from more of you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I understand that there is treatment for the beginning stages of Alzheimer's disease that can stave off serious decline. There are also new tests to determine if a person is in the beginning stages, at which point it would be advantageous to take the new drugs. Am I right in this?

Dear Reader: While there have been recent advances in both the diagnosis and treatment of Alzheimer’s disease, the advances are more limited than your question suggests.

Alzheimer’s is a complex disease. Despite decades of research, we are still in the early stages of understanding it. This form of dementia unfolds through multiple pathways and includes a number of subtypes. Also, it often presents alongside other forms of dementia. This means progress in identifying and treating Alzheimer’s is slow and gradual.

Despite a shortage of effective treatments currently, an early diagnosis helps the person and their family understand ongoing changes. Catching it early can help avoid unnecessary medical interventions. New, highly sensitive tests that can detect blood-based biomarkers may transform Alzheimer’s diagnosis.

This includes blood tests known as Lumipulse or Elecsys. The U.S. Food and Drug Administration approved these last year -- with important caveats. The tests look for proteins associated with the formation of amyloid plaques in the brain. Amyloid plaques are abnormal accumulations of protein that can disrupt neural function, and they are a biological marker seen with Alzheimer’s. However, their presence alone is not enough for a diagnosis. Some older adults with no cognitive impairment have amyloid plaques in their brains. For that reason, the FDA has limited the use of these tests to adults showing signs of cognitive impairment who are over age 50 for Lumipulse or over age 55 for Elecsys.

Currently there are two categories of treatment, both producing modest effects. One is drugs to manage and improve a person’s symptoms. This includes drugs such as donepezil, which act on neurotransmitters and related signaling pathways within the brain. Memory, attention and language improve for some people. Memantine, another medication, may have a modest protective effect on the brain.

The other category is a newer class of drugs that clear the amyloid plaques from the brain. These modestly slow disease progression and cognitive decline by 25% to 35%. They do not stop Alzheimer’s, but they are the first medicines to alter the course of Alzheimer’s. These drugs may have significant side effects and require a comprehensive plan of care and follow-up, including multiple brain MRIs.

These new drugs have transformed research into new therapies. There are more clinical trials in Alzheimer’s than ever before. Studies indicate other pathways besides the amyloid protein that might be targeted for new therapies. Dr. S. Thomas Carmichael, the chair of neurology at UCLA Health, notes that “the field is filled with new hope and energy. We know that we can alter the course of the disease. Though this is modest, it is a pivot point that increases energy for other and distinct approaches that may more substantially reduce this disease.”

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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