Blood pressure issues

Dear Ask The Doctor: Hi, I recently had a physical on 12/31 and my BP was a bit high at 150/82...my physician told me to come back for a follow up but in the meantime check my BP at home on a weekly basis...I have gone back twice to my doctors and my BPs have still been slightly high at 130s-140s/70s....when I check them at home there are roughly 120s-130s/70s...I have lost about 18 lbs and am continuing to exercise and eat healthy...I have one more followup in April but I am nervous that it will still be relatively high and my doctor told me he might start me on a BP med which I definitely do now want...what can I do?

Dear Way: You may be experiencing “white-coat hypertension”, where due to the added stress and anxiety of visiting the doctors’ office the BP readings are significantly higher here than normal. A 24 hour ambulatory BP monitor will give a more accurate assessment of your blood pressure throughout the day. This could be organized by your family practitioner. There are many lifestyle measures that can be modified to lower blood pressure (BP). These include: Weight reduction as you have mentioned with a target Body Mass Index of <25; reduced sodium intake <100mmol/day = 2.4g sodium; increased daily physical activity minimum of 30 minutes/day, limit alcohol intake <3 units/d for men; smoking cessation; reduced saturated fat/cholesterol intake, adequate calcium and magnesium dietary intake and adequate intake of dietary potassium approx 90 mmol/d. The DASH diet (Dietary Approaches to Stop Hypertension) has been promoted by the National Heart, Lung and Blood Institute.