DEAR DR. DONOHUE. I take my blood pressure with my own blood pressure machine. In the morning, when I first wake up, it is at its highest. During the day it returns to a normal reading. Is this normal? – B.B.

Not exactly normal. Blood pressure normally hits a low point in the early morning hours while people are still sleeping. It rises during the day.

Yours is a pattern that is a reversal of the usual blood pressure cycle.

Is there any significance to it? Some blood pressure experts feel that a blood pressure rise of 50 points greater than its lowest reading in any 24-hour period might be a warning sign for a future stroke.

It’s impossible for you to take your blood pressure while you sleep. There are, however, round-the-clock blood pressure monitors that can take and record pressure throughout the day and night. Check with your doctor to see if he or she can locate such an instrument for you and if he or she feels that it is truly necessary for you to obtain this information.

Short of using a 24-hour monitor, the same experts who preach the above warning suggest a substitute test. They say that if blood pressure is higher than 140/90 within the first hour after rising, that is an equally valid prediction of the possibility of future stroke. Don’t take the blood pressure immediately after the alarm clock jolts you to wakefulness. An alarm clock going off raises my blood pressure considerably.

A rise above the 140/90 cutoff in either the first or second number is significant.

Blood pressure problems are among civilization’s greatest medical illnesses. The blood pressure pamphlet helps people get a handle on the significance of high blood pressure and its treatment. Readers can obtain a copy by writing: Dr. Donohue – No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My 4-year-old grandson was sitting in my lap. I could see him studying my hands. He asked me why I have brown spots on the backs of my hands. I never paid any attention to them until he brought it up. I couldn’t give him an answer. I asked a few friends, and they told me they are liver spots. Do they mean something is wrong with my liver? – D.R.

Those brown blotches are officially known as solar (sun-induced) lentigines (len-TIDGE-uh-knees). I suppose they are called “liver spots” because of their color.

They have nothing to do with the liver’s health. They have everything to do with exposure to sunlight year after year. Take a look at the backs of the hands of almost everyone older than 55. You’ll see that the majority have these spots.

They are not cancerous. They do not become cancerous. They have no serious implications.

If they are a cosmetic embarrassment, laser treatment, bleaching agents such as hydroquinone, and the acne medicine Retin-A can eliminate or lighten them.

DEAR DR. DONOHUE: What’s the difference between atrial fibrillation, which you often write about, and ventricular fibrillation, from which my dad died? Because of the many treatments available for fibrillation, I have never been able to understand why he died. Please explain. – D.S.

The difference between atrial and ventricular fibrillation is greater than the difference between day and night.

Fibrillation is an uncoordinated, rapid squirming of heart muscle. A fibrillating heart cannot pump blood. Fibrillation of the upper heart chambers – atrial fibrillation – is a very common heart rhythm disturbance. It reduces the heart’s pumping ability a bit, but the heart can still deliver blood to the body. Atrial fibrillation can often be controlled with medicines. One of the most important features of it is the very real possibility of clots forming in the quivering atria and traveling to the brain to cause a stroke. That’s the reason for giving people with atrial fibrillation anticoagulant medicine such as Coumadin.

The ventricles are the heart’s pumping chambers. If they start to fibrillate, the heart cannot pump blood to the body. Ventricular fibrillation must be treated quickly, or death occurs in a matter of minutes.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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