Q My husband has "white-coat hypertension" in the form of highly elevated blood pressure whenever he goes to the doctor for his routine checkups. He has a blood pressure monitor at home and checks his blood pressure at least once a day. The machine was calibrated twice by the doctor and was found to be accurate. My husband's readings at home are always 120 or less systolic over 80 or less diastolic with the home machine, but can be 160 systolic at the doctor's office. Does he need additional medication for his blood pressure?

A Reactive hypertension -- high blood pressure resulting from a situational rather than a medical source -- is very common. When it's the result of seeing the doctor -- the "white coat" part -- it can lead to overtreatment if not recognized.

You and your husband have done exactly the right thing -- bought and tested a home machine, and your husband regularly tests his blood pressure at home.

If the readings at home are consistently good and there are no other signs of poorly controlled blood pressure -- the doctor may look at the back of the eyes, listen to the heart, check kidney tests or even get an echocardiogram to look for signs of damage from high blood pressure -- I would not recommend additional medication.















However, one cause of a heart murmur is a defective heart valve. One of these valves, the mitral valve, prevents blood from leaking back into the left atrium from the left ventricle. If this valve is partially blocked -- we use the term "stenotic," and it can be from calcification, rheumatic heart disease or some other cause -- it may lead to enlargement of the left atrium. If the atrium is too big for too long, it can cause atrial fibrillation, which is an abnormal, irregular heartbeat.

In other words, there is one kind of heart murmur that can lead to atrial fibrillation, but it's one of many. Ask your doctor for the cause of your murmur.

Q I am 89. My memory isn't good. I take coconut oil, hoping to improve it. What is your opinion on that?

A Coconut oil has a high concentration of saturated fat. Saturated fat is a factor in raising cholesterol and clogging arteries. However, the effect of coconut oil in those regards isn't as bad as was once believed.

Coconut oil also contains medium chain triglycerides. They have been suggested as a preventative for Alzheimer's disease with its loss of memory.

Personally, I would wait until there is more evidence that coconut oil wards off Alzheimer's disease before using it on a regular basis.
