Q. I just got diagnosed with high blood pressure but feel fine - no tiredness, headaches, or anything. Do I really need drugs?

A. The alarming thing about high blood pressure, or hypertension, is that it is silent - you feel normal. No headaches, tiredness, or anything. And then you wake up one morning permanently paralyzed and unable to speak - a stroke. Or, have shortness of breath from heart failure.

These complications start occurring above a blood pressure of only 115 over 75, and doubles if the top number - the systolic pressure - gets to only 135, or the bottom number gets to only 85.

Above age 55, nine out of 10 of us will get hypertension. Above age 50, a top number of more than 140 becomes a much more important predictor of risk than the bottom number. If your doctor agrees, then try getting your pressure down through natural means first before resorting to drugs.

To check your own pressures, forget finger or wrist BP cuffs - they're not accurate. Get an automated arm apparatus. But you'll still need to be choosy because even expensive ones may be inaccurate. To find a good one, go to www.dableducational.com/sphygmomanometers/p_devices_2_sbpm_ua.html.

Let your doctor know if home pressures are consistently above 135/85 (above 125/75 if you have diabetes, kidney or heart problems). The cuff bladder width should be at least 40 percent of the arm circumference (big patients need wider cuffs; otherwise the pressure reads too high).

Lose weight if you're overweight. Increase aerobic exercise - walk an extra 10 minutes twice a day. Eat less pizza, Spam, ramen, hot dogs and other salty foods. Eat less red meat. Watch alcohol intake and stop smoking.

Eat four to five servings of vegetables and another four to five servings of fruits each day, along with two servings of low-fat (1 percent or skim) dairy products a day (milk, yogurt or cheese).

For sample menus and recipes (like "blackberry and balsamic chicken"), go online to www.medlineplus.gov. Find "high blood pressure" under "health topics" and look under "nutrition."

Which drugs are best? Most patients should be started on thiazide diuretics based on the latest studies - look up the acronym "ALLHAT" on the Internet. But most people will need two or more drugs to get to the in-office BP goal of 140/90 (or 130/80, if you have diabetes or kidney disease) - even in the elderly, and even if your blood pressure has been high all your life. And even if you're getting lots of exercise and eating right because these lifestyle changes alone will not lower your risk of stroke and heart disease enough if your blood pressure is still high.