Tag Archives: Hypertension

SILENT BLOOD PRESSURE DROP WORTH IDENTIFYING

VITRUVIAN MANRecommendation:  Check blood pressure when sitting….but on occasion, when standing after 1-2 minutes to look for a BP drop.

 

When you check your blood pressure, it is generally recommended that you do this in the sitting position.  That is the most accurate and consistent way to check your pressure, but doctors know that sometimes blood pressure drops when you stand.  This can be due to variations in how much liquids and salt you have eaten, your activity level, the medications you take, and health issues and medications that can affect blood pressure.

When you stand, baroreceptors, tiny sensors in your blood vessels, assess your body position and adjust blood pressure to maintain adequate blood flow to the brain in all positions and to even out your blood pressure at all time, but a drop in blood pressure upon standing, due to gravity effects, can result in profound symptoms including light headedness, dizziness, shortness of breath, fatigue, or even fainting.

A new study of over 4000 healthy adults in Ireland showed that blood pressure drops occur much more frequently than we realize, and they increase with age, with nearly 40% of those 80 and older having a significant drop in blood pressure when we stand.  Not everyone is aware of this drop, they don’t feel it directly, but it may be having effects on how they feel and function.

So, I recommend that when you check your blood pressure, you do so in the sitting position, and on occasion, after you have stood for 1-2 minutes, to see if your blood pressure is maintaining itself.   It should be within 15 points difference on the top (Systolic) and up to 5 points difference on the bottom (Diastolic).  If you find it is more than that, it’s worth discussing what you can do to help minimize or deal with these blood pressure variations.

Read more >>>>>>HERE.

 

NEW BLOOD PRESSURE GOALS FOR THOSE OVER 60

cool microphonesNew guidelines for blood pressure treatment and control were just released and the news is good for many of us with hypertension.

The big news is that for those over 60 years old blood pressure goals are a little higher than previously recommended.  This is good because we can treat few patients, label fewer patients as hypertensive, and not ‘push multiple medications’ to get blood pressure lower-and-lower

The news goals are now set at 150/90.

This means that if you are above either of these numbers you need medication, or if on medication and you remain higher than these numbers, you need an additional medicine.

Lower than these numbers, you can just keep an eye on the blood pressure with routine monitoring.  If you are on the borderzone, checking every 1-2 months is best.  If well below these numbers, checking every 3-6 months on your own is reasonable.

Read more HERE

 

ARE CALCIUM CHANNEL BLOCKERS SAFE IN WOMEN?

riskA recent study in JAMA (Journal of American Medical Association) has raised questions about the safety of one of our most commonly prescribed blood pressured medications, the CALCIUM CHANNEL BLOCKERS.

In a case-control study, the researchers demonstrated at 2.5x greater risk of breast cancer in those women on the medication for 10 years or more.

Although this study is ‘suggestive’ of concern, the method that they used in the study has researchers looking into this questions further and is not definitive enough to warrant a change in our approach.  So, the researchers will be doing more studies, and we will keep our eyes on this, but for now, no change in medication has been recommended.

Despite this, if you remain concerned, please come to the office to discuss this further.

<<<<<<<Calcium Channel Blockers include:  Norvasc (Amlodipine), Calan (Verapamil), Cardizem (Diltiazem), Procardia (Nifedipine)>>>>>>>

 

QUESTION ABOUT ARB MEDICATIONS AND CANCER

announce a bunchA PATIENT WROTE:

I just read in the Wall Street Journal today  (WSJ ARTICLE) about the angiotensin 
receptor blockers that may cause lung cancer. I have been taking one of 
those drugs for a while. I take Losartan, 100mg once a day. Should I be 
taking something else? There is a 30% increased chance of cancer from 
this drug. Please let me know how you feel about this.

Thanks,

A patient


MY RESPONSE:    

I saw the article….and if you read it with some objectivity, you will see there is a great deal of controversy here.

Not sure where this will shake out…..so would not change…yet.

Why?  I think it’s premature…..and the jury is still out.

Alternatives have their issues as well……

This is quite an inflammatory article….without more perspective, it would be unreasonable to stop the medication now, but if you prefer….we could switch to something similar, that should work as well, but which has some other potential baggage.   See…that’s the problem…..things are often more complicated than they appear.  The alternatives, like ACE inhibitors….have the rare chance of life-threatening allergic reactions….but I’ve never seen one that I’m aware of…..so you would change one ‘theoretical’ issue for a second ‘known’ issue that is of extremely small frequency.  Not sure it’s worth it.

I am on an ARB class drug too….and I am not changing at this point.

But….we need to monitor this data and see if further research validates the concerns.

D

DIURETICS ARE BETTER FOR OBESE PATIENTS WITH HYPERTENSION

A recent study published in the British journal Lancet, showed that diuretic medications work better for obese patients with hypertension than other medication types.  This is good information, as it provides better medication selection in this group.

Who is obese?  Well, about 25% of us in the U.S.  If you want to know your BMI (body mass index), you need to know your height and weight, and you can look at our BMI index in THE KEYS, my Minibuk (page 27).

http://doctordoug.com/wp-content/uploads/2012/04/ebook-The-Keys-Doug-Lakin-MD.pdf

 

BENICAR BLOOD PRESSURE MEDICATION MAY BE ASSOCIATED WITH DIARRHEA

A series of patients on Benicar, a safe and effective blood pressure medication, have developed diarrhea due to small intestine irritation. The medication (Olmesartan) can cause a change in the small intestine similar to celiac disease. It resolves with stopping of the medication.
This finding is of some interest as Benicar is a popular blood pressure medication and this was not considered a likely side effect of this medication until now.
If you are having diarrhea or loose bowel movements while on Benicar, be in touch to discuss alternatives.

YOUR NEVER TOO OLD TO TREAT YOUR BLOOD PRESSURE

A study from England called the Hypertension in the Very Elderly Trial (code name HYVET) showed that treating patients over 80 years old, for their blood pressure, resulted in reduced heart disease and improved longevity.
It has been argued that at that age, treating blood pressure is of arguable benefit and there are concerns about the negatives of initiating therapy with strong medications that can affect the heart. The findings that benefits occurred within 1 years time, shows us that treating blood pressure is highly effective, worthwhile, and provide near-term benefits….so don’t miss out on your blood pressure medications–it pays off.

TEKTURNA (ALISKIREN) POTENTIALLY DANGEROUS BLOOD PRESSURE MEDICATION IN DIABETES

Tekturna is a relatively new blood pressure medication from Novartis. It is used in select patients who otherwise may not tolerate or respond to other, more standard blood pressure medications.
I have seen it used in these situations to general good effect, but it is only a handful of instances.
A recent study in diabetic patients showed that combining Tekturna and and ACE Inhibitor (like Lisinopril/Ramipril) or and ARB medication (Losartan/Diovan) led to increased kidney and heart issues.
The benefits of this combination were touted to afford improved kidney protection, but it appears to be just the opposite, causing increased kidney problems and strokes as well.

At this point, if you are taking Tekturna, do not just ‘stop’ the medication, but get in contact with me to discuss the pro’s and con’s of it in your particular situation. Likely it is best to stop the medication, but if it is a near ‘last-resort’ medication for blood pressure control, the positives may still outweigh any new negative information.

DUIRETICS CONTINUE TO RULE THE DAY

A recent study showed the benefits of Chlorthalidone, and old-time diuretic, in treated elevated blood pressure.

Systolic hypertension (top number high blood pressure) is common as we age and often is difficult to treat adequately. Inexpensive diuretics are particularly good for this issue, but results may seem inadequate with little drop in the blood pressure number.

Despite this, using this diuretic provide statistically significant reduction in hypertension complications.

Go Diuretics!