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Doctors' Answers to "Frequently Asked Questions" - Blood Pressure

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Controlling Blood Pressure and the "K Factor" [posted 1/12/99]
Question: I have recently read a book about how to control blood pressure primarily through controlling the intake of potassium and sodium. The "K-factor" is what the author calls the ratio of potassium to sodium, which he says should ideally be 4. He believes that practically all primary hypertension can be alleviated by following a dietary routine, which achieves this. Is this approach a sound one, and does the medical community support it?

Answer: Well, the opposite of a low sodium diet is a high potassium and there are many who think that calcium, potassium and magnesium are more important to blood pressure than sodium, but this is not perfectly clear.

Medication controlling Blood Pressure [posted 1/11/99]
Question: After taking tenormin for almost two years with good control of my BP I became symptomatic and my BP elevated significantly. I tried adding avapro with very little effect. I then stopped that and started cardura, which also did a thallium stress. I have been on cardura 2 mg for two months with good results. My physician and I decided that I would stay on that dosage as it seemed to be controlling my BP. Now, after only about 4 weeks on it I am having an elevation again. Why after good control for almost 2 years would this be happening? What other causes could there be? Would you advise any other testing?

Answer: I'd check the arteries to your kidneys using a ultra sound or a ct to ensure they aren't becoming narrowed. There are other potential causes, but they are few treatments available for the others.

High Blood Prssure Reading Concern [posted 12/08/98]
Question: I have always had borderline low blood pressure. Today I went to the doctor and my BP was 110/90. I checked again later and the two readings were 128/86 and 143/94. Needless to say I am shocked. Could Prevacid or Probantheline affect blood pressure readings? Maybe I am grasping at straws but I can't find any info about this.

Answer: Maybe, one robin does not spring make. Keep checking it. Alcohol can elevate blood pressure in some, ensure you have been off ethanol for a couple of days and see if that can elevate your bp.

Atenolol for High Blood Pressure [posted 11/25/98]
Question: I would like to know about the effectiveness of the drug Atenolol. Is it possible that the drug would no longer lower one's blood pressure after using it for a couple of months? At first it seemed to really lower my blood pressure, but over the past few weeks my pressure has creeped up again. Any info you can give me would help.

Answer:  One rarely develops tolerance to the beta blockers. What is causing your elevation in blood pressure? I would focus on the cause to see if something is evolving.

Dizziness & High Blood Pressure Medication [posted 11/24/98]
Question: My doctor prescribed 5 mg of Ziac daily, I started Friday and immediately experienced dizziness, lightheadedness and was unabe to focus my eyes. Is this normal? I really felt bad.

Answer: Did you check your blood pressure. Also, check your bp at home out of the doctor's office. Many patients get treated for elevated bp when the only time it is up is in the md's office. The treatment for this type of blood pressure problem is to not go to the doctor's as often. Some patients do have a marked reaction to Ziac, but, I suspect you may be overtreated. What is your bp at home off meds?

High Blood Pressure Concerns [posted 11/3/98]
Question: I found that my Blood Pressure was 149/92 at several times of testing. What can cause this problem and is it serious?

Answer: I can't tell you the cause without more history/physical exam. Most of the time, we don't find a specific cause and we just treat the symptoms. The treatment guidelines are now anything consistently above 135/85. It used to be 140/90 depending on age and other risk factors. It should be treated if usually above 135/85. But, the first way to treat this is to lose 10 pounds and see what effect that has. A low salt diet will help occasionally. If these do not work(5-6 months) see your MD.

Blood Pressure & Beta Blockers [posted 10/30/98]
Question: I have taken blood pressure medicine for 10 years. Untill 6/98 I was taking prinivil and now I am taking Diovan and Cardura. I have 2 questions. The first question is my blood pressure is running about 130/82 when I'm relaxed, but when I go to the Doctor or get excited about something it is about 155/100. Also, if I exercise a lot for a few days my bloodpressure goes up. Is this normal? My second question is about beta blockers. I had a heart cath. done 4 years ago and all my arteries were good in fact the Heart Doctor said they were almost too open. He said I should take a beta blocker because my heart beats too hard, too fast. My doctor put me on 25 mg of Atenolol. I felt good and my bloodpressure was great. But, my resting heartrate is normally about 55 a min. and with the beta blocker it dropped to 35 and my heart skipped a lot. My doctor said I would not be able to take beta blockers. Are there beta blockers that do not slow the heart rate down?

Answer: All the beta blockers will slow the pulse. But, small doses(like Ziac) might be an option. The rise with exercise and in the office is normal. The question is how much with exercise? This is probably why they would like a beta blocker.

Hypertension & Kidney Problems [posted 10/19/98]
Question: I am a 25 year old female that has had hypertension for 2 years. I was perscibed Plendil 2.5mg/day, then 5mg/day and finally 10mg/day. However, none of these doses lowered my blood pressure. I have now been on Toprol-XL 50 mg/day for two weeks and from the blood pressure machine at the pharmacy, it is finally down to 112/72. It has been running 160/100. I have seen a nephrologist and show no signs of kidney disorder. My mother also has hypertension. Should I see a cardiologist or just continue with the medication as prescribed by my primary care physician? I am worried that I will be taking pills for the rest of my life when there may be some cause other than genetics.

Answer: There are potential causes of hypertension that can be corrected in occasional patients. I assume the renal specialist checked your renin levels, checked for a pheochromocytoma, and checked the arteries supplying your kidneys?

Stopping Blood Pressure Medication [posted 10/16/98]
Question: I would like to get off Amiloride as I am having problems with dry mouth and eyes. Is it possible. My bp is 126/78 and I have lost weight since I first started medication 3 yrs. ago. I am otherwise healthy.

Answer: Stop it and see what your blood pressure is. If you have lost greater than 10 pounds, you may not need the medication.

Solving HyperTension Problems Post Liver Transplant [posted 10/15/98]
Question: I am currently experiencing moderate hypertension as a side effect of the immunosuppressant medication Neoral (after liver transplant 10/96). Having tried several blood pressure medications, I find Cozaar to have the least additional side effects. However, the 50 mg tablet seems to be a bit too much for me. Since 50 mg is the smallest size tablet available, would it be safe to carefully divide a single pill in order to reduce its effective dosage. Are there any significant absorbtion rate problems I should be aware of?

Answer: Split it in two is ok. Most physicians recommend twice a day dosing. Absorption is not a major problem with this medication.

Blood Pressure & Dizziness [posted 10/6/98]
Question: I am taking the following medications on a daily basis in the morning: IMDUR - 30 MG, TOPROL XL - 100 MG, VASOTEC - 20 MG, and HUMLIN. I am a 63 year old male and have as you can see also diabetes. My diabetes started when I was 56 years old, and there is a family history of diabetes. The symptoms I am encountering are daily dizzy spells. My blood pressure at present is: 210 over 110. I also failed my stress test 4 weeks ago. Please advise what I should do. I am also visiting a cardiologist on a regular basis.

Answer: The dizziness is clearly not caused by low blood pressure. The question is whether it will improve with better blood pressure control. Get your blood pressure where it belongs first and see if the dizziness remains.

Tone Changes [posted 10/6/98]
Question: I have high blood pressure and recently switched to verapamil. I also have paroxsymal atrial tachycardia (pat) and was prescribed dijoxin while in the navy. It seemed to have no effect. A physician's at my work site discovered that while taking my blood pressure, there was a "tone" change. I informed my personal physician as she and i are trying to find a medicine i am comfortable with for high blood pressure. What causes the "tone" change and is this serious. As an example, the p.a. took my blood pressure last night and it was (140) and the tone changed and he read it as 120/80. The reason i changed from norvasc is to find some side effects i can live comfortable with. Thank you.

Answer: The tone changes are Korsakoff sounds and are of no significance.

Blood Pressure Drugs Interactions [posted 10/2/98]
Question:Is it safe to take Lisinipril for high blood pressure and also take Robinul for problem sweating at the same time? I have started taking 1 mg of Robinul twice daily while taking 20 mg of Prinivil once a day. I feel great and have no side effects that I can tell of.

Answer: No problem.

Blood Pressure & Triglyceride Counts [posted 10/1/98]
Question:I am presently taking Atenolol 75mg for high blood pressure. I have been taking this medication for about 3 years. My triglyceride count is high (higher each year) my doctor is concerned. I eat a low fat diet. Can this medication affect my triglyceride count?

Answer: Possibly, but, not a usual problem. Elevated triglycerides are usually a marker that you will eventually develop diabetes mellitus. Triglycerides by themselves are not much of a cardiac risk. Some say no risk at all. Diabetes is and I would really focus on weight loss. I would not treat the triglycerides themselves(with medications) unless they are about 1,000 or possibly 5,000. However, many physicians would treat these, I'm not one.

Electronic Blood Pressure Meters [posted 7/23/98]
Question: I take Zestril and a diuretic (HCTZ) for my blood pressure. When I test at home my blood pressure is normal. When I go to a doctor's office it goes up. I know this sometimes happens to people. I use an electronic blood pressure meter at home. I use a AND Engineering U-751 self inflating blood pressure monitor. Are blood pressure meters accurate? My blood pressure at home on one of these meters is 107/72. Also, are their any physical restrictions as to what a person can do if their blood pressure goes to slightly or moderately elevated levels so long as a person takes their medications?

Answer: Next time you go to the doctor's take your cuff and check your blood pressure with your/their machine. If their is agreement (plus, minus 5 points or so) your readings are correct. In that case, the answer is don't go the doctor's so much. Concerning your last question, it depends on the numbers. The best way is to get the bp mean (1/3 high and 2/3 low) and see what your average number is doing.

High Blood Pressure and Relafen [posted 7/23/98]
Question: I've been taking lotrel for three months but my pressure is still up, usually around 170/96 and my pulse is always in the 90's. I also take relafen for arthritis would that affect the performance of the lotrel. I was on tenormin, but even doubling from a single dose did no good.

Answer: Relafen will occasionally cause sodium retention. If your blood pressure is sodium dependent (20% of Caucasians), it could have an effect. You would need to stop it for 3 weeks or longer to see any effect. However, I suspect you have no relationship between the Relafen and the BP. First, have your doctor check your rennin levels to see if they are high or low. Most Caucasians have high rennin non-caucasians have low rennin hypertension (80%). But, more importantly it allows your physician to focus on drugs which would work in either condition, rather than hit or miss.

High Blood Pressure and Exercise [posted 7/17/98]
Question: Is there a correlation between strenuous exercise (weightlifting in my case) and elevated blood pressure? I lift weights five days a week for approximately 20-30 minutes. I have recently been diagnosed with having high blood pressure. In the last week my readings have varied from 130/96 to 150/118. Are my exercise habits actually aggravating my blood pressure condition? For most of my life I have had blood pressure readings of 120/80. My weightlifting routine has been pretty much the same for the last 25 years. I am 53 years old.

Answer: There are some people who think that isometrics and weight lifting will elevate the blood pressure during the exercise. It is not thought to elevate the BP when you are not lifting though. However, weight lifting usually causes weight gain (mainly muscle) and this can elevate blood pressure in some. You might try getting your weight down 10 pounds or so. Multiple small reps are usually better to do this than higher poundage lifts.

Blood Pressure
Question: My BP was running 130/96. Using COVERA-HS, 180mg, I reduced it to 130/90. Using Hawthorn and cayenne pepper I can reduce the BP to 130/80 30 minutes after taking, and I take three times per day. When rising my BP is 130/94. Is this healthy to reduce the BP and then let it go back up? Would I be better off with a chemical drug to maintain a continuos low normal BP?

Answer: 130/96 is only mildly elevated. If the bottom number(diasystolic) is about 90-most physicians would treat this. Treatment should initially focus on weight reduction(10 lbs or so), salt restriction, and increased exercise. Small rises in young men are usually treated. There is disagreement over this issue. The blood pressures you provide are fairly consistent. Your blood pressure will vary 20-30 points over the course of the day in a normal manner. These numbers are very similar. This small variation would be of no concern.

Blood pressure medicine
Question: My mother is 76 years old and is taking a blood pressure medicine called Verapamil, which is a calcium blocker. She is experiencing a tingling sensation in her feet. Is this a side effect and what are other likely side effects?

Answer: Verapamil will produce some swelling in about 30% of patients. Possibly this is the problem. If she stops the medication she will know in about 2-3 days (discuss with her physician). It sounds like she is experiencing some sort of peripheral neuropathy, usually not related to verapamil. I'd discuss it with her doctor. This probably isn't verapamil unless she has a lot of swelling.

Blood Pressure
Question: I have been taking Maxide and Procardia for 15 years. Can I take it indefinitely? My latest blood pressure was 149 over 79. I am a 56 year old female.

Answer: There doesn’t seem to be any problems with this. Long term side effects so far are minimal. Maxide has been around about 25 years, and Procardia for 15 years, so this is the limit of our information base.

Question: My father is 70 yrs old and in very good health and shape. He has been taking Tenormin 50mg for the past 10 yrs to control blood pressure. Two yrs ago he fainted/passed out while sitting in a chair, recovered and was checked out for heart/stroke etc, but all checked. Last year he again passed out, this time falling back and hitting his head on the floor and was unconscious for a time. Again extensive tests at the emergency room showed no obvious problems. Last week and one year later, he again passed out, this time the injury to his head was quite bad, but he is recovering and again all checks out.

Answer: Tenormin is a beta blocker and a very useful drug for hypertension and angina. However, it is poorly tolerated by older patients since it tends to slow the pulse and cause fatigue. The pulse slowing generally worsens with advancing age;hence , why he may be having the problem not. Be advised that we do not discover the cause of syncope in about 30% of cases, I suspect the doctor is changing medications in an attempt to see if they go away with the change. Calcium channel blockers are well tolerated compared to beta blockers.

Adalat vs Procardia
Question: My mother is 68 years old, she takes adalat xl 30 tablet(Bayer Co.) once a day for blood flow. After a week, she finds that she has the blood-pressure lowering effect. But she didn’t have this kind effect before when she took Procardia xl 30 mg(Pfizer Co.). So how should she do right now ?

Answer: First rule of medicine-if it works keep doing it. Same drug so it must be in the delivery system which is different. I'd keep on it if it is working.

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