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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
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
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
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
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
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
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
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
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
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
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
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
Electronic Blood Pressure Meters
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
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
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
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.
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 doesnt 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
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 didnt 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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