DEAR DR. GOTT: My hypertension has been treated for many years with lisinopril 20 miligrams daily and amlodipine 5 milligrams daily. These medications seem to have little effect on my numbers. My systolic readings are in the range of 140 to 165, while my diastolic readings are in the 50s.
I recently came across an article on the topic of isolated systolic hypertension, in which a physician pointed out that this form of hypertension can lead to serious problems — stroke, heart disease, chronic kidney disease and dementia. The doctors and nurses who have taken my blood pressure have universally said that the diastolic reading was not a consideration; however, this report indicated that medications to control systolic hypertension should not be allowed to cause the diastolic pressure to go below 70 mmHg.
I am an 82-year-old diabetic male off medications for three years now due to exercise and diet. I also have symptom-free bradycardia. I would very much appreciate your comments on this report.
DEAR READER: I am a little confused. You indicate you are a diabetic and have hypertension that was treated with two medications. You then go on to state that you have been off medications for three years. Does this mean the antihypertensives, diabetes meds or both? In any case, I congratulate you on taking control and maintaining a healthier lifestyle.
Isolated systolic hypertension is defined as a systolic reading of greater than 140 and a diastolic reading of less than 90. The condition can result from hyperthyroidism, a leaky heart valve or other causes.
There was a time when doctors devoted their attention to the second number, the diastolic, with the thought the body could tolerate fluctuations in the first reading. Then there was the “blanket rule” that the first reading would be normal at 100 plus the age of the patient, i.e., 175 in a 75-year-old male. Both schools of thought have been modified. Today, the systolic and diastolic are of equal importance, and the 100-plus reading has been totally abandoned.
Of concern in patients with isolated systolic hypertension is that prescribed medications may affect the second number, lowering it to the point that it might increase the risk of heart attack or stroke. The fine line then becomes keeping the diastolic at no less than 70 mmHg, while simultaneously keeping the systolic at an appropriate figure, just as the report indicated.
My guess is that your diastolic readings are too low, and that you might require medication to bring both numbers into line. Take a copy of the article to your physician for his or her review. A determination can then be made about whether you should be back on the two medications or not. No matter what, I would continue the exercise and diet modification.
The lisinopril you are/were taking is an ACE inhibitor used to treat hypertension and congestive heart failure. It can be used alone or in conjunction with other drugs for the same purpose. The amlodipine is a calcium channel blocker that works to lower blood pressure and decrease the heart rate. It, too, can be used in conjunction with other drugs for best results.
To provide related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
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