Q: I am a male, 79 years of age, in relatively good health. Many are surprised when they become aware of my age, commenting how much younger I appear. I’m 5’11” and weigh 177 pounds stripped. I’m very active, always keeping mentally and physically busy; however, I have suffered with hypertension and cholesterol problems for years. I tried statins for the cholesterol but discontinued them after suffering joint problems. If I watch my intake of sweets, my readings can drop from 240 to possibly 170. I follow a healthy diet, limiting red meat to once a week with a couple of days of fish and chicken. One day may also be meatless.
The primary reason for soliciting your advice is my hypertension problem. During the past three or four years the readings have averaged about 140/75. I’ve been taking hydrochlorothiazide (HCTZ) 25 mg and Diovan 160 mg during that time. My diastolic is almost always in the 60s. I read once in your column the diastolic should not be lower than 60. Upon researching the Mayo Clinic site, a reading of over 60 is considered abnormal. I have not discussed this new concern with my doctor since I only became aware of this problem a day or so ago. However, I did ask him about the low diastolic readings and he did mention the fact that blood vessels harden as people age, thereby contributing to the problem. He suggested I reduce the HCTZ by half and that I should monitor my readings and report any significant changes to him. For the past few days my systolic reading went up a couple of points but the diastolic remains unchanged so now I’m concerned about the effect of the increase in my systolic reading.
I have reported heart palpitations to my doctor, especially those I have upon awakening. I also find myself losing some “zip” at times, but at my age I suppose that is to be expected. My primary doctor is always attentive to my concerns and always tells me I’m in fine shape. Any comments you choose to provide will be deeply appreciated.
A: Blood pressure readings are determined by the amount of blood a heart pumps, coupled with the amount of resistance it receives in the arteries as it flows. Thus, the more the heart pumps into narrowed arteries, the higher a person’s readings will be.
As I have reported in the past, there are two types of hypertension – primary (essential) and secondary. The first form takes years to develop and a person, unless checked, may never know the condition exists because there are often no symptoms. The second form is caused by an underlying condition that may be caused by a congenital blood vessel defect you are unaware of, an adrenal gland tumor, kidney problems, taking over-the-counter pain relievers, cold remedies, decongestants, prescription drugs, amphetamines, cocaine, other illegal drugs, and more.
Risk factors that enter the picture include a family history of hypertension, leading a relatively sedentary lifestyle, consuming too much salt in the diet, the use of tobacco that can raise blood pressure readings but can also cause arteries to narrow, having high cholesterol readings, stress, having too little vitamin D in your daily diet, and numerous other factors. You admit to having cholesterol problems that, alone, can cause elevated systolic and diastolic readings. And, while you may not admit to leading a stressful life, from the tone of your letter and your concern over your readings, I interpret that as self-induced stress, which could be linked to your palpitations.
Normal reading fall into the 120/80 range, although many physicians feel 75 is a better diastolic count. Pre-hypertension systolic readings range from 120 to 139, with diastolics ranging from 80-89. If your physician is or becomes concerned about your readings – either the first number or the second, he or she can order testing that might include a urinalysis, lab work to check on your cholesterol and other numbers, and/or an EKG that will measure your heart’s electrical activity and give an indication if your heart is enlarging or beginning to show strain. That EKG can also indicate if issues exist that can be linked with the palpitations of which you speak. Further, you appear to be testing yourself at home. If this is done on a daily basis and you find yourself stressed prior to testing, you might choose to take readings two or three times a week. If things get really out of whack, call the physician who prescribed your medication and ask for guidance. Speaking of your doctor, have you brought your cuff and stethoscope to his or her office to verify your readings? This would be done by getting a reading from the office equipment and your home equipment. You may be quite surprised to find variations between the units used and a problem doesn’t exist at all.
Draw a deep breath, try the reduced dosing recommended and stay in touch with your health care provider who can get you on the right track.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Hypertension” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott MD Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
