DEAR DR. GOTT: I am a 68-year-old woman from Africa. My systolic blood pressure is constantly high, but never above 170 or so. With carvedilol/indapamide, it comes down to about 148-150. My diastolic blood pressure, even without medication, never goes above 70 and is usually in the 60s. I am intrigued by why this is so.
Apart from this, my general health is very good to excellent. I am 5-foot-1 and weigh 130 pounds. I do aerobic/strength/weight exercises for one hour three times a week. My HDL is about 60, my LDL is about 210, and my C-reactive protein is almost nil. My glucose level is usually 100 or below.
I do not use salt, rarely eat out, snack on fruits and vegetables (mostly), do not smoke and do not drink excessively (maybe two glasses of wine per week). I do not use a lot of caffeine. I usually drink four cups of tea, half a cup of coffee and 32 ounces of water a day.
I still work, and my job as an educational consultant is not that stressful. A long time ago I was told that my heart was larger on the right side, and I’ve wondered if this will have an effect on my blood pressure.
My mother had hypertension and diabetes, both of which she controlled with diet for most of her life. She passed away at age 75. On the other hand, my father was very healthy except for kidney stones and passed away peacefully at the age of 96.
DEAR READER: You have a type of hypertension known as isolated systolic hypertension, common in older individuals because artery elasticity is reduced. Systolic pressure is the force blood exerts against arterial walls during contractions of the heart. Diastolic is the pressure exerted between beats. So essentially what is happening is that when your heart contracts, the artery wall doesn’t stretch as much, thus increasing pressure, whereas between contractions, pressure returns to normal.
The bottom line? You still have hypertension.
You state that your LDL “bad” cholesterol is 210. This is extremely high, since a normal level is 100-129 or lower. I hope that this is simply a mistake and you wrote your total cholesterol level rather than your LDL. If not, I urge you to speak to your physician about possible treatment options, such as niacin, omega-3 fish oil, flaxseed oil, or prescription cholesterol-lowering drugs, statin and non-statin alike. Combined with your hypertension, high cholesterol further increases your risk of heart attack and stroke.
Also remember that a diet high in fats such as certain meats, cheeses and other dairy items, snack foods, butter, luncheon meats and more, will raise the LDL level. These food items should be reduced or removed from your diet. You may benefit from reducing your tea intake. The caffeine in it is quite variable and can raise both systolic and diastolic values.
Now about your right-sided heart enlargement: I think you need to be seen by a cardiologist to have this further investigated. While you have had this a “long time,” seemingly without symptoms, it could be an indication of a problem such as pulmonary hypertension. How long is a “long time”? Years? Decades? How long have you had the hypertension? Did the two findings coincide?
Without knowing more about your health history, it is impossible for me to say whether your right-sided enlarged heart is to blame — in full or in part — for your hypertension. My feeling is that it isn’t, but I cannot say this with any certainty.
Make an appointment with your cardiologist to discuss your concerns. He or she is your best source for answers.
Readers who are interested in learning more can order my Health Reports “Understanding Cholesterol,” “Coronary Artery Disease” and “Hypertension” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order for each report to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title(s), or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.
