Q: I am taking Diltiazem HCL and Lisinopril for blood pressure. It kept my blood pressure within range and my doctor said my ankles were swollen, that I should take Spiron/HCTX tabs three times each week. It still dropped my blood pressure. Now I’ve stopped taking the medicine and only take one fourth tab of Spiron each day. My blood pressure is between 112 and 135. Is this okay? I’m 83 years old and feel great.

A: Normal blood pressure readings fall into four categories that range from normal to stage two hypertension. In order for a physician to make a correct reading, he or she should take two or more readings on each of two office visits. Generally speaking and considering adults only, a systolic reading below 120 and a diastolic reading below 80 (120/80) would indicate a normal blood pressure. Systolic readings from 120 to139 fall into the category of pre-hypertension. Those of 140 to 159 are an indication of stage 1 hypertension and those of 160 systolic or higher or a diastolic of 100 or more indicates stage 2 hypertension. The figures provided are for hypertension as the sole health condition, yet if an individual has other medical conditions including heart disease, chronic kidney disease, diabetes and others, a physician may choose to be more aggressive to keep readings lower than normal.

Diltiazem is used to treat high blood pressure. It is in a group of drugs known as calcium channel blockers that work by relaxing the heart muscles and blood vessels. Lisinopril is in a group of drugs known as ACE inhibitors (angiotensin converting enzymes). It, too, is used to treat high blood pressure and other conditions that include congestive heart failure. Spironolactone with a brand name of Aldactone is an aldosterone receptor antagonist, potassium sparing diuretic that treats high blood pressure, edema, heart failure and a number of other conditions. Aldactazide is spironolactone with the diuretic HCTZ (hydrochlorothiazide).

Diuretics (water pills) may be prescribed for those individuals that suffer from hypertension. They are designed to help rid the body of water and salt through the process of urination that, in turn, lowers blood pressure and lessens the work the heart must perform. I can understand with the medication you are on that your blood pressure might drop to lower-than-desired readings. This, as you have discovered, resulted in you having to decrease the dosage of the Spironolactone. Diuretics do come with rather unwanted side effects that may include frequent urination that can be a nuisance, fatigue and weakness, blurred vision, headaches, dehydration, a loss of appetite, and more.

I am slightly confused because you indicate you have stopped the medicine but take Spironolactone in a reduced dose. Does that imply you no longer take the Diltiazem and Lisinopril and are only taking the Spironolactone? Beyond this, your readings are good but I feel it is important that you remain under the care of your prescribing physician who can monitor your blood pressure readings on a reasonably frequent basis until he or she is satisfied things are going well. You don’t mention any other medical issues you might have but the use of the diuretic may be for other conditions that you may not have mentioned. If you have the confidence in your prescribing physician, stick with him or her and be sure to ask questions when you have them. After all, you certainly want to continue advancing your years as an octogenarian and moving forward toward the big nine oh! Good luck.