DEAR DR. GOTT: I’m a 42-year-old male diagnosed with pre-hypertension. My blood pressure was running 150/90 so my doctor put me on Micardis (telemisartan/hydrochlorothiazide 80/1.25 mg). My question is, why is he putting me on such a high dose? Should I go to another doctor and get a second opinion?
DEAR READER: By my standards, pre-hypertension is a systolic pressure between 120 and 139, with a diastolic pressure between 80 and 89. I don’t know if your physician has given you the benefit of the doubt with one reading only and is leaning toward the diagnosis or if you have been seeing him or her for quite some time and your numbers have been steadily creeping up. I consider you to be beyond pre-hypertension. You are a stage 1 hypertensive. As you are likely aware, the first number reported (the systolic) is the pressure exerted against your arteries during the beat of your heart. The second number (the diastolic) measures the arterial pressure between beats when the heart is at rest. Symptoms are non-existent in pre-hypertension, so my guess is your physician checked your blood pressure as part of a routine visit or complete annual examination. Now that there is some concern, it should be checked more frequently.
Causes for numbers to rise can include atherosclerosis (the buildup of fatty deposits in the arteries), sleep apnea and such conditions as thyroid, kidney or adrenal diseases. Then, too, you did not indicate if you are on any other medication – prescribed or otherwise. Common over-the-counter decongestants, cold remedies, pain relievers, and some prescription drugs can cause your readings to elevate, as can the use of illegal drugs. If you carry a few extra pounds on you and lead a sedentary lifestyle, consume too much alcohol or smoke tobacco, consume too much salt through the foods you eat or have a family history of hypertension, you should make appropriate dietary and lifestyle changes.
Begin by formulating an exercise plan you can take to your physician for his or her approval. If you like to walk, swim, bike, work out at the gym or mow your lawn, make a mental note. Vary the proposed routine so you won’t get bored. On your own, you can review your eating patterns. If you are overweight, substitute lean meats, fish and chicken for broiling. Choose fresh fruits and vegetables, whole grain breads and cereals. If you stop after work for a beer or two, indulge every second or third day only. Take the salt shaker off your kitchen table. At your age, you can aim for 2,300 mg of sodium each day or less and this includes that small bag of chips or those delicious French fries you might want to indulge in. Micardis does come in a lower dose – specifically 40/12.5. I cannot begin to guess why your physician chose the dosage he or she did. Ask when you next visit and get an answer you can live with.
If you incorporate these changes, you may not even need medication to bring your figures into line and that would make it all worthwhile.
Readers who would like related information can order my Health Report “Hypertension” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my office at PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.
