High Blood Pressure Readings Call for Additional Medication

DEAR DR. ROACH: I am a 68-year-old female who was diagnosed with high blood pressure at 32. I am 5 feet, 5 inches tall and weigh 130 pounds. I’ve been taking 240 mg of verapamil for all of these years. A few years back, my medication started coming in 120-mg dosages, so I started taking one in the morning and one at night. My blood pressure both at home and at the doctor’s office is often higher than I think it should be, averaging 138/88. Recently, I used a 24-hour blood pressure monitor, which showed that more than 50% of my daytime readings were above 140/90, while my nighttime readings averaged 118/82. I am still waiting to hear back from my doctor regarding the results of this test, but I wanted to get your thoughts. Should I be on some other type of medication? Should I alter the timing to get better daytime readings? -- E.T.

ANSWER: In my opinion, these readings are not ideal. Twenty-four-hour, ambulatory blood pressure readings are usually 5 to 10 points lower than office blood pressure readings, so your average daytime readings are correspondingly higher. There is strong evidence that in people at high risk for heart attack (such as those who are already known to have blockages), controlling blood pressure to an average of less than 120 systolic (the first or top number) and less than 70 diastolic (the second or bottom number) reduces risk. It’s not as clear for people who are at a lower risk, such as people who have high blood pressure without any additional risks. In my own practice, however, I will usually try to get my patients close to those optimal numbers, as long as the medication does not cause side effects. In a situation like yours, I would consider additional daytime medicine. More verapamil might be reasonable, but many doctors might use a different medication, such as a diuretic, in the morning to try to get the optimal blood pressure with less risk of side effects. Very often, the choice of blood pressure medication depends on any other medical issues a person may have. Only your doctor knows enough about your medical condition to make a personalized recommendation.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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With our crazy spring weather, with several frosts, a drought followed by massive rainfall, should I worry about my garden?

Does anyone remember a “normal” weather year? Not in recent history, it seems, but this year is a doozy! Looking back at the temperature swings we’ve had this year, January through April each had close to or more than half the month with highs at least 10 degrees above the average range. May went the other way, with half thenightsreachingtemperatures at least 10 degrees below average and, in W. Bloomfield where I live, three solid frosts that month. June’s temperatures seem to hover close to average,which is a bit of a relief. Looking at precipitation, again it has been all over the map. Generally speaking, though, we had very little snoworrainJanuarythroughthefirst week of June. Between Friday, 6/9 and Wednesday 6/14, we received over two inches of rain! Crazy, right? As I told our Farm Manager, Mike Kincaid, we can always count on a gully-washer right as the peonies start to flower, but this has been an exceptional amount of rain in just a few days.

So,howdoesallof thesetemperature and precipitation swings affect our plants? For established plants you should not need to worry. They have reserves of food to help them through stressful times. If we go back to very dry conditions, which we most likely will over the next couple of months, you may want to supplement watering plants with higher water needs, such as hydrangeas. With newly planted material, of course, you will want to be sure to add water as needed. We like to see the plants get about an inch of water per week – a small investment in a rain gauge is money well spent to help you know how much water your plants have gotten. And remember, when we do get a gully-washer, most of that rain runs off before it can percolate into the soil. Sometimes the best measure of moisture is to stick your finger in the soil and judge by feel.

-Andrea Lista, CCE Monroe County