Welcome to Dr. Rowena's Q&A about High Blood Pressure

Lowering BP with weight loss

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: I am taking Norvasc (10mg), lisinopril / HCTZ (20/12.5mg); I also use Resperate for 20 min 4-5 times a week, and walk for 1 full hour 5 times a week. My current weight is 213lb, height is 5′10″, and BMI is 30.6. I have lost 53 pounds over the last year and increased my walking, yet my hypertension is still high. Is there a breakpoint, when my lower weight will bring down my blood pressure?

A: Congratulations on the weight loss. Keep on losing. Your BMI still isn’t in a healthy range. Even thin people can get high blood pressure. There is no magic weight where high blood pressure disappears.

Blood pressure highest in the evening — is it normal?

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: My morning blood pressure is regularly 130/80 every morning around 8am. As the day goes by, it gradually increases, sometimes getting as high as 150/85 by 11pm. Is this normal? I’ve been led to believe blood pressure is highest in the morning.

A: Blood pressure naturally increases in the early morning as the body prepares for the day. This is different than the increase in blood pressure caused by activity. Your blood pressure is not normal. Blood pressure increases caused by activity should remain in the normal range. A systolic pressure reading that is repeatedly over 140 needs to be treated. Make an appointment to see your doctor and bring in your blood pressure readings.

Medication changes while on RESPeRATE?

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: If using Resperate lowers the blood pressure of one of your patients, would you approve that patient to discontinue taking BP medication while on Resperate?

A: Using RESPeRATE alone to control blood pressure is a possibility. Many factors need to be considered by a doctor prior to attempting to wean a patient off blood pressure drugs. A person with mild hypertension and no other health problems being treated with a low dose diuretic would be the best candidate. Don’t stop taking medicine on your own. Talk to your doctor.

Normal BP and age?

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: As one ages, I believe the arteries also age. As such, the norm of 120/80 may not be applicable to those in the 60-80 year range, otherwise these groups may be over-treated. Is there a table showing safe BP ranges for patients in the various age groups?

A: For all adults, 120/80 or less is considered normal blood pressure. Blood pressure at a level of 140/90 or more needs to be treated even if you are elderly. Not everyone can be safely treated to this level but lowering high blood pressure has been shown to be beneficial to even the very old. Charts are available showing average blood pressure based on age up to the mid 60’s. Click here.

How hypertension affects the kidneys

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: How does hypertension cause chronic kidney failure?

A: Over time, uncontrolled blood pressure damages blood vessels. Diseased blood vessels are unable to deliver blood effectively to vital organs such as the kidneys. Without enough blood, tissue dies. When enough tissue is lost, the affected organ no longer can function at full capacity. As more tissue dies, function continues to decline. With intervention, loss of function can be stopped or slowed.

Preventing weight gain from medication

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: I take metformin and actos for type 2 diabetes but it makes me gain weight especially around my stomach. What can I do to prevent this?

A: It is important that you stay on your medicine for diabetes. There are only two ways to prevent the weight gain. You can either eat less or exercise more. A combination of less eating and more exercising is doubly effective. The calories you consume must be less than the calories you burn with daily activities for weight loss to occur. You might want to talk to your doctor about exercise and weight reduction diet recommendations.

Treating anxiety without medication

Written by: Dr. Rowena | Posted: Jan 27 2010

Q: I am prone to anxiety. What is the best way to help it without medication? Also, every time I go to the gynecologist, my blood pressure is sky high even though I take Inderal 60 mg on a daily basis. What helps white coat syndrome?

A: Exercise. Regular exercise has been shown to reduce anxiety and is good for your heart. Most of us don’t make time in our lives for enough exercise. Shorts bursts of exercise scattered throughout the day are effective. Thinking it takes an hour long session to get results is wrong. Do what you can when you have some time. Ten minutes here and there can really make a difference. Learning to control your anxiety especially that is associated with a doctor visit can help with white coat syndrome. Wikkipedia offers a good discussion of the topic. Click here.

High BP in the morning

Written by: Dr. Rowena | Posted: Jan 12 2010

Q: Why is our BP consistently highest when we wake up in the morning? Are such high readings of systolic >160 mm and diastolic >100 mm an indicator one needs medical attention although BP at other times of day seem normal (or range near high normal)?

A: A morning blood pressure of 160/100 needs medical attention. Make an appointment to see your doctor. Blood pressure increasing in the morning is a natural biorhythm of the body. A significant number of people have a stroke or heart attack in the early morning because of this biorhythm.

Relationship between BP and insomnia

Written by: Dr. Rowena | Posted: Jan 12 2010

Q: What is the relationship between BP and insomnia?

A: A recent study has shown that people with chronic insomnia have an increased risk of developing high blood pressure. Getting a good night’s sleep is important for your health. Talk to your doctor if you are having problems with sleep.

Experimental carotid stimulator for HBP

Written by: Dr. Rowena | Posted: Jan 12 2010

Q: I have drug resistant HBP and take several meds which work more or less with plenty of side effects. I have heard about a device similar to a pacemaker which attaches to the carotid artery, I believe, and which experimentally at least, is supposed to be quite effective with zero drugs! What can you tell me about its availability, effectiveness, etc.?

A: For a discussion of a case where a carotid sinus stimulator was used in a patient with uncontrolled high blood pressure click here.
The device known as the Rheos is still being studied and will likely be expensive. For a news release about the product click here.