Question: I am 73 and have had high blood pressure for years. I take telmisartan (other medications gave me bad side effects) and regularly test my blood pressure: the values range from 160/90 to 170/103 (and last year they were around 180). I’m afraid I’m having a stroke. Can you recommend alternative ways to lower blood pressure?
Brian Kempton, by email.
A: These measurements show that you need a more effective treatment.
A healthy blood pressure is between 90/50 mmHg and 120/80 mmHg. The first number, systolic blood pressure, measures the pressure in your blood vessels when your heart contracts; the second, diastolic, is the pressure between beats.
The treatment of high blood pressure – also called hypertension – should always include non-drug measures in addition to medication.
Research shows that reducing daily salt intake can lower blood pressure; for example, a reduction of 3 grams reduces systolic pressure by an average of 5 mmHg, according to one study (salt causes our bodies to retain water, which increases the volume in our blood vessels and increases blood pressure). blood pressure).
A regimen for lowering blood pressure should always include non-drug measures in addition to medication
Being heavier increases the amount of work your heart has to do, causing blood pressure to rise – and weight loss has also been shown to lower blood pressure; this decreases by between 0.5 and 2 mmHg (systolic) for every kilogram of weight lost.
In addition, regular aerobic exercise can also lower blood pressure by 4 to 6 mmHg for systolic blood pressure, and by 3 mmHg for diastolic blood pressure.
Then there’s DASH (Dietary Approaches to Stop Hypertension), which involves eating plenty of vegetables, fruits, low-fat dairy products, whole grains, poultry, fish and nuts: it has been shown to lower blood pressure by 6 to 4 mmHg.
In your longer letter you ask about participating in studies of alternative medicine for high blood pressure. I would advise against this, because in a randomized study you can end up in a placebo group that does not receive the treatment.
But I think changes in your medications can make a difference.
There are four types of medications used to treat high blood pressure: diuretics (which help by reducing the volume of fluid in your blood vessels); calcium blockers, which reduce how much the heart and arteries constrict; angiotensin-2 receptor blockers, which relax blood vessels – and angiotensin converting enzyme (ACE) inhibitors, which also relax blood vessels, through a different mechanism.
Typical medications prescribed to lower high blood pressure include medications that relax blood vessels
Patients usually receive a combination of two medications. Since each type of drug has a wide range of options, you will almost certainly be able to find a combination that does not cause side effects.
Talk to your GP, or ask for a referral to a specialist, about adding to your current single-drug regimen. I’m hopeful this will help.
Q: I have osteoarthritis, but I can live with painful joints. My problem is that when I bend my head – for example while ironing or reading – I get a terrible pain in the back of my head. These disappear when I raise my head.
Name and address provided.
A: The symptoms you describe are those of a rare neurological condition called occipital neuralgia, which is a complication of your osteoarthritis.
It causes intense sharp or throbbing pain at the back of the head and neck, due to the occipital nerves, which exit the spinal cord on either side at the back of the head, becoming pinched or irritated.
As your arthritis has progressed, the opening through which these nerves pass may have become smaller, which explains why you feel pain when your head is bowed or flexed.
Some patients notice that their scalp becomes sensitive to the lightest touch, making washing your hair or lying on a pillow painful.
The condition is diagnosed based on your medical history; the diagnosis can be confirmed by injecting local anesthetic into the area (to see if this stops the pain causing the movement).
Although we cannot reverse osteoarthritis, physical therapy combined with a short course (four to six weeks) of an anti-inflammatory drug should relieve occipital neuralgia.
IN MY OPINION… Take action in the 1930s to stop dementia
News earlier this week of a new blood test for Alzheimer’s disease offers welcome hope for an early diagnosis and possibly better treatment for this devastating condition.
The problem is that the changes in the brain that result in Alzheimer’s disease can begin decades before the symptoms that lead to a diagnosis.
But a blood test – if the result is positive – could mean those affected can reduce their risk factors, potentially averting the disease: these include high blood pressure, elevated cholesterol, smoking, obesity and lack of physical activity.
More difficult is dealing with medications that increase risk if taken long term, such as benzodiazepines (e.g. diazepam), tricyclic antidepressants (e.g. amitriptyline) and antihistamines (e.g. chlorpheniramine): there would be a need to weigh the risks against the benefits to weigh. of these medications.
A blood test means people can also adopt things known to help prevent dementia, such as a healthy Mediterranean diet.
But while we wait for such a test to be rolled out, the key message now is to think about these factors early, in your 30s and 40s.
Warn your adult children.