Controlling Your Blood Pressure Archive

Q. I am a 47-year-old man with diabetes being treated with insulin and high blood pressure treated with lisinopril and low-dose hydrochlorothiazide (HCTZ). I have read that HCTZ can actually cause diabetes. My physician says not to worry about it, but I do.

A. HCTZ can cause modest elevations in blood glucose levels. However, a low dose of HCTZ will have very little effect on your body's chemical balance, whether or not you have diabetes, or whether your diabetes is well controlled. The single most important thing you can do to prevent complications from diabetes is to control your blood pressure. This will lower your risk of kidney and heart disease, as well as stroke. Lisinopril is an ACE inhibitor, a class of drugs that lowers blood pressure and helps protect the kidneys. Adding a low dose of HCTZ to your lisinopril is a good idea, and I often use this combination in my own patients.

Before you begin any exercise program, discuss your exercise plans with your doctor. Men with high blood pressure may be advised to avoid certain activities due to concern about excessive dehydration when taking diuretic medications. If you take a diuretic, you would generally begin exercise with a lower volume of water in your system, which would be further depleted upon sweating. In addition, medicines for hypertension, such as beta-blockers or calcium channel blockers, would limit your maximum achievable heart rate.

Over the long-term, weight training in combination with aerobic exercise lowers resting blood pressure. Men with well-controlled blood pressure may safely pursue weight (i.e., resistance) training with a few caveats. For one thing, during the act of weight lifting, immediate spikes in blood pressure occur. The spikes are more pronounced when an individual performs a breath hold and strains during the lift, resulting in what's called a Valsalva maneuver. During the Valsalva maneuver, blood flow returning to the heart decreases and the pressure in the chest cavity rises.

A difference of 10 or more points could signal peripheral artery disease.

Roll up both sleeves the next time you check your blood pressure at home or have it measured by a health care provider. Why? A recent analysis of 20 different studies in which blood pressure was measured in both arms came to two noteworthy conclusions.

If you are trying to keep a lid on your sodium (salt) intake, keep an eye on everyday foods. Bread, cold cuts, pizza, and poultry were the four leading sources of sodium in the American diet in 2007–2008, according to a report from the Centers for Disease Control and Prevention (CDC).

Bread and rolls usually don't taste salty. But since we eat them so often, a hundred milligrams here and another hundred there add up.

If you have resistant high blood pressure (hypertension), you are probably already doing a lot to lower it. But a study suggests that people with resistant hypertension rarely get two particularly effective drugs, and often they get a drug combination that's not very helpful.

Resistant hypertension occurs when blood pressure stays high despite taking three or more drugs, or when a person needs four or more drugs to reach blood pressure goals. Colorado researchers reviewed insurance claims for more than 140,000 such people. Only 3% were receiving chlorthalidone (Hydone, generic), a diuretic (water pill) that several studies suggest is more effective at reducing blood pressure and curbing bad cardiovascular consequences than the most-often-prescribed diuretic, hydrochlorothiazide (HydroDiuril, generic).

Q. My systolic blood pressure is high in the morning (about 165), but in the evening it drops to below 100. I am taking two blood pressure medications daily and still experiencing seriously low blood pressure at night. What would you suggest?

A. Everyone's blood pressure changes throughout the day, and it's often highest in the morning and lowest at night. You seem worried about the low pressure at night, but that would concern me only if it's accompanied by symptoms such as dizziness or fainting. A systolic (top number) pressure below the normal of 120 is usually not worrisome. In fact, studies show that low blood pressure while you are sleeping predicts low cardiovascular risk.

Symptomatically silent, it's often the first step toward a stroke or heart attack.

Blood pressure — your doctor routinely checks it because high blood pressure can contribute to strokes, heart attacks, heart failure, and other serious illnesses.

For some people, controlling blood pressure is a matter of eating a healthier diet, exercising more, and reducing stress. Others must add one or more medications. When these standard approaches don't do the trick, a novel technique that uses a pacemaker-like device may someday help.

The Rheos system (see illustration) works on baroreceptors (patches of nerve endings that are sensitive to changes in blood pressure) located inside the carotid arteries that run up either side of the neck. The device stimulates these baroreceptors using a pacemaker-like pulse generator connected to wire leads that run to each baroreceptor.

Uses for beta blockers range from lowering blood pressure to improving heart failure.

The release of the first beta blocker in the early 1960s revolutionized the treatment of chest pain caused by exertion or stress (angina). Over the following four decades, these old dogs have learned many new tricks, from protecting the heart after a heart attack to controlling heart failure. Today, millions of Americans take a beta blocker.

The hidden burden of high blood pressure

Cordero A, Bertomeu-Gonzalez V, Moreno-Arribas J, Agudo P, Lopez-Palop R, Masia MD, Miralles B, Mateo I, Quiles J, Bertomeu-Martinez V. Burden of systemic hypertension in patients admitted to cardiology hospitalization units. American Journal of Cardiology, published online Aug. 24, 2011.

Can a hospital stay make you anemic?

Salisbury AC, Amin AP, Reid KJ, Wang TY, Masoudi FA, Chan PS, Alexander KP, Bach RG, Spertus JA, Kosiborod M. Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction. American Heart Journal 2011; 162:300-309 e3.