Strategies to control your blood pressure

Dear Dr. Roach: My whole family has heart problems. I’m 74 years old. My blood pressure has been high lately. Today it’s 143 over 79. Some days 139 over 73. It’s always different, but still high.

I take 20 mg of lisinopril twice a day. Now I am taking 10 mg of amlodipine also. My doctor says there’s nothing else he can do for me. I am 5 feet 3 inches tall and weigh 147 pounds. I’m going to Weight Watchers to lose weight. Should I contact a cardiologist? — S.S.

The goal of lowering blood pressure is to reduce the risk of adverse effects of high blood pressure, especially heart attack and stroke. The most recent study, which has changed the way many physicians practice, showed that lowering blood pressure to a goal of 120 systolic reduces the risk of these events and of overall death rates. Most experts would recommend a lower blood pressure goal than your current level.

If you are having no side effects from the lisinopril and the amlodipine, and if the numbers you wrote are typical for you, then you have two options: additional (or different) medication, or an evaluation to look into why your blood pressure might be high.

Common causes include obstructive sleep apnea, excess alcohol use and blockages in the arteries to the kidneys. There are many other uncommon causes, including tumors that make substances that increase blood pressure. However, few people will have an identifiable cause of elevated blood pressure.

I am confused why your doctor would say there’s nothing more to do; it’s likely that he didn’t communicate as well as he could have. Adding a lowdose diuretic medication would be very common in this situation, and it may get your blood pressure to goal.