IS BLOOD PRESSURE A FIXED NUMBER?

Q: Everyone talks about blood pressure as if it were a fixed number. I take mine every morning after breakfast and keep a running daily, 30-day and 90-day average.

If I don’t take it at about the same time every day, the reading will be higher. My running average is 113/65. My heart rate is 55. But during the day, I might get up to 130/70 or maybe a little bit higher. So, the question is, what is my BP? Is it the one early in the day or the one that fluctuates throughout an average day? Arguments or exciting sports push it up even more.

When I was first diagnosed with high blood pressure a year ago, the reading was 220/110. The doctor put me on amlodipine and olmesartan. I have gradually gotten my pressure down to the current levels with medication, diet and exercise.

A: Thank you for pointing out how activity, emotional state and time of day can change blood pressure readings. The technique used to make the measurement can also affect the reading.

You have set a good example for everyone on addressing blood pressure through attention to exercise, diet and blood pressure medications. Others who would like to learn more about controlling hypertension may wish to consult our eGuide to Blood Pressure Treatment. This online resource discusses a range of medicines as well as nondrug approaches to controlling this risk factor. It also describes in detail how to measure BP properly. You will find it in the Health eGuides section at www.PeoplesPharmacy.com.

Q: I had rotator cuff surgery on my shoulder almost a decade ago. Last year I started having pain in that shoulder again. The doctor said I have a lot of inflammation there and prescribed gabapentin.

The pharmacist said this is not commonly used as an anti-inflammatory drug. When I looked it up, I discovered it is an anticonvulsant. Why are doctors prescribing an epilepsy drug for pain?

A: You are correct that gabapentin was originally developed for treating epilepsy. The Food and Drug Administration has also approved its use for treating postherpetic neuralgia. This is persistent severe pain following an outbreak of shingles.

According to a review by the independent analysts at the Cochrane Collaboration, gabapentin can help some people with nerve pain due to diabetes or shingles (Cochrane Library, June 9, 2017). At least half of the people in the studies they reviewed did not get great pain relief from gabapentin, however. The FDA has not approved it as an antiinflammatory agent.

Doctors might be prescribing this medicine for other types of pain because their other options are limited. They are reluctant to prescribe narcotics because of the opioid crisis. NSAIDs such as celecoxib, diclofenac or naproxen can cause serious side effects. These may include ulcers, kidney damage and stroke or heart attack.

Q: Months ago, my doctor prescribed clindamycin for an ear and sinus infection. Three days later, I got really sick with stomach cramps, dizziness, a splitting headache and diarrhea. My doctor told me to stop the drug immediately. I still have loose stools and stomach cramps nearly every day.

Two of my neighbors had a similar reaction and wound up in the emergency room. One of them thought he was having a heart attack, while the other had the same reaction I did. What is going on?

A: You should be tested for a Clostridioides difficile (C. diff ) infection. Clindamycin is notorious for killing off beneficial gut bacteria. This can allow C. diff to dominate. You may need special treatment to control this challenging microbe.

The FDA warns: “Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate.”