Would big weight loss change need for HBP meds?

DEAR DR. ROACH »

A friend was diagnosed with high blood pressure several years ago and has been on a hypertensive drug since then. However, over the past years, he has lost over 50 pounds and is no longer overweight. He works out every day. He never exercised prior to his diagnosis. He seems to be eating healthier foods now, too. Shouldn’t he be reevaluated regarding the need to continue taking his drug? And what is the procedure to see if he needs to continue with the drug?

— R.I.

DEAR READER » High blood pressure is usually a condition people have for lifetime; however, even when it requires medication, it can sometimes be successfully treated with lifestyle interventions. This is particularly true when a person has a lot of work to do to get to a healthier place.

Losing weight has a variable effect on blood pressure, and occasionally has a profound effect — this is true also of the effect of weight loss on diabetes. A healthier diet, especially salt reduction, can lower blood pressure. Regular exercise and stress reduction techniques can have an added benefit.

His doctor should be measuring his blood pressure at every visit. If the blood pressure is getting lower than his goal, the doctor should reduce the dose or even take it away completely. However, there are some times when his doctor might want to keep the blood pressure medicine going, such as when the medicine has two beneficial effects (say, beta blockers that work for high blood pressure and migraine, or an ACE inhibitor for a person with diabetes and high blood pressure).

My experience is that a few people really hate taking medicines, even after years, while others just get in the habit and stop thinking about it. If your friend really wants to stop the medicine then he can talk to the doctor about a trial of lower dose or stopping the medicine.

DEAR DR. ROACH » Can a weakness toward alcoholism be inherited and run through a family for generations? Or is each person a separate case, and subject to his own behavior and health career?

— N.M.G.

DEAR READER » A family propensity to alcohol use disorder has long been known. Both environmental effects and genetic predispositions have been identified.

There is no certainty about who will have the predisposition to develop problems with alcohol, but a person with a family history needs to be more careful than others to recognize when they are beginning to develop problem behaviors.