New doc­tor, new blood pres­sure tar­get, but who’s right?

The Western Star - - LIFE - Keith Roach Read­ers may email ques­tions to ToYourGood­[email protected]­nell.edu or re­quest an order form of avail­able health news­let­ters at 628 Vir­ginia Dr., Or­lando, FL 32803.

DEAR DR. ROACH: I am a 91-year-old male. When I switched pri­mary care physi­cians, my new doc­tor shook his head be­cause my pre­vi­ous doc­tor had never told me about my low GFR read­ings and be­ing border­line di­a­betic.

In the past I had as­sumed that if the doc­tor didn’t men­tion any low or high blood test re­sults, every­thing must be OK. I no longer as­sume: I ask for a copy of the re­sults and ques­tion them.

The new doc­tor re­ferred me to a nephrol­o­gist. My blood pres­sure at the time was usu­ally in the 130-140/60-70 range. He told me that for a per­son of my age, that was too low. He gave me a tar­get of 159/89. Then on my next visit to pri­mary care, I was told that my blood pres­sure was too high; I was pre­scribed losar­tan. I am test­ing my blood pres­sure daily, and the past few days it has been in the 170s. So, what is a good tar­get for my blood pres­sure? Which doc­tor is cor­rect? — A.L.

AN­SWER: There is no ab­so­lute right an­swer to your ques­tion. On the one hand, over­ag­gres­sive treat­ment of blood pres­sure in a 91-year-old is un­nec­es­sary and may lead to symp­toms of light­head­ed­ness, es­pe­cially upon stand­ing. Other blood pres­sure drugs may have ad­di­tional side ef­fects.

On the other hand, a 91-yearold has a higher risk for heart dis­ease and stroke, and in some­one with a low GFR read­ing (a mea­sure­ment of kid­ney func­tion) and border­line di­a­betes (which fur­ther in­creases the risk of heart at­tack and stroke), most ex­perts would aim for a blood pres­sure goal that is closer to 120-130/80-85, as long as it isn’t caus­ing an­noy­ing symp­toms. I’m not clear why the doc­tor wasn’t happy with your usual blood pres­sure, since a level of 130-140/60s seems very rea­son­able for a man your age if you aren’t hav­ing side ef­fects. If 170 is the usual sys­tolic pres­sure on your new reg­i­men, I would ask about go­ing back to the old one.

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