Volatile blood pressure is tricky to control

Dear Doctor: In the past few years, I’ve been experiencing “volatile blood pressure.” It will go from 71/38 to 280/90 in half an hour. It happens in all situations. I could be knitting and do a check, and it will be 200/68. I have had 24-hour urine tests and lots of blood work. I was on 25 milligrams of Cozaar (losartan), but it caused a real dive. Do you have any advice on how to control this? — P.D.

A Volatile, or labile, blood pressure can have several causes. Although it is rare, a pheochromocytoma must be considered. It is a tumour that can intermittently secrete substances, like epinephrine, that raise the blood pressure. I am pretty sure the 24-hour urine test was to look for this. Blockages in the arteries to the kidneys sometimes cause spikes of blood pressure, as can some other uncommon causes.

There are several blood pressure regimens that are recommended for labile blood pressure, but all of them are limited by blood pressure getting too low.

In many people, despite no apparent symptoms of anxiety or depression, adding an antidepressant sometimes can eliminate blood pressure spikes and improve quality of life. It may be worth a short trial to see if it can help stabilize the blood pressure.

High blood pressure is one of the most common ailments for the general population. A booklet on it describes what it does and how it’s treated. Readers can order a copy by writing: Dr. Roach Book No. 104, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for US$4.75/Cdn$6 with the recipient’s printed name and address.

Dear Doctor: My 55-year-old son daily begins “happy hour” in late afternoon with two martinis. This is followed by other alcoholic beverages at dinner and throughout the evening till bedtime. However, he complains that he awakens at 3 a.m. So now he “occasionally” takes an over-the-counter sleep aid. I’m very concerned that this is a dangerous situation. — A.M.D.

A I think you are right to be concerned.

A martini typically has the alcohol content of about 1.4 standard drinks, based on an National Institutes of Health drink calculator I found online. So your son very clearly is in the “problem drinking” category. Adding an OTC sleep aid, such as diphenhydramine, can exacerbate toxicity of alcohol.

Cutting down drinking will be likely to help many problems, both now and in the future, including the sleep disturbance.