I’m fit, so why do I need blood pressure pills?
Every week Dr Martin Scurr, a top GP, answers your questions
MY BLOOD pressure is causing me some confusion. I work out in a gym with a personal trainer three times a week, go once or twice more each week, play golf twice weekly and walk the dog daily. Yet my blood pressure is around 150/ 70, occasionally 152/62. My GP thinks this is too high and has put me on pills. I am 65. My father is 97 and my mother is 92 — both still here!
LName and address withheld. eT me start with the basic facts. Hypertension — high blood pressure —is the greatest single risk factor for heart disease and is a more common cause than raised cholesterol, diabetes or smoking.
Despite this, hypertension is under-treated, with only 50 per cent of sufferers getting treatment.
The main reason is that patients stop taking their pills; they don’t see the point of taking tablets longterm for a condition that has no obvious symptoms, and there may be adverse effects.
High blood pressure is any reading over 140/90 and is diagnosed based upon an average of two readings taken during two or more visits to the GP surgery or hospital clinic.
The first number is the systolic pressure — the blood pressure when the heart contracts to force blood around the body. The second, the diastolic, is a measure of the pressure as the heart relaxes to fill with blood.
Recently, we have increasingly relied on ambulatory blood pressure monitoring, which involves the GP fitting the patient with a cuff on one arm, attached to a portable automatic blood pressure measuring gadget which records the pressure every 30 minutes while the patient goes about a normal day.
a 24-hour average above 130/80 is suspicious as, in the healthy, there is a significant drop when reclining and asleep at night.
The second best test is home blood pressure monitoring, where the patient tests their own blood pressure. This is still regarded as superior to results obtained at the GP surgery, where anxiety may produce a misleadingly high reading.
There are different ideas about how often patients need to take measurements — I usually suggest three times a week, at different times of day.
There are two definitions of hypertension. Primary (previously called essential) hypertension is when a patient’s high blood presWe sure has no identifiable cause.
belIeve it develops due to a combination of genetic and environmental factors. age, obesity, family history, salt intake, excessive alcohol, a sedentary lifestyle, personality issues — all are important risk factors.
Secondary hypertension is due to factors known to increase blood pressure, such as oral contraception, continuous use of non-steroid anti-inflammatories, treatment with steroids, many medicines such as antidepressants and illegal drugs such as cocaine.
Some illnesses increase blood pressure, including kidney disease, hormonal disorders ( excess production of aldosterone from the adrenal glands, for example) and obstructive sleep apnoea.
The higher the blood pressure, the greater the risk of complications, such as the muscle of the heart walls becoming thickened, ultimately leading to heart failure.
Other possible consequences of uncontrolled hypertension include stroke and kidney damage.
For all these reasons, and despite your excellent exercise programme and outstanding family history, you should accept the medication your GP has prescribed.
Side- effects are not inevitable. Furthermore, there are many alternative types such as betablockers, thiazides, ace inhibitors and calcium channel blockers (most patients require a combination of drugs for good control).
Remember that there are also lifestyle alterations that can lower blood pressure, such as restricting salt intake, losing excess weight and eating a diet high in fruit, veg, grains, chicken, fish and nuts. I HAVE had gout for more than 25 years. My doctor put me on allopurinol initially, but after a long period took me off, stating a link to kidney problems. I’m also on warfarin due to two bouts of deep vein thrombosis, and have a blood-clotting condition. What can I take for my gout attacks?
B. D. Lawes, swansea. GOUT is an intensely painful type of acute arthritis. It occurs when small crystals form in and around the joints, and is caused by high levels of uric acid in the blood. Uric acid is created when the body breaks down chemicals in food called purines. Some people are unable to excrete uric acid effectively through the kidneys.
eating too many foods that are high in purines (such as red meat and seafood) can also raise your risk of gout, as can alcohol and sugar-sweetened drinks or those containing high levels of fructose (a naturally occurring sugar in GOUT many fruits).
is more common in men, and genetic factors, obesity, high blood pressure, diabetes and high cholesterol also play a part.
For those having recurrent attacks, the best course of action is prevention. This is achieved partly through lifestyle changes — such as addressing high blood pressure and changing your diet long-term.
an appropriate drug should also be taken regularly. Typically, this is allopurinol (which reduces uric acid production) or probenecid (which increases excretion of uric acid through the kidneys).
The success of allopurinol is wellestablished, but it has, on rare occasions, been implicated in kidney damage. around 0.1 per cent of patients may be affected by allopurinol hypersensitivity syndrome, which can lead to lifethreatening kidney failure.
It is unclear from your letter whether you actually have kidney problems, or whether your doctor is merely concerned about the risk. certainly, patients with chronic renal impairment must start on a lower dose; patients with acute renal failure should avoid it.
In addition to preventive measures, acute attacks must be treated promptly. The first choice is usually non- steroid anti-inflammatory (NSaID) drugs, such as indomethacin or naproxen. but these aren’t suitable for people who, like you, are taking anticoagulants.
Those who can’t take NSaIDs may benefit from the drug colchicine, though it can’t be used in patients with severe liver impairment or reduced kidney function. and it’s best avoided in people taki ng the drugs cyclosporine, tacrolimus, amiodarone, the antibiotics erythromycin and clarithromycin and some antifungals.
For your future attacks, my first thought would be colchicine, provided you do not have renal impairment and are not taking any of the drugs listed above. a double dose should be taken at the start of an episode, then three tablets daily.
The next option is a corticosteroid, such as prednisolone tablets, or an injection of triamcinolone directly into the joint. Steroids must be used with caution in cases of heart failure, poorly controlled hypertension or diabetes, but are permitted in kidney disease.
The picture in your case is clearly complex. However you do need a supply of a suitable safe medication you can commence the moment an attack begins. Discuss colchicine and oral steroids with your GP.