Know when you need BP meds?

Dear Dr. Roach: I’m a 71-year-old female who is basically in good health. I am active and still working. I usually walk 3 miles per day, and try to stay limber by doing strength training and stretching. I eat healthy with low salt and hardly any caffeine. I tend to have high reactions to drugs.

How do you know when you really need blood pressure medicine? — D.C.S.

Variations in blood pressure send many people to see their medical doctor. It is somewhat surprising, then, that there remains uncertainty about deciding who needs treatment.

A single reading a few times a year at a doctor’s office is not the optimal amount of data. A high-quality home blood pressure cuff is a great way to get additional information. The more readings, the better the picture.

Blood pressure does go up and down, and so it is the average blood pressure that you want to know. Blood pressure at night tends to be lower than during the day, so there are standards for average daytime (130⁄80) and nighttime (110⁄65).

A 24-hour ambulatory blood pressure monitor has become the definitive method of measuring blood pressure, and is a better predictor of the types of events we are trying to prevent (heart attack, stroke) than office blood pressures.

Getting many readings throughout the day is likely to be a better guide to when treatment is necessary than just the doctor’s office. Blood pressure can go up if a person is anxious or nervous. While an occasional reading of 135 or 140 is not a problem, an average systolic over 130 is higher than optimal. Treatment even of that low number does reduce the risk of heart attack and stroke, at least in people who had additional risks for heart disease.

You and your doctor should check your average reading to decide whether treatment will be helpful.