Se­niors can re­act to BP med­i­ca­tion

Sun Sentinel Palm Beach Edition - - PUZZLES - Dr. PKaeui l th DoRnoahcuhe GOOD HEALTH Write to Dr. Roach at [email protected] med.cor­nell.edu or mail to 628 Vir­ginia Dr., Or­lando, FL 32803.

DEAR DR. ROACH: I won­der if you could com­ment on the nega­tive side ef­fects of var­i­ous blood pres­sure med­i­ca­tions for those over 65 — par­tic­u­larly folks who are 80-plus. Should a per­son be on more than two med­i­ca­tions if one’s blood pres­sure is gen­er­ally 150-160/70-80? Does the an­swer change if the per­son also has chronic atrial fib­ril­la­tion?

I am on three blood pres­sure med­i­ca­tions meds, have chronic atrial fib­ril­la­tion and have had ex­tremely bad light­head­ed­ness, to the point of al­ter­ing my qual­ity of life. I am on one med­i­ca­tion (cloni­dine) that was listed as hav­ing many side ef­fects, like the ones I men­tioned. I checked with my phar­ma­cist and got the same info: It’s not good for se­niors.

I would ap­pre­ci­ate your thoughts on blood pres­sure med­i­ca­tions and their ad­verse re­ac­tions, es­pe­cially in se­niors. — S.B.

In an ideal world, peo­ple with high blood pres­sure could con­trol it with a sin­gle med­i­ca­tion that would not have any side ef­fects. The guid­ing prin­ci­pal of­ten be­comes not what is ideal, but what is best in a dif­fi­cult sit­u­a­tion.

It of­ten takes ex­ten­sive tri­als to find the right com­bi­na­tion of med­i­ca­tions to get the blood pres­sure in an ac­cept­able range while still hav­ing an ac­cept­able level of side ef­fects. It’s not clear that you have achieved ei­ther of those goals:

160⁄80 is not ad­e­quate blood pres­sure con­trol, and life-al­ter­ing light­head­ed­ness is not ac­cept­able.

I un­der­stand your frus­tra­tion, but please wait on your doc­tor be­fore dis­con­tin­u­ing blood pres­sure med­i­ca­tion.

A new reg­i­men is called for, and maybe a com­plete re-eval­u­a­tion of the pos­si­ble causes of high blood pres­sure. For ex­am­ple, when I see cloni­dine used, I of­ten con­sider whether the di­ag­no­sis of ob­struc­tive sleep ap­nea has been missed.

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