Blood pres­sure goals not al­ways clear

The News-Times - - ADVICE/GAMES - Keith Roach, M.D.

Dear Dr. Roach: My hus­band is 75. I am 68. Our fam­ily doc­tor says that our blood pres­sure av­er­age is fine at 140/80 with no medicine. We thought it should be 120/70, but he says the limit is higher for se­niors in or­der to de­crease falls. This is pretty con­fus­ing. Do you think it’s OK?

S.M.

An­swer: The best goal for blood pres­sure has been the sub­ject of con­tro­versy. For the over­all pop­u­la­tion, a level of 120/80, slightly less than the av­er­age blood pres­sure in the U.S. and Canada, is as­so­ci­ated with a lower risk of heart dis­ease, stroke and death than a blood pres­sure of 140/80. But the dif­fer­ence is pretty small. A blood pres­sure of 160/90 has a sig­nif­i­cantly higher risk, and at blood pres­sures above 160 sys­tolic (that’s the first or “top” num­ber), the risk for stroke and heart dis­ease rises steeply.

A re­cent trial (the SPRINT trial) showed that among older peo­ple with high blood pres­sure who had in­creased risk for heart at­tack, a sys­tolic blood pres­sure goal of 120 was bet­ter at re­duc­ing risk than a blood pres­sure goal of 140. Both groups had a di­as­tolic (the “bot­tom” num­ber) goal of less than 90. How­ever, the goal among peo­ple at lower risk is not as clear.

Most ex­perts would not treat peo­ple with medication un­less their av­er­age blood pres­sure is over 140 sys­tolic or over 90 di­as­tolic. In peo­ple treated with medication, some ex­perts pre­fer a goal of less than

130/less than 90, while oth­ers would treat to less than 120/less than 90. It is true that more blood pres­sure medication and more in­ten­sive goals can lead to greater side ef­fects, in­clud­ing falls. How­ever, in the SPRINT trial, there was NO in­crease in fall risk and a

0.6 per­cent in­crease in the risk of faint­ing.

Non­drug ther­apy, which in­cludes mod­est salt restrictio­n, reg­u­lar exercise and stress re­duc­tion, can lower the blood pres­sure enough that peo­ple do not need medication.

Dear Dr. Roach: Can Lyme dis­ease send a per­son into Parkin­son’s dis­ease? I tested pos­i­tive for Lyme — I had the bulls-eye rash, fever and ter­ri­ble headaches. Af­ter a month on doxy­cy­cline, my left arm started shak­ing and my neu­rol­o­gist di­ag­nosed me with Parkin­son’s. The doc­tor said it had noth­ing to do with the Lyme dis­ease. What is your opin­ion?

S.M.

An­swer: I can ab­so­lutely un­der­stand why you might sus­pect that the neu­rol­o­gist could be wrong. The co­in­ci­dence seems too much to be­lieve. How­ever, I think your neu­rol­o­gist is prob­a­bly cor­rect.

The dif­fer­ent types of neu­ro­log­i­cal com­pli­ca­tions of Lyme dis­ease are many and var­ied.

A de­tailed neu­ro­log­i­cal exam by a neu­rol­o­gist would look for signs of Parkin­son’s dis­ease — not just the tre­mor you de­scribe, but also mus­cle rigid­ity and changes in gait. Th­ese would be very un­usual in Lyme dis­ease.

I did find cases re­sem­bling some as­pects of Parkin­son’s dis­ease, but they im­proved with treatment. It is pos­si­ble that the stress of the Lyme dis­ease has­tened the on­set of Parkin­son’s dis­ease you were des­tined to get.

I say your neu­rol­o­gist is “prob­a­bly cor­rect” be­cause what I found — ab­sence of data to sup­port a cor­re­la­tion — does not mean that there is no cor­re­la­tion, and it is pos­si­ble that time may prove Lyme dis­ease is con­nected to Parkin­son’s. How­ever, I think it’s un­likely.

Read­ers may email ques­tions to: ToYourGood­[email protected] .cor­nell.edu or mail ques­tions to 628 Vir­ginia Dr., Or­lando, FL 32803.

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