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Dr. Anderson: Altitude & Hypertension

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Dr. Anderson: Altitude & Hypertension

Dr. Eric Anderson, a charter diplomat of the American Board of Family Practice and a former president of the New Hampshire Academy of Family Physicians, is a regular contributor to Travel Tips 'n' Tales. He is widely traveled and published, having written a travel health column for Travel 50 & Beyond and a weekly online column, Ask The Doctor, for The New York Times Syndicate.
Dr. Anderson invites you to send your questions regarding travel health issues to ericmd@lorrypatton.com

Dr_Anderson210.jpg Q. I just want to know if there is a threshold level of hypertension that is more likely to be affected by high altitude sickness and at what altitude? For example, I am what is considered high normal. With tiny dosage of atenolol, like 5mg (1/4 of the normal 25mg tablet), my BP goes down to an average 114/69, pulse 70. These readings are always taken at rest and here in the plains of Oklahoma. I plan to go to Cuzco, Peru (10,000 ft). I am just wondering what hypertensive persons should be aware of.
Thanks for any feedback.
S. Q.
A. Your request raises more questions than answers. So maybe you should go and get your cup of decaf first because there are several issues here:
1. Do you have a family history of heart disease, how old are you, are you overweight and how well do you tolerate hard activity in low-lying Oklahoma? Let's assume all those questions have satisfactory answers.
2. How high is your "high normal " blood pressure without medication? There are two schools of thought regarding high normal blood pressure. The older view is that persons with it should bring their weight down to normal, reduce salt, and add or increase daily exercise -- in other words look to lifestyle changes to improve general health. The newer thought is that doctors should be more aggressive with low dose medication because attempts to modify life styles usually fail and, meantime, both doctor and patient have wasted months or years fiddling around achieving nothing.
3. That said, there was also a prior concern that lowering a fairly normal blood pressure might lower it too much and that, in itself, cause serious problems. We do need some blood pressure (BP) to pump blood through the brain, heart and kidneys, for example, and if we lowered it too much, statistics suggested this might be harmful.
4. I hate to get technical but bear with me here for a moment on that suggestion.

eric_graph.gif Picture a graph line high on the right and low on the left where the high mark meant lots of circulation problems like strokes and heart attacks; and the bottom axis showed increasing blood pressure as you went left to right. OK, what this line sloping top right to bottom left showed was that, as BP decreased, so the incidence of problems dropped. So far, so good. We are talking about a straight line here, OK?
But further research showed the bottom left line did not stay straight; it started to turn up at the end on the left. The graph had a handle there like that on a walking stick. This was called "the J-point." In other words, complications started to show up at this end point if we dropped the BP too far.
The most recent studies suggest that we may have been too concerned about this J-point. Nevertheless it makes doctors hesitate about dropping blood pressure too low.
5. Where am I going with this? Well, let me say: without knowing all your details and without having you in front of me, my first thought is that, if your BP drops that low with a small dose of atenolol (and it is small, most patients take 50 mg a day and some take 100 mg) do you really need it? Especially since now I am coming (finally, you will think!) to the concerns about your question.
6. Yeah! What about the trip to Cuzco?
Although you are taking only a tiny amount of atenolol you would appear to be extraordinarily sensitive to it. Therefore the cautions about this medication, one of the drug family called Beta blockade, hold even though your dose is small. Beta blockade zaps adrenaline. Adrenaline helps in any crisis ( the primitive so-called "fight or flight" crisis) by putting up BP, speeding the heart rate and opening up the bronchial tubes in your lungs, amongst other things. So atenolol, to a degree, prevents those things from happening and at altitude your body might want them to happen and do better if they do. That's how it compensates for less oxygen getting into your lungs.
7. Assuming you are otherwise healthy (as in my second paragraph) I don't feel your tendency to run a high normal BP will cause you any more problems in Cuzco than what normal people get. It's the treatment you are taking for your BP that might make it a bit difficult.
8. So what's the answer. I think you should challenge yourself by going to 10,000 feet in North America on your atenolol under the same circumstances as you will confront in Peru. That is, if you are flying from a low level in Oklahoma to 10,000 feet all in one day (an unfortunate way to do it), do the same in North America where you will be close to modern medical facilities. Sure that costs but compared to the total price of your Peru adventure it makes sense. If you can handle this experience medically in North America, you should be OK in South America.
Ideally, you should get yourself in good shape now in Oklahoma , and approach the height of Cuzco slowly so your body doesn't have the problem of adjusting to altitude in one day. And be moderate with activity to begin with. And you should discuss this now with your own doctors because they know you betterthan I and may feel I am making an awful fuss over an unlikely scenario. And maybe I am. But many persons in your situation would come off atenolol for the trip. Beta blockade should be tapered slowly and not stopped abruptly. Your doctor will explain.
By the way, I have nothing against Beta blockade; I took atenolol myself for 10 years for my BP and my wife still takes it for her health problems.
Have a great trip. I've never made it to Machu Picchu, myself. Tell us how it went. How about sending a postcard or an email to Lorry and me at Lorry Patton's Travel Tips 'n' Tales?
NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult with your personal physician before following any medical advice and to please read the Travel Tips 'n' Tales "Terms of Use" found on the bottom of each page of this website. Dr. Anderson's opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n' Tales.