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Dr. Anderson: Hypertension
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Dr. Anderson: 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 firstname.lastname@example.org
Living with hypertension
Question: I am a 53 yr old white female. Height 5'5" and weight 1l5 lbs. I am an
athlete. Hypertension runs in my maternal side of the family.
I live primarily at sea level in Florida. Untreated, my BP can fluctuate
from below normal to 150/100 off and on. Pulse is generally in high 60's.
My physician has me on 4 mg of Atacand once per day. This has stopped the
severe fluctuations but if I ride or work out for a couple of hours, I drop
to about 90/60 and pulse of 100.
I spend several months a year in Colorado, where we live at 8900
feet. I was there this year and after about 5 days after arrival I was at 200/120. I added a diuretic after a couple days which only lowered it
about 5 points. Added 5 mg valium as needed and this only made a couple of
points difference. I was actually quite ill with headaches, puffiness, poor
sleep, etc. We stayed a month, so I also doubled Atacand to 8 mg and
continued the other things for the duration. We flew home and the evening
we arrived in FL my pressure was normal and for a couple of weeks it was
hypo until my body could become accustomed to reducing the meds back to 4 mg
Now, I don't know what to do about this. I developed the hypertension in
2001 while living in CO and do not seem able to regulate it now when I am
there. Do you have any suggestions?
My physician in CO says she has never heard of a body failing to acclimate
to the altitude and self adjust the BP. I have stayed there for months and
not been able to do so. But at sea level it is much less.
FYI: My cholesterol is 170; I have a slightly abnormal heart beat but EKG
evaluation shows it to be something familial and probably OK. I am not
totally menopausal yet but in and out. Don't take any HRT.
Interesting story. Although I admit doctors sometimes murmur, "Hmm.
Interesting." when they don't quite know what's going on, I do have a couple
of emphatic things to say, however.
First, high blood pressure in the young may have a reason such as a tight
band around the big blood vessel, the aorta, or around one of the arteries
to a kidney. If so those patients may be cured by surgery. In older
patients, however, extensive workups looking for a cause seldom achieve
anything; the majority of patients with elevation of blood pressure have
what's called essential hypertension, meaning we don't know essentially why
they have it.
Second, there are more persons over the age of 60 in America with high blood
pressure than have normal pressure. It goes with aging. So unless your aunt
means your family members had hypertension as young persons or, if older,
had the severe form called "malignant hypertension," I would be inclined to
dismiss her concerns. And I would even more strongly dismiss any family
history of relatives aged 80 to 100 having strokes and heart failure. It's
meaningless: one quarter of all older deaths are due to strokes, one quarter
to heart problems, one quarter to cancer and the rest vary but include
OK. That's the family. Let's look at you. You clearly are in great shape.
You exercise so much I wonder if you could be anemic, a common problem in
athletes. If so you would have trouble at altitude but anemia is so easily
excluded I doubt that's your problem. Nevertheless you could have been
volume depleted as a result of skiing and exercising at altitude and Atacand
causes difficulties in dehydrated persons. (You are, however, on a low dose
of Atacand and, yes, diuretics are often added to the regime which may seem
odd considering the drug has problems with volume or salt depleted
Your physician is right that normal people acclimate to altitude but a
person on medications whose side effects vary is not a completely normal
person. I think both you and I agree you had some altitude sickness when you
had headache and poor sleep, etc. in Colorado. Your thoughts that you "might
try something different" seem reasonable. There are so many different
medications for high blood pressure. Problem is you won't know how well
they'll work at altitude till you get back to Colorado. There's a
cardiologist, Randall Carter Marsh, MD, at the North Colorado Medical Center
in Greeley, Colorado who's known to be receptive to questions and he may
have further suggestions.