Ask the doctor: Why blood pressure bounces up and down
Why blood pressure bounces up and down
A recent test revealed my blood pressure to be quite low.
I have been taking tablets for high blood pressure for some time and thought this lower level was an improvement.
However, I am shortly to have further checks and it seems that this situation is not as healthy as I thought.
Why are my levels fluctuating, and which is worse — too high or too low?
George Giles, Clevedon, Somerset.
A healthy blood pressure is around 120/80, and experts agree that a blood pressure above 140/90 is bad for health
You sound somewhat dispirited by what has happened, yet I believe that it is good, rather than bad, news.
It appears the combination of the two tablets you have been taking is too powerful and what is needed is a reduction in treatment.
However, before I explain your options, let me give you some background about your condition.
When your blood pressure is tested, the reading produces two numbers (in your case, 102/65).
The first number represents the pressure in your blood vessels when your heart contracts (it’s the contraction that produces your heartbeat).
Each contraction sends out around a teacupful of blood; the pressure forces it to move along the blood vessels.
At this point your blood pressure is at its highest, known as systolic pressure.
When the heart relaxes and is refilling, preparing for the next contraction, the pressure drops back. This lower reading is your diastolic pressure.
A healthy blood pressure is around 120/80, and experts agree that a blood pressure above 140/90 is bad for health.
This is called hypertension, and can damage the heart and blood vessels, increasing the risk of stroke, heart attack and kidney disease (due to the delicate vessels in the organ becoming damaged).
High blood pressure is the net effect of a number of factors including your genetic make-up, weight, levels of physical fitness, salt intake, and even mood (prolonged periods of stress are thought to trigger it).
More from Martin Scurr for the Daily Mail…
You tell me you are taking 5mg of lisinopril and 2.5mg of bendroflumethiazide.
These work by widening the blood vessels and reducing the total volume of liquid in the blood stream, which both act to lower blood pressure.
But while levels below the recommended cut-off point of 140/90 are associated with better future health, your level — 102/65 — may be considered too low, particularly if you are in an older age group.
That’s because this group seems more prone to dizziness (due to a lack of oxygen reaching the brain), which can result in falls.
This does not present problems for everyone, and if you are thriving, then well and good.
But some people will feel faint and weak at this low level.
If this is the case, the treatment needs to be reduced, followed by a period of regular monitoring should blood pressure become too high again.
Most of us in medical practice struggle to get our patients onto treatment that is consistently effective, and it often needs two or three medicines to achieve it.
Evidently the combination of your two drugs is proving too powerful; perhaps your GP could try you on lisinopril alone, or even at 2.5mg daily rather than 5mg, though that remains the decision of your doctor.
Judging from the tests and attention your GP surgery is giving you, I believe you are in a good position, and in very good hands.
Following months of severe pain in my neck and arm, an MRI scan showed that one of the discs in my neck had ‘slipped’ and another was damaged.
I was prescribed a course of painkillers to allow the disc to settle but since stopping these four weeks ago the pain has escalated again.
My GP and neurosurgeon have said the ultimate solution would be to replace the disc with an artificial one — but I really want to avoid that.
Many people have recommended visiting a chiropractor or osteopath.
Although I am unsure about this, I am desperate for a solution and would value your opinion.
Lorraine Mulligan, by email.
There is not one of us who does not experience neck problems at some stage in middle age — indeed it is one of the most common complaints presented to GPs.
Accordingly, there is a dizzying array of professionals who claim they can ease your pain, including osteopaths, Alexander technique teachers, McTimoney therapists, practitioners of the Bowen technique, and acupuncturists — a whole gamut of confusing possibilities.
As you have become aware, friends, relatives, and others all have their suggestions and know someone who knows someone who was swiftly eased by a brilliant intervention — but it never seems to work for you or me, and there is always the worry about safety.
You have been carefully investigated and the MRI scan has identified the problem: one of the shock-absorbing discs between the bones of the spine, at the base of the neck, has split.
Its soft core is now bulging out and pressing on the nerve that runs from the spinal cord to the forearm and hand, triggering severe pain.
A second disc in your neck is also showing signs of damage.
CONTACT DR SCURR
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email firstname.lastname@example.org — including contact details.
Dr Scurr cannot enter into personal correspondence.
His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
Your doctor’s first approach has been to prescribe gabapentin, a drug which is effective for nerve derived pain.
Although the medication does nothing to directly help the healing of a degenerating or ruptured disc, it does reduce muscle spasm, which can buy some time for the body’s natural healing processes to do their work.
Healing will also be helped by regular exercises taught by a physiotherapist. But any type of neck manipulation is completely out of the question — so definitely no visit to an osteopath or chiropractor.
Manipulation will only traumatise the damaged disc further, and maybe even cause the already bulging disc to rupture — so beware.
A further period of waiting, aided by gabapentin to help deal with pain, may be called for — even for months rather than weeks.
However, if there is a sign of the muscle wastage in the hand on that side — for instance, an obvious loss of muscle bulk, or weakness — on top of persistent pain, инструкция you may need to consult the neurosurgeon again.
This muscle loss implies an even greater degree of nerve pinching, to an extent that the muscles are no longer receiving signals and are wasting away.
If this is the case, then surgery to relieve the pressure on the root may be required — and disc replacement might be necessary.
I wish you the best of luck.
By the way…
If I was a woman, I’d choose this contraception
As I become more senior in my years, I find the patients I mainly care for are also in an older age group.
No longer the young mothers and toddlers with whom I was inundated when I, too, had a young family.
And so I find myself thinking about the problems peculiar to their age.
It feels as if the Pill is not the easy and happy option it once was, even though it can be safe and trouble-free right up to the menopause
One of those is contraception: at a recent medical meeting I found myself sitting next to a GP who, at 34, has completed her family — three children — yet, as she pointed out, has certainly ten, if not 20, reproductive years ahead of her.
What to do?
More and more of the women I see are averse to taking hormones: it feels as if the Pill is not the easy and happy option it once was, even though it can be safe and trouble-free right up to the menopause.
Women who have that all-too-common problem of unreliable and haphazard menstrual bleeding in their 40s are now frequently offered the Mirena coil, which deals with two problems at the same time.
It is a brilliant solution that stops any bleeding from the womb by making the lining stable, and it also provides contraception.
But it is not perfect for every woman: tiny amounts of progesterone hormone are leached into the system and some individuals respond badly to this with weight gain, breast tenderness or haphazard bleeding.
Sterilisation is an obvious alternative, but there is, somehow, a natural reluctance that deters many.
It involves invasive surgery for men and women, with local anaesthesia for vasectomy in the men and general anaesthesia for women.
Neither procedure is risk-free and both require time, trouble and a measure of courage — on top of having to deal with a sense of finality.
But a new option for women is Essure, a non-surgical sterilisation procedure.
The tiny device, smaller than a matchstick, is put in the uterus at the entry point of the fallopian tubes, which carry eggs down from the ovaries.
The procedure is painless, and the device remains there for ever, causing no sensation.
Over the next three months, there is a local scarring response that blocks the tubes, ensuring infertility.
The technique has been proven in more than 500,000 women over ten years, it is the most effective contraception known, and there are no side-effects or problems.
This is a significant advance in the healthcare of women.