I am old enough to remember in the days before there were any decent blood pressure medicines.

We saw people go downhill with kidney problems, heart attacks and general deterioration. But the real heartbreakers were the young people, who came in after a massive stroke at age 35 and left their kids fatherless or motherless.

Well, blood pressure is still a problem (it is one of the main reasons for early death here in the Philippines, where many cannot afford treatment).

There are lots of reasons for high blood pressure, including kidney disease, but most cases are “idiopathic” which is doc speak for “Who knows?”. During the last 40 plus years, there have been lots of articles about renin angiotensin and other stuff, but what it comes down to for a busy doc is: keep the blood pressure down, and the patients do well.

What medicine you use is also a bit complicated debate. But for most people it comes down to: whatever works.

You see, what kills people is the high pressure wearing out the plumbing. I would tell my men (who hated to take their medicine) that it was like running your car at 50 miles and hour in first gear. Yes, your car runs okay, but it will wear out the engine..kidney damage and heart attacks. And since the pressure is high, the pipes might burst, so you might have a stroke.

Convincing people to take their medicine was a big thing: it’s expensive, you don’t “feel” sick, and the dirty little secret about the older blood pressure medicines was that they ruined your love life…
That is why there used to be a lot of debate on who to treat and when to treat. The original VA study was about if we should treat people with “mild” high blood pressure which back then was 160. And then after some years, the data came back: Keep the pressure under 140.

And nowadays, if you have diabetes or heart disease, your doc may actually keep your pressure under 125.

The latest debate is about the “old- old”: people over 80.

In treating blood pressure, there is a question if you treat the bottom number, the top number, or the average. And the answer is: All three.

In a young pregnant lady whose blood pressure is 125/110, she may be having early toxemia and needs treatment.

The “trick” is that blood pressure is a pump: the heart pumps and you get the top number, and then there is a pause and you get the bottom number.

But there is a third element in the bottom number: The blood vessels are “elastic” and when they fill, they stretch, so when the heart is refilling for the next blast, the elastic walls help keep the pressure up.

But when you get old, the vessel walls become hard, often full of placques and calcium and fibrous tissue instead of smooth muscle.

So your top number might need to be higher to keep the bottom number and average number high enough to stop you from fainting.

So sometimes if you lower grandmom’s blood pressure too much, she falls and breaks her hip. Bummer. But not doing so might risk a stroke. And the medicine has side effects. So what do you do?
So lots of docs didn’t treat grandmom’s pressure quite as much as her grand daughter’s, not because they were neglecting grandmom, but because they wanted to keep her going. And the older blood pressure medicines often had a “sedative” side effect that slowed down the elderly.

The side effect problem is one reason that docs joke if grandmom gets senile, check if she’s taking anything…even cold pills, stomach pills, and stuff like Ibuprofen can cause sedation and confusion.

However, the newer medicines have fewer side effects, so there is a new study to check how far we should go to keep down Great Grandmom’s blood pressure. And the answer is back. Yes. Please treat her.

In the latest trial which began in 2001, patients with high blood pressure were either given a low dose diuretic and an ACE inhibitor called perindopril in tablet form once a day, or a dummy pill.

Lead researcher Professor Chris Bulpitt said: “Our results are great news for people in this age group because they suggest that where they have high blood pressure, such treatment can cut their chances of dying as well as stroke.”

In fact, the numbers were so impressive they stopped the study early.

The medicine used: “water pill” (diuretic) and an ACE inhibitor are medicines that don’t make you sleepy.

So tell your great grandmom that yes, she needs to treat her “mild” high blood pressure, even if it doesn’t give her headaches.

And the medicines used are expensive, but not that expensive: one generic combination is $22.95 a month, and probably cheaper if you take two pills instead of one.

Remember: It’s a lot cheaper than a nursing home.


Nancy Reyes is a retired physician living in the Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at Hey Doc Xanga Blog

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