Volatile blood pressure tricky to control

Ask Dr. Keith Roach M.D DDiFo KMk McjuaceUnMLB

Volatile blood pressure tricky to control

DEAR DR. ROACH: In the past few years, I've been experiencing 'volatile blood pressure.' It will go from 71/38 to 280/90 in half an hour. It happens in all situations. I could be knitting and do a check, and it will be 200/68. The emergency and ambulance teams know me very well. I have had 24-hour urine tests and lots of bloodwork. Most of the time it is low, so how can I raise it up? I was on 25 milligrams of Cozaar (losartan), but it caused a real dive. Do you have any advice on how to control this? — P.D.

ANSWER: Volatile, or labile, blood pressure can have several causes. Although it is rare, a pheochromocytoma must be considered. It is a tumor that can intermittently secrete substances, like epinephrine, that raise the blood pressure. I am pretty sure the 24-hour urine test was to look for this. Blockages in the arteries to the kidneys sometimes cause spikes of blood pressure, as can some other uncommon causes.

If your doctor is convinced that there is no identifiable medical condition causing these high pressures, he or she may wish to give you treatment you can take at home when the pressure is very high, rather than sending you to the emergency room each time. There are several blood pressure regimens that are recommended for labile blood pressure, but all of them are limited by blood pressure getting too low.

In many people, despite no apparent symptoms of anxiety or depression, adding an antidepressant sometimes can eliminate the blood pressure spikes and improve your quality of life. It's thought that there may be emotional issues that people are not consciously aware of. It may be worth a short trial (a few weeks) to see if this type of treatment can help stabilize the blood pressure.

DEAR DR. ROACH: My 55year-old son daily begins 'happy hour' in late afternoon with two martinis. This is followed by other alcoholic beverages at dinner and throughout the evening till bedtime. However, he complains that he awakens at 3 a.m. and cannot get back to sleep, so now he 'occasionally' takes an overthe- counter sleep aide. I'm very concerned that this is a dangerous situation and feel his sleeplessness has something to do with the heavy alcohol intake. What do you think? — A.M.D.

ANSWER: I think you are right to be concerned.

A martini typically has the alcohol content of about 1.4 standard drinks, based on an National Institutes of Health drink calculator I found online (http://tinyurl.com/hwygoru). So your son is having nearly three standard drinks before dinner, and then it sounds like he has at least two more. This very clearly is in the 'problem drinking' category. Adding an OTC sleep aid, such as diphenhydramine, can exacerbate neurological and muscular toxicity of alcohol.

There are many adverse health issues from drinking so much alcohol — a common one is sleep disturbance, both in falling asleep and staying asleep. Cutting down drinking will be likely to help many problems, both now and in the future, including the sleep disturbance.

The website above has many helpful tips for people who want to cut down. Your son also may get help from his own doctor, a psychiatrist or an addiction specialist.

*** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.