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Hypertension/Follow-up qns on hypertension


QUESTION: Hi Dr Falkinburg,

This is a follow-up to my earlier question which you have so kindly and proficiently answered.  I cannot trace your answer from the archive to provide the link. For your reference, below is my question which you have already answered. I have followed your good advice to continue my medication.

"I am 63 years old.  Two months ago I was diagnosed to have high blood pressure, and I was prescribed Amlodipine Besilate (5mg)to be taken one tablet daily for life. My b/p now reads below 120/90.  I am thinking of stopping the medication.  

May I have your advice?  If I need to continue for life, what is the reason for this and would there be any side effects in the long run?"

Below are my follow-up questions.
1. I was told that the diastolic figure is more important than the top figure.  Is this true?
2. Can a person have heart attack even if the b/p is on healthy levels?
3. My b/p levels fluctuates even during the day. Is this normal?  On many occasions the readings were above 130/80 despite my medication of Amlodipine Besilate (5mg).  I use the electronic gadget to measure my b/p, which I am told is not that accurate.
4. Lately I experienced near black-out spells when standing up after bending down. Is this cause for concern?
5. Just for reference, what are the possible highest and lowest b/p readings?

Regards and my sincere gratitude,

Justin Choo

ANSWER: Good afternoon, Justin,

Antihypertensive medication must be taken for life. If the medication is discontinued, the pressure will rise again and any benefit derived will dissipate.

The symptoms you described, lightheadedness when arising from a bending or supine position (orthostatic hypotension), is the most common side effect of blood pressure reduction.  It tends to improve with time.  Otherwise, the risks of medications are nearly zero, but can involve some rare allergic reactions. Any risk, however, pales to insignificance when compared to the complications of poorly controlled hypertension.  
Strokes are the most common complication but the incidence of heart attack is high as well. Hypertension is to your arteries as traffic is to roads.  The more traffic, the faster your roads wear out.

1.  Both systolic and diastolic pressures are important.  The older you become, the more important the systolic pressure becomes and it correlates with stroke risk in older persons.

2.  Yes, especially is the cholesterol (low density lipoproteins) are elevated.

3.Yes, it is normal for the blood pressure to fluctuate during the day.  You want the AVERAGE to be below 149/90.  I like mine below 130/80.  Right now, mine is 111/58. In 1983 mine was 170/110.  I began my medication then.  My Father was hypertensive and he discontinued his medication because he thought it was stupid.  When he was my age (73) he had been dead for two years.  He had a disabling stroke in 1976 and died complicating pneumonia in 1980, after four years in a nursing home. Not a pretty sight and totally preventable!

4.  I'm not concerned with a little "orthostasis".

5.  The lowest is 0.  Not good!  It correlates with no blood flow and one rapidly dies. The highest may exceed 300.  Also not good and is associated with severe hypertensive encephalopathy with stroke and hemorrhage into the brain.  You do not want either.

So, take your medication and do as your Doctor advises and you will live a long happy life.

Good to hear from you again, Justin. You do seem to be responding well to your treatment.  Do NOT stop your meds.

Very sincerely,

Dr Falkinburg

---------- FOLLOW-UP ----------

QUESTION: Hi Dr Falkinburg,
2. Can a person have heart attack even if the b/p is on healthy levels?
2.  Yes, especially is the cholesterol (low density lipoproteins) are elevated.
After thinking about your answer to my question #2, I would like to seek a further clarification?  From my simple logical reasoning, if b/p is normal it means that blood flow is normal and there is no blockage by cholesterol accumulation in the arteries.  How can “elevated cholesterol (low density lipoproteins)” cause heart attack?
Hope you don’t mind my digression here.  Isn’t your diastolic pressure of 58 be considered too low?
Thanks for your time,
Justin Choo

Good morning, Justin,

Your blood pressure, taken in your arm, tells you only the pressure within the brachial artery generated by the forceful beat of the heart.  that pressure is ASSumED and, in fact does, relate to the pressure throughout the entire arterial tree.  The important point is that the pressures higher than 140/90 correlate with an increased risk for the complications of hardening of the arteries, namely, heart attack, heart failure (the heart is no longer able  to pump blood forward against the high pressure), stroke, kidney failure and gangrene extremities. Keeping the pressure less than 140/90 or 130/80 prevents or postpones those complications.

A high ldl cholesterol and/or a low high density lipoprotein (also called good cholesterol) correlated with accelerated hardening of the arteries and heart attack and stroke especially.  The low density cholesterol (LDL) is a light protein that flows in the blood in the periphery of the artery where it gets plastered onto the wall, especially at the branching points of the arteries.   This results in injury to the wall and the the bodies attempts to repair the damage actually accelerates the process of harding of the arteries and, therefore, complications.

Having hypertension and a high LDL and a low HDL gives your vascular tree a triple wammy and complications at an early age.  Treatment is essential.

I might add that use of tobacco dramatically accelerated this process.

My diastolic pressure of 58 is GREAT!

Having a normal blood pressure does NOT assure you that there is no blockage from cholesterol.  It just tells you that a chronically elevated head of pressure is not CONTRIBUTING to the wear and tear on your arteries.

The bottom line is that you want your blood pressure absolutely normal, your LDL cholesterol less than 100 and your HDL cholesterol higher than 40.

You should not use tobacco and you should get at least 30 minutes of vigorous aerobic exercise three times weekly.

Do these things and you probably will live to a ripe old age and have a lot of fun along the way.  If you do not do them, the picture will not be pretty.

Good to hear from you again and best of luck to you.


Dr Falkinburg


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Newell R. Falkinburg, M.D. FACP


Any question regarding hypertension or clinical nephrology


35 years of experience in the field of nephrology & hypertension. Emeritus Professor of clinical Medicine at a major medical school and director of Nephrology & Hypertension at a university affiliated medical center.

M.D. Board certified internal medicine Board certified Nephrology & hypertension

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Fellow, American College of Physicians

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