DEAR DR. ROACH: I read that high blood pressure is 140/90, but I thought 120/70 was optimal. Has the standard number increased? — D.M.I.
ANSWER: The “pressure” in “blood pressure” is given in millimeters of mercury. It is a measurement of the pressure inside large blood vessels, first at its peak during the left ventricle squeezing (the systolic, or top number) and then at its lowest, right before the ventricle starts squeezing again (diastolic, or bottom number). Both of these numbers are important, and they provide important information about the physiology of the heart and blood vessels, as well as provide prognostic information about the risk of heart attack and stroke.
In general, for healthy people, the higher the numbers, the greater the risk. The optimum blood pressure for health is about 110/70, but there are some people with lower values who are also very healthy and who have very low risk for vascular disease.
Risk for heart disease starts to go up more significantly at about 140/90, but above a systolic number of 160, the risk goes up even more dramatically. The trend in blood pressure control over recent years has been toward making the blood pressure closer to the optimum, as long as treatment is well-tolerated. Having a slightly lower risk of heart attack may not be worth it to a person who has significant symptoms from blood pressure medicines.
Fortunately, blood pressure is much easier to control than it used to be with better medications and with non-drug treatments, such as stress reduction, healthy diet, regular moderate exercise and, for some people, salt restriction.
DEAR DR. ROACH: I am an 89-year-old man who has been taking tamsulosin (Flomax), 0.4 mg, for many years. I take it after supper in the evening. I get up at night three or four times to urinate. Would it be better to take it after lunch? I would be happy if I could reduce the number of times I get up to maybe only once or twice. — P.J.S.
ANSWER: Tamsulosin is in the class of alpha blockers, and they relax smooth muscle, a special type of muscle found in the prostate and in blood vessels (among other places). Relaxing the smooth muscle in the prostate makes the urethra, the tube that carries the urine from the bladder and through the prostate, larger. As a result, men can empty their bladders more easily.
However, even though tamsulosin is better at relaxing smooth muscle in the prostate than in blood vessels, some men will get lightheaded upon standing when using it. This occurs especially on the first dose, and over time most men no longer have trouble. It is usually dosed at nighttime so that the lightheadedness on standing is minimized. You can take it at any time of the day (a half-hour after eating is recommended, at the same meal of the day), but I doubt it will work much better.
Many experts will use 0.8 mg in men who haven’t had an ideal response and who do not have lightheadedness. I’d ask your doctor whether an increased dose might be better. Before considering another drug, be sure you avoid too many liquids at night, especially alcohol, and try voiding your bladder twice before bed to make sure it is as empty as possible.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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