Dear Dr Roach: I’m trying to find the best blood pressure medication with the fewest side effects for a 77 year old Hispanic male with swollen ankles at the end of the day and readings of 160/76 with a pulse of 64.
Of all the drugs on the market to treat high blood pressure, which is the best with the fewest side effects? Some reputable health magazines have mentioned telmisartan. Is it true? — NV
Answer: There is no single answer to your question. It depends on the person and their other medical conditions. Even then, there is often trial and error. For most people who find that non-drug therapy has failed to control blood pressure, we are looking for a regimen that brings blood pressure back to target with minimal or no side effects.
Hispanics are a very large group of people, often from radically different backgrounds. Not surprisingly there is no data to guide therapy and I know of no drug that is better or worse for Hispanics
Your blood pressure is only elevated on the top number, the systolic number. This is common in older people. Three classes of drugs are recommended in this situation as first-line treatment: thiazide-type diuretics, calcium channel blockers and an ACE inhibitor or ARB.
Thiazide diuretics, such as HCTZ or chlorthalidone, are very old and inexpensive treatments that have been shown to reduce the risk of stroke in older people with high systolic blood pressure. Unfortunately, they often only have a modest reduction in blood pressure and your systolic pressure is at least 20 points higher than ideal, so a thiazide alone is unlikely to be effective enough.
Calcium blockers are much stronger agents, but the most commonly used ones, such as amlodipine (Norvasc), often cause or worsen ankle swelling. This can be treated with compression stockings.
ACE inhibitors (like lisinopril) and ARBs (like telmisartan) usually have very few side effects. ACE inhibitors occasionally cause coughing; ARBs almost never do. They are reasonably potent and have also been shown to protect the heart and kidneys in those at risk.
Often, in terms of lowering blood pressure and having no side effects, a combination of drugs is better than the highest possible dose of just one.
The best evidence shows that blood pressure control, not agent choice, correlates best with efficacy. Choosing an effective drug with little or no side effects is the goal. The choice varies by person.
Dear Dr. Roach: What is alopecia? –S
Answer: The word “alopecia” means “hair loss“, and there are several different patterns. The word itself borrows from an animal disease. It comes from the Greek and means “fox mange”, a parasitic disease causing hair loss. (Many animals have mange.)
When people talk about alopecia, they are often referring to alopecia areata, a common type of hair loss without scarring. It occurs in inconspicuous round patches, usually on the scalp, but can occur in all hairy areas and in different patterns. Nails can also be affected. Thyroid disease is commonly associated with alopecia areata, but it is generally considered an autoimmune disease.
A serious form of alopecia areata is alopecia totalis, which is the complete loss of hair from the scalp. Another is alopecia universalis, which is the loss of all body hair, including eyebrows and eyelashes.
There are many other forms of alopecia, some of which damage and scar the hair follicles. These should be handled by an expert. Dermatologists specialize in diagnosing and managing hair loss.
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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.
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