Ask: I am concerned about my blood pressure. The top number is very high, between 138 and 216, while the bottom number is in the 70s and 80s. But I haven’t used salt on my food for 30 years, I don’t smoke and rarely drink. I eat a lot of fruits and vegetables and have a good cholesterol level. I can’t figure out why I have this problem. Can you suggest a solution?
Karen Buckley, Kettering.
A: I understand why you are surprised, and there are probably many readers in a similar position. Let me start with a quick tutorial on what the blood pressure readings mean.
A reading consists of two numbers. The top number is the systolic pressure, which is the pressure in the arteries when the heart contracts, pushing blood out with each beat (about 140 ml, a teacup). A normal value is 120 or less.
The second number, the diastolic pressure, is when the heart relaxes between beats – it should be 80 or less. If the reading is consistently over 140 over 90, this is known as hypertension.
Treatment for all types of hypertension is essential as it can lead to heart disease, heart attacks, strokes, kidney dysfunction and left ventricular hypertrophy (file photo)
What you are describing is a subtype called isolated systolic hypertension (ISH), where the systolic (upper) value is greater than 140 and the diastolic number is less than 90. This condition affects elderly patients; Studies have shown that systolic pressure rises and diastolic pressure falls after the age of 60. The increased pressure results from a decrease in the stretchability or elasticity of the artery walls – part of the aging process.
ISH is responsible for up to 80 percent of high blood pressure cases in this age group. Other risk factors include obesity, lack of exercise, genetics (such as hypertension in one or both parents), and high salt intake.
Treatment for all types of hypertension is essential as it can lead to heart disease, heart attacks, strokes, kidney dysfunction and left ventricular hypertrophy (an enlargement and thickening of the walls of the heart’s main pumping chamber).
Treatment may include lifestyle changes such as salt restriction, exercise and weight loss, and long-term medication.
Nigel Beaumont asks, “Why doesn’t the NHS routinely check for prostate cancer?”
Even if you don’t add salt to your food, keep in mind that many manufactured foods, such as ready meals, have a lot of ‘hidden’ salt. We shouldn’t consume more than 6g (about a teaspoon) of salt per day, so always check food labels.
Studies have confirmed the effectiveness of these lifestyle measures in controlling blood pressure. However, if they do not decrease the systolic value after several months, drug treatment should be started.
It is unclear if you are already under the care of a specialist, but I recommend that you consult your primary care physician about starting any medication as you seem to have ISH despite a healthy lifestyle.
This is not the place for me to describe the different drug classes available, that is a job for your primary care physician to fully understand your medical history – crucial in your case as we don’t want to trigger your diastolic reading. drop too low. If that happens, you could have complications such as dizziness or even fainting when you stand up.
The goal should be a gradual reduction in blood pressure over a period of three to six months. Of course, this takes time, observation and regular appointments – rather scarce features at the best of times, let alone during a pandemic.
Ask: We are constantly being told that more men die from prostate cancer than women from breast cancer, so why doesn’t the NHS routinely monitor this?
Nigel Beaumont, by email.
A: There are nearly 50,000 new cases of prostate cancer each year in the UK. It will be diagnosed in one in six men, and it is responsible for more than 11,000 deaths each year. With such statistics, it seems sensible to screen all men of a certain age. After all, we are often told that early treatment saves lives.
However, introducing prostate cancer screening is far from easy. The prostate-specific antigen (PSA) test is not ideal for screening, and we cannot determine whether a man has a slow-growing cancer that may never cause him problems, or an aggressive tumor that, unless treated, will be a killer.
Surgery, radiotherapy, chemotherapy, and hormone-suppressing drugs all carry the risk of side effects such as incontinence and impotence.
A European screening study that followed men for 13 years found that routine screening with the PSA test reduced the number of deaths by 21 percent. However, to save one life, 781 men had to be screened and 27 of them treated. In other words, the reduction in deaths came at the expense of significant overdiagnosis and overtreatment.
Based on that, the most sensible route is for men to be aware and see a doctor if they have urinary symptoms: increased frequency, especially at night, a feeling of incomplete emptying, poor flow or effort to empty the bladder.
Most of the time these symptoms are due to benign enlargement of the prostate, but if they persist this is a reason to be checked.
In my opinion … Colds can have its benefits
Throughout my years of working in health care, like clockwork on around the tenth day of the fall period, we begin to see children pouring through the door, their parents seeking advice on complications from recently acquired colds, ear infections, tonsillitis, or sometimes just a persistent sore throat and temperature.
Two weeks later the parents encounter similar problems, their children acting as vectors for the viruses.
Toddlers have an average of five to seven colds a year and adults two or three. This year, I expected rates to drop as a result of the measures taken since the start of the Covid pandemic.
However, I already hear from patients, colleagues and friends that there are many colds. This makes me wonder if our new protections are as effective as we hoped.
A couple I know has been protecting since March. They have very good medical reasons for this, and yet they have both contracted bad colds in one way or another.
Even the best strategies are not perfect, but there is no reason to throw the baby out with the bathwater: every effort must be made to stay socially distant, use masks properly and follow relevant advice.
And if you do catch a cold, don’t despair – scientists at Yale are investigating the idea that a pinch can boost the immune system and provide some protection against Covid-19.
I’m not suggesting you pick up a winter bug on purpose – but in such daunting times, any good news is welcome.