HEALTH MATTERS: The ABCs of blood pressure RX

• Dr. Joshua Wynne

Dr. Joshua Wynne

Talk about it

Q. I have high blood pressure and have to take three different medications to keep my pressure under control. Why do I have to take so many pills?

A. Your experience is typical, as many (and probably most) patients with hypertension have to take more than one drug to control their blood pressure. High blood pressure is a common problem, and one that increases in frequency with age. In most people, the precise cause is unknown, although when high blood pressure is found in children or young adults, a tumor in a gland or narrowing of a blood vessel may be the culprit. What is important is that high blood pressure of whatever cause needs to be treated. Since in most cases there is no identifiable cause, we need to use medication to bring the blood pressure reading down to normal. If we don’t, various complications can occur, including stroke, heart attack, or kidney or heart failure. There are four or five major classes of medications we use to treat high blood pressure, but there are dozens of different formulations of medications in each class. We typically pick a drug from one class and see how it works. If it isn’t fully effective, we’ll either increase the daily dose or add a drug from a different class of medications. Why? Because doing this maximizes the beneficial effects of the medications while limiting the side effects. As an example, one type of medication tends to increase the heart rate, while another type tends to decrease it. So by using them together, the heart rate effect of each drug balances out. Keep taking those pills, and keep that blood pressure under good control.

Q. My elderly mother has arthritis, as do many of her friends. What causes arthritis?

A. Arthritis is an inflammatory condition that affects the joints in the body. The most common type is called osteoarthritis, and is more common as we age. It is a degenerative process that affects the cartilage surrounding the joint. But there are dozens of other less common causes of arthritis, including rheumatoid arthritis, the arthritis associated with psoriasis (a skin condition), gout, and infections. A unique form may be seen in children, called juvenile rheumatoid arthritis. Osteoarthritis can cause pain and reduced mobility of the joint, and tenderness when the joint is touched. One feature that typically distinguishes osteoarthritis from many of the other types of arthritis is the lack of joint redness, warmth, and swelling from fluid in the joint. Treatment of osteoarthritis includes medication, physical therapy, and, in some cases, joint replacement. Many of the other forms of arthritis (like rheumatoid arthritis) may affect other parts of the body beyond the joints. In rheumatoid arthritis, for example, the lungs, the sack around the heart (pericardium), and the eyes may all be affected. As far as your mother, she probably has osteoarthritis related to her aging, but to be sure that she doesn’t have one of the more serious types like rheumatoid arthritis, a checkup with her health care provider would be in order.