Friday, June 19, 2009

Cushing's: Nothing gets her blood pressure down

Dear Dr. Donohue: I have had severe high blood pressure for many years. I have tried all the medicines you can think of. I am 62 and have had one ministroke. I used to weigh 235 pounds. I lost 100 pounds. I watch my salt. I have tried everything. Can you recommend anything?



Dear F.: Blood pressure that doesn't drop by making life changes (weight loss and diet) or by taking three or four blood pressure medicines is called resistant high blood pressure (hypertension). Your weight loss is admirable. It should have reduced your pressure. Watching your salt intake is also important. That entails more than not using the salt shaker. It requires you to carefully look for the salt content (listed as sodium or sodium chloride) of all your foods. Commercial soups, frozen dinners, many canned goods and luncheon meats often have a high salt content. Your diet should be one of fruits, vegetables, whole grains and one where meat and fats are eaten sparingly. Increase foods with lots of potassium in them: tomatoes, potatoes, prunes, lima beans, kidney beans, navy beans, bananas, oranges and orange juice, spinach, peaches, cantaloupe and broccoli. Potassium lowers blood pressure.

Exercise for 30 minutes every day. Get your doctor's approval first, and start out modestly.

For resistant high blood pressure, your doctor has to look for the less-common causes of it. Sleep apnea, adrenal gland tumors, Cushing's syndrome, narrowed kidney arteries and rare tumors such as pheochromocytoma are cases in point.

Some medicines raise pressure. Nonsteroidal anti-inflammatory drugs are an example -- Aleve, Advil, Motrin, aspirin and other NSAIDs. Don't drink more than two alcohol drinks a day.

A new medicine, one completely different from all other medicines, is now available. It is Tekturna. Something must be done for your pressure.