Blood Pressure That Won't Budge

DEAR DR. DONOHUE: I've 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'm not looking for another. I used to weigh 235 pounds. I lost 100 pounds. I watch my salt. I have tried everything. My family has a history of high blood pressure. Can you recommend anything? -- F.

ANSWER: 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 (unrefined wheat, barley, rye and oats) 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. Brisk walking is fine.

For resistant high blood pressure, your doctor has to look for the less-common causes of it. Sleep apnea (loud snoring with pauses when there is no breathing), adrenal gland tumors, Cushing's syndrome, narrowed kidney arteries and rare tumors such as pheochromocytoma are cases in point.

Go over your medicines. 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.

More than 30 blood pressure medicines are on the market. I bet you haven't tried all 30 or combinations of them. Some brands come with two medicines in one pill, easing the burden of pill-taking. A new medicine, one completely different from all other medicines, is now available. It is Tekturna. Something must be done for your pressure.

The booklet on high blood pressure gives the story of this very common malady. To receive a copy, write: Dr. Donohue -- No. 104W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Allow four weeks for delivery.

 

From http://www.thewestsidestory.net/article/Your_Health/News/TO_YOUR_GOOD_HEALTH_By_Paul_G_Donohue_MD/19835

Merits and pitfalls of mifepristone in Cushing's syndrome

From http://www.eje.org/cgi/content/abstract/EJE-09-0098v1

European Journal of Endocrinology (2009) In press
DOI: 10.1530/EJE-09-0098
Copyright © 2009 by European Society of Endocrinology

Frederic Castinetti, Martin Fassnacht, Sarah Johanssen, Massimo Terzolo, Philippe Bouchard, Philippe Chanson, Christine DoCao, Isabelle Morange, Antonio Pico, Sophie Ouzounian, Jacques Young, Stephanie Hahner, Thierry Brue, Bruno Allolio and Bernard Conte-Devolx

F Castinetti, Department of Endocrinology, La Timone Hospital, Marseille, France
M Fassnacht, Dept. of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Josef-Schneider-Str. 2, Wuerzburg, Germany
S Johanssen, Dept. of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Josef-Schneider-Str. 2, Wuerzburg, Germany
M Terzolo, Dipartimento di Scienze Cliniche e Biologiche, Medicina Interna I, Orbassano, Italy, Orbassano, Italy
P Bouchard, Service d'Endocrinologie, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, FR-75571 Paris Cedex 12 France, Paris, France
P Chanson, Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Paris, France
C DoCao, Clinique Endocrinologique Marc Linquette, CHU, 59037 Lille-Cedex, Lille, France
I Morange, Department of Endocrinology, La Timone Hospital, Marseille, France
A Pico, Servicio de Endocrinología y Nutrición. Hospital General Universitario de Alicante, Alicante, Spain, Alicante, Spain
S Ouzounian, Service d'Endocrinologie, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, FR-75571 Paris Cedex 12 France, Paris, France
J Young, Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Paris, France
S Hahner, Dept. of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Josef-Schneider-Str. 2, Wuerzburg, Germany
T Brue, Department of Endocrinology, La Timone Hospital, Marseille, France
B Allolio, Dept. of Medicine I, Endocrine and Diabetes Unit, University Hospital, University of Würzburg, Josef-Schneider-Str. 2, Wuerzburg, Germany
B Conte-Devolx, Department of Endocrinology, La Timone Hospital, Marseille, France

Correspondence: Frederic Castinetti, Email: CastiFred1@free.fr

Objective: Mifepristone is the only available glucocorticoid receptor antagonist. Only few adult patients with hypercortisolism were treated to date by this drug. Our objective was to determine effectiveness and tolerability of mifepristone in Cushing's syndrome.

Design: Retrospective study of patients treated in seven European centers.

Methods: Twenty patients with malignant (n=15, 12 with adrenocortical carcinoma, 3 with ectopic ACTH secretion) or benign (n=5, 4 with Cushing's disease, 1 with bilateral adrenal hyperplasia) Cushing's syndrome (CS) were treated with mifepristone. Mifepristone was initiated with a median starting dose of 400 mg/day [200-1000]. Median treatment duration was 2 months [0.25-21] for malignant CS, and 6 months [0.5-24] for benign CS. Clinical (signs of hypercortisolism, blood pressure, signs of adrenal insufficiency) and biochemical parameters (serum potassium and glucose) were evaluated.

Results: Treatment was stopped in 1 patient after 1 week due to severe uncontrolled hypokalemia. Improvement of clinical signs was observed in 11/15 patients with malignant CS (73%), and 4/5 patients with benign CS (80%). Psychiatric symptoms improved in 4/5 patients within the first week. Blood glucose levels improved in 4/7 patients. Signs of adrenal insufficiency were observed in 3/20 patients. Moderate to severe hypokalemia was observed in 11/20 patients and increased blood pressure levels in 3/20 patients.

Conclusion: Mifepristone is a rapidly effective treatment of hypercortisolism, but requires close monitoring of potentially severe hypokalemia, hypertension and clinical signs of adrenal insufficiency. Mifepristone provides a valuable treatment option in patients with severe CS when surgery is unsuccessful or impossible.

Pressure Cooker

I am feeling pressure from so many sides, people want me to do this for them, husband wants me to do that for him, house needs everything done.

Now a website that deals out "seals of approval" that I had on my site wants me to jump through hoops. I have long had their seal on my Cushing's site. Over the weekend they complained that they couldn't find the "contact us" form, that they didn't believe I had updated many pages in one day, that some of the medical links were out of date.

I wrote back, explained how I was updating the whole site from HTML to css and trying to do as many pages as I could per day. I sent them the link and told them that it was on the menu on ever page TWICE.

They thought that the contact form seemed to be "beta" Huh? It works, it's been up for years. They wanted a date when the update would be complete. Since I've been doing that since last August, I have no idea when I'll be done. And I can't go test every %#$& link in every article on the thousands of pages of website.

So, I said I was removing their seal. Enough. I cannot deal with this stuff anymore. I have enough pressure in my life, everywhere. I don't need more from other websites!