High blood pressure with only the second number high


DEAR DR. DONOHUE: I haven’t found out why the second number of my blood pressure is consistently high. It’s around 90 to 100 or more. I am a reasonably healthy 59-year-old woman. Would blood pressure pills work for me? Any advice? — K.K.

ANSWER: You have what’s called isolated diastolic hypertension, a high second number of the blood pressure reading. The first number, systolic pressure, is the force imparted to the blood by the contracting heart. The second number is diastolic pressure, the pressure in the circulation between heartbeats. Normal blood pressure is a reading less than 120/80. Prehypertension is 120-139/80-89. Hypertension, high blood pressure, is 140 and above/90 and above. High blood pressure is an elevation of both numbers or only one of the numbers, either systolic or diastolic pressure.

Isolated diastolic hypertension is somewhat rare. What to do when only the diastolic pressure is high is a conundrum. One large study of isolated diastolic hypertension showed that it progressed to elevation of both numbers within six years in a significant percentage of patients. Other studies, however, have not demonstrated increased mortality when only the diastolic pressure is high.

You can attempt to lower your reading by limiting your sodium (salt) intake to 1,500 mg a day, losing weight and faithfully exercising daily. Brisk walking counts as exercise. If your doctor detects any damage to body organs, like your kidneys, heart or eyes, then treatment with medicine is indicated. Your kidneys’ health is gauged by not finding protein in the urine. Your heart’s health can be demonstrated with an EKG. The doctor examines your eyes with a lighted instrument to see the health of blood vessels there. A thyroid blood test demonstrates whether that gland is raising your pressure. For diastolic high blood pressure, most often only a single drug is needed for control.

The booklet on high blood pressure discusses the more common causes of this prevalent disorder. Readers can obtain a copy by writing: Dr. Donohue — No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What is your opinion of the recently developed stool DNA test for colon cancer? It’s not an invasive test, and there’s no need to purge your colon before the sample is collected. — A.W.


ANSWER: Colon cancer cells shed their DNA into feces. So do normal cells. The currently available test cannot detect all the genetic changes that occur when cancer strikes, so the results are not 100 percent accurate. In the first week of this February, a refined DNA test was described that is quite a bit more sensitive for picking up cancer changes.

This test will be a great value in the detection of colon cancer. Time will tell how valuable it will be. I don’t think it will supplant colonoscopy entirely. But it may be of value in determining when a colonoscopy is needed.

DEAR DR. DONOHUE: I am a 64-year-old woman who hopped over a puddle of water to avoid it and heard a popping sound in my knee. It has not been very painful to walk, but the knee has been tender, sore and stiff. It does hurt a bit when I bend it. My knee area is enlarged. It’s been four weeks since I hurt it. There has been no improvement. I haven’t gone to a doctor because our health insurance has a high deductible. Can I treat this on my own without risking permanent damage? How long can I safely take Advil every day? — B.S.

ANSWER: From this distance, I can’t give you a diagnosis. You need an evaluation by the family doctor or an orthopedic surgeon. Either doctor can tell you if it’s safe for you to delay treatment. That initial visit will not be so expensive. The directions on the Advil bottle tell users not to take it longer than 10 days unless a doctor has advised otherwise.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.