DEAR DR. DONOHUE: Hypertension runs in our family. My son is 36 years old and not overweight. He came to visit, and I took his blood pressure. It was 188/123. He had medication but no longer takes it. I believe it is because he is a newlywed, and the medication was causing impotence. He won’t discuss it. He is trying to watch his salt intake and eat healthier food, but I know this is not enough. Is there any help for him? – V.W.

ANSWER: Your son’s blood pressure requires urgent treatment because of its magnitude and because of his young age. He must get the pressure controlled quickly or he will suffer changes in his arteries that lead to a heart attack, stroke and kidney damage – perhaps not all three, but one of them is more than enough to create huge problems.

High blood pressure does run in families, but as yet no one has isolated a single gene responsible for it. Most high blood pressure comes from a mix of environmental factors and a genetic propensity.

A few hypertensives have a correctable abnormality that, if remedied, eliminates the high pressure completely. Examples of such conditions are narrowed kidney arteries and tumors of the adrenal gland. Although such disorders are rarely seen, they should be considered in a man as young as your son, even with his family history of high blood pressure.

Yes, there is help for your son. Salt restriction, important as it is, is not the sole answer for him. He needs medicine. Some blood pressure medicines can affect erectile function. But the cupboard is filled with many medicines, and there will be more than one that can control his pressure without the side effect of erectile dysfunction. He has to see his doctor and soon, or he is going to incur permanent organ damage.

High blood pressure is one of the world’s leading medical problems. The hypertension pamphlet outlines the mechanisms that lead to it and their treatment. Readers can order a copy by writing: Dr. Donohue – No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: When I was 16, one of my ovaries was removed. My uterus works very well. Menstrual periods are normal. Now I am 31. I have a boy who is 7. My husband and I both want one more child. Do I still have a chance to have one? – Z.S.

ANSWER: Yes, you have a good chance of having another baby. Your remaining ovary works fine. Your normal menstrual periods are proof of that. Furthermore, at age 24, eight years after your ovary was removed, you had a healthy baby. There is not a lot of study on the fertility of women who have only one ovary, but there is enough to say that such women can and do get pregnant without much difficulty.

DEAR DR. DONOHUE: My wife was 68 when she had a ruptured brain aneurysm. She was in the hospital for 41 days. I took her home and cared for her. Eleven weeks after discharge from the hospital, she had bedsores that wouldn’t heal. Suddenly her body temperature dropped, and she felt very cold to the touch. She was rushed to the hospital, where she died 10 hours later.

The death certificate stated: sepsis, hypothermia, cerebrovascular accident.

What are those? – C.K.

ANSWER: “Sepsis” means that the blood has been invaded by bacteria. Such blood infections can cause a drop in blood pressure and a drop in body temperature. Hypothermia is a low body temperature. In your wife’s case, the bacteria most likely entered her blood through her bedsores. She had septic shock, which is often lethal.

A cerebrovascular (brain blood vessel) accident is a stroke. Your wife’s stroke came from the rupture of an aneurysm on one of the brain’s arteries. Aneurysms are weak spots on the artery wall. They form a fragile pouch that often breaks. The resulting bleeding is often catastrophic.

DEAR DR. DONOHUE: I am a 58-year-old woman who needs to start jogging again. You said a few months ago that physical exertion early in the morning can cause a heart attack because the blood is thick then. I have to jog early, but I don’t want to fall down dead. What can I do? – S.S.

ANSWER: I don’t want you to fall down dead, either, but it is true. More heart attacks occur in the morning than at any other time of the day. In the morning, there is often a surge in blood pressure, and that puts a burden on the heart. In addition, blood platelets stick to each other with greater avidity in the morning, and, when they do, clots can form within arteries – another reason for morning heart attacks. (The sticky platelets were the reason I said blood is thicker in the a.m.) Furthermore the body’s natural clot-busting apparatus is sluggish in the morning.

Plaque – the mound of cholesterol, fats, platelets and protein clinging to the artery wall – is at its most fragile state in the morning. The stress of exercise can rupture plaque. Pieces break off the mound and drift to smaller heart arteries where they occlude blood flow – another reason for morning heart attacks.

All this needs to be put into perspective.

The number of heart attacks that occur each year during exercise is about one for every 15,000 exercising individuals. The majority happen in the morning. So should everyone forgo morning exercise? No. If you have been seeing a doctor and if the doctor has declared you heart-healthy, then you can exercise any time of day you find convenient.

If middle-aged people don’t know the status of their hearts’ health, they should find it out before they begin an exercise program, and, in particular, they should not exercise in the early morning hours until they have been examined.

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.

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