DEAR DR. ROACH: I am a 62-year-old white, petite female who has suffered with hypertension since age 33. I have never been the slightest overweight, never drink alcohol and have never used drugs or smoked. I try to exercise every day. Some days, I have migraines, and I believe it is from the high blood pressure. My family has no history of HBP. I am not a diabetic.

Yesterday, at the doctor’s office, my blood pressure was 172/118 and my pulse was 109. I was shocked. I have been in intensive care several times to get it down. I can’t figure out why it has such erratic behavior. It continues to be up even on strong medications. I am currently on four medications, and yesterday my doctor added another. After a couple of years, I have had to change the medications because they seem to quit working. Are there new drugs for HBP? Is there something I’m not doing that I should or shouldn’t do? I am very fearful of a stroke or heart attack. I have had every test there is to find the cause. Nothing showed up. — M.S.

ANSWER: Most of the time, we are unable to figure out why a person has elevated blood pressure. Less than 5 percent of the time, after a careful look, we can find one of the “secondary” causes of hypertension whose treatment can reverse HBP.

The most common is called renal artery stenosis. Blockages in the arteries that bring blood to the kidneys cause the kidneys to sense low blood pressure, so the kidneys respond by increasing renin, which begins a cascade that increases the blood pressure. Another rare cause is a pheochromocytoma, a benign tumor of the adrenal gland, which I mentioned a week or two ago. It secretes epinephrine (adrenaline) and causes high blood pressure and fast heart rate. If you have had every test, your doctor would have looked for these causes, but a pheochromocytoma can be missed. I see many cases of sleep apnea causing difficult-to-control high blood pressure, and even a petite woman can have sleep apnea, even though we think of it more commonly in the overweight.

There are experts in managing high blood pressure, and this sounds like a time to consult one if you haven’t already. I can’t suggest a medicine without knowing a lot more, and that is what a hypertension specialist would do.

DEAR DR. ROACH: If I walk three miles, six days a week, do I get as much value out of taking my trike out for the same time and the same route? — M.G.

ANSWER: Bicycles are more efficient than walking, so you will burn less calories biking the same distance on a bike than walking. I don’t know about trikes — I suspect they would give about the same benefit as biking. I recommend doing both — walk one day, trike another.

READERS: The booklet on urinary tract infections provides a summary of typical signs and symptoms of UTI and the appropriate treatment. Readers can order a copy by writing: Dr. Roach — No. 1204, 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.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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