Doc: Volatile blood pressure tricky to control
Dear Dr. Roach: In the past few years, I’ve been experiencing “volatile blood pressure.” It will go from 71/38 to 280/90 in half an hour. It happens in all situations. I could be knitting and do a check, and it will be 200/68. The emergency and ambulance teams know me very well. I have had 24-hour urine tests and lots of blood work.
Most of the time it is low, so how can I raise it up?
I was on 25 milligrams of Cozaar (losartan), but it caused a real dive. Do you have any advice on how to control this?
Dear P.D.: Volatile, or labile, blood pressure can have several causes. Although it is rare, a pheochromocytoma must be considered. It is a tumor that can intermittently secrete substances, like epinephrine, that raise the blood pressure. I am pretty sure the 24-hour urine test was to look for this.
Blockages in the arteries to the kidneys sometimes cause spikes of blood pressure, as can some other uncommon causes.
If your doctor is convinced that there is no identifiable medical condition causing these high pressures, he or she may wish to give you treatment you can take at home when the pressure is very high, rather than sending you to the emergency room each time.
There are several blood pressure regimens that are recommended for labile blood pressure, but all of them are limited by blood pressure getting too low.
In many people, despite no apparent symptoms of anxiety or depression, adding an antidepressant sometimes can eliminate the blood pressure spikes and improve your quality of life.
It’s thought that there may be emotional issues that people are not consciously aware of. It may be worth a short trial (a few weeks) to see if this type of treatment can help stabilize the blood pressure.
Dear Dr. Roach: You recently wrote about a surgically placed implant for erectile dysfunction. What is it that gets implanted? And where is it implanted? Thanks for your attention to my ignorance.
Dear K.V.N.: Implants are reserved for men who have not had results from oral medications, and those who cannot use or who have failed injections and vacuum devices. An appropriate medical evaluation is appropriate for all men with erectile dysfunction.
There are several different types of implants, but the most commonly used is a three-component implant, which consists of two plastic inflatable cylinder prostheses placed surgically in the penis, with a fluid reservoir placed in the abdomen, and a small manual pump in the scrotum.
The implants are then inflated by the pump moving the fluid from the reservoir into the cylinders. All the components are internal.
With newer devices and surgical techniques, complication rates are lower (but still not zero), and patient satisfaction rates are well over 90 percent.
Email questions to ToYourGoodHealth@med.cornell.edu.