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Dear Dr. Roach: I am wondering if there is a safer inhaler to use in place of an albuterol inhaler. I have high blood pressure that, at times, is very difficult to control. I have not yet tried the albuterol inhaler. I was prepared to, but stopped before doing so after reading the side effects and potential dangers to the heart for someone with high blood pressure.

Anon.

Dear Anon.: Asthma is a condition of reversible airway obstruction. It has many triggers, such as smoke or other airborne irritants. Exercise, infection, cold air and emotional stress also can trigger an asthma attack, and in some people, attacks can happen for no clear reason.

Once an attack occurs, treatment with a fast-acting inhaler like albuterol provides relief for most people, and it can even be lifesaving in people with very severe asthma. I recommend that all people with asthma have a fast-acting inhaler just in case. People with frequent symptoms should carry it with them, as well as keep one in their home/work/car as appropriate. During an attack, the benefit outweighs the negligible risk to the heart.

However, it’s not optimal to take medicines like albuterol all the time. They do raise the heart rate, causing palpitations and tremor. Albuterol usually does not raise blood pressure significantly.

People who use a lot of albuterol or similar inhalers are more likely to be hospitalized for asthma than those who don’t. To some extent, this is due to having more severe illness.

Inhaled steroids are another type of inhaler for asthma. They prevent attacks, instead of treating them, and they are useless for people who are having an acute attack. However, people who use more inhaled steroids are less likely to be hospitalized than those who don’t.

People who need albuterol should take it. People who need to take albuterol frequently should be on a better control medication, such as inhaled steroids, so that they need albuterol less often.

Dear Dr. Roach: I have high blood pressure, and I take 10 mg of lisinopril. I had a transthoracic echocardiogram done, and “mild concentric left ventricular hypertrophy” was listed on the results. What does that mean?

D.K.

Dear D.K.: The left ventricle is the heart chamber that squeezes blood to the body (rather than to the lungs, which the right ventricle does). “Hypertrophy” means the muscle of the ventricle is thicker than normal. “Concentric hypertrophy” means the thickening is symmetric, and that is most commonly seen in people with high blood pressure, especially if it wasn’t caught early or wasn’t treated well for some period of time.

Lisinopril is generally a good treatment for most people with concentric LVH, but some people need additional treatment. Many physicians, including myself, try to get the blood pressure down into the 120/80 range in people with LVH, as long as they can tolerate the medication.

Email questions to ToYourGoodHealth@med.cornell.edu.

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