Dr. Roach: Would significant weight loss change need for HBP meds?

Keith Roach
To Your Health

Dear Dr. Roach: A friend was diagnosed with high blood pressure several years ago and has been on a hypertensive drug since then. However, over the past years, he has lost over 50 pounds and is no longer overweight. He works out every day. He never exercised prior to his diagnosis. He seems to be eating healthier foods now, too. Shouldn’t he be re-evaluated regarding the need to continue taking his drug? And what is the procedure to see if he needs to continue with the drug?

— R.I.

Dear R.I.: High blood pressure is usually a condition people have for lifetime; however, even when it requires medication, it can sometimes be successfully treated with lifestyle interventions. This is particularly true when a person has a lot of work to do to get to a healthier place.

Losing weight has a variable effect on blood pressure, and occasionally has a profound effect — this is true also of the effect of weight loss on diabetes. A healthier diet, especially salt reduction, can lower blood pressure. Regular exercise and stress reduction techniques can have an added benefit.

Dr. Keith Roach

His doctor should be measuring his blood pressure at every visit. If the blood pressure is getting lower than his goal, the doctor should reduce the dose or even take it away completely. However, there are some times when his doctor might want to keep the blood pressure medicine going, such as when the medicine has two beneficial effects (say, beta blockers that work for high blood pressure and migraine, or an ACE inhibitor for a person with diabetes and high blood pressure).

My experience is that a few people really hate taking medicines, even after years, while others just get in the habit and stop thinking about it. If your friend really wants to stop the medicine then he can talk to the doctor about a trial of lower dose or stopping the medicine.

Dear Dr. Roach: Can a weakness toward alcoholism be inherited and run through a family for generations? Or is each person a separate case, and subject to his own behavior and health career?

— N.M.G.

Dear N.M.G.: A family propensity to alcohol use disorder has long been known. Both environmental effects and genetic predispositions have been identified. One study on twins estimated that just over half the increased liability to alcohol use disorder is due to genetics. However, it is important to know that there isn’t an “alcoholism gene” and that, as you say, a person’s own unique situation has a major impact on whether they will develop a problem with alcohol consumption.

There is no certainty about who will have the predisposition to develop problems with alcohol, but a person with a family history needs to be more careful than others to recognize when they are beginning to develop problem behaviors. Many people with problem drinking do not recognize it, and may resent attempts by family members to help.

Many young people meet criteria for problem drinking, but that behavior often ceases. If a person continues to problem drink after age 25 or so, especially binge drinking (more than four drinks at a time for a woman, five at a time for men), then they are at significant risk for having problems throughout life and should consider getting help. This may be some counseling from your family physician, a mutual help group such as Alcoholics Anonymous, referral to a mental health professional or addiction specialist, and in some cases medication.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.