Dear dr Roach: I’m trying to find the best high blood pressure drug with the least side effects for a Hispanic male, 77 years old, with swollen ankles at the end of the day and readings of 160/76 with a pulse of 64.
Of all the drugs in the market for treating high blood pressure, which one is the best with the least side effects? Some reputable health magazines mentioned telmisartan. Is that true? — NV
Answer: There’s no single answer to your question. It depends on the person and their other medical conditions. Even then, there is often some trial and error. For most people who find that non-medication therapy has been inadequate to control blood pressure, we seek a regimen that gets the blood pressure down to the goal with minimal or no side effects.
Hispanics are a very large group of people, often with dramatically different backgrounds. It’s not surprising that there is not data to guide therapy and I am unaware of any medication that’s better or worse for Hispanics
Your blood pressure is elevated only on the top number, the systolic number. This is common in older people. There are three classes of drugs that are recommended in this situation as first-line treatment: thiazide-type diuretics, calcium blockers and an ACE inhibitor or ARB.
Thiazide diuretics, like HCTZ or chlorthalidone, are very old and inexpensive treatments that have been proven to reduce the risk of stroke in older people with elevated systolic pressure. Unfortunately, they often have only a modest reduction in blood pressure, and your systolic pressure is at least 20 points higher than is ideal, so a thiazide alone is unlikely to be effective enough.
Calcium blockers are much more potent agents, but the most commonly used ones, like amlodipine (Norvasc), often cause or worsen ankle swelling. This can be treated by supporting stockings.
ACE inhibitors (like lisinopril) and ARBs (like telmisartan) generally have very few side effects. ACE inhibitors cause cough occasionally; ARBs almost never do. They are reasonably potent and also have been proven to protect the heart and kidneys in people at risk.
Often, in terms of blood pressure reduction and freedom from side effects, a combination of drugs is better than the highest possible dose of just one.
The best data show that it’s getting the blood pressure under control, not the choice of the agents, that best correlates with effectiveness. Choosing a medicine that is effective with no or almost no side effects is the goal. The choice varies by person.
Dear dr Roach: What is alopecia? — p.
Answer: The word “alopecia” means “hair loss,” and there are several different patterns. The word itself borrows from an animal disease. It’s from the Greek, meaning “fox mange,” a parasitic disease causing hair loss. (Many animals get mange.)
When people say alopecia, they are often referring to alopecia areata, a common type of non-scarring hair loss. It occurs in discrete round patches, usually on the scalp, but can occur in any hair-bearing areas and in different patterns. Nails may also be affected. Thyroid disease is commonly associated with alopecia areata, but it is generally considered an autoimmune disease.
A severe form of alopecia areata is alopecia totalis, which is total loss of scalp hair. Another is alopecia universalis, which is loss of all hair on the body, including eyebrows and eyelashes.
There are many other forms of alopecia, some of which damage and scar the hair follicles. These should be treated by an expert. Dermatologists specialize in diagnosis and management of hair loss.
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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 send mail to 628 Virginia Dr., Orlando, FL 32803.
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