89 yoF, HTN, arrhythmia

89 yoF, HTN, arrhythmia
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loreendawson
Message 1 of 5 , Feb 14 7:34 PM
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I have an 89yoF patient who has had HTN for many years but has refused all treatment. to date.  BP in office was 206/96 first visit and 210/96 second visit.  I have talked her into trying some meds but am not sure what to start with.  She is reluctant, and will stop if there are side effects.  Kidney function is low normal.  Cholesterol very mildly elevated.  Glucose normal.  All other health factors normal.  She is mentally functioning well. Vegetarian since childhood.  Smokes 4 cigarettes per day.  Very light physical activity.  Recent EKG showed evidence of old infarct, right bundle branch block, premature atrial and ventricular contractions.

Would an ACE inhibitor be the place to start, or a calcium channel blocker?  I recognize she may likely need multiple meds eventually, but would like to get her started on something.

Thanks
Loreen Dawson, ND
Sechelt, BC



Dr. Greg Nigh
Message 2 of 5 , Feb 14 8:09 PM
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I recommend you start with taurine, dosed at 1g BID. Have her do that for 5 days. Assuming no negative effects (mostly watch for brain fog/cognition issues, but they are rare), increase to 2g BID. Again, if she tolerates it for 5 days, then go to the max dose of 3g BID.

Taurine is an overlooked and very interesting substance. Its effects range from reducing sympathetic activation, to water balance regulation, to regulation of heart rate, to fat digestion and absorption (via bile production). Six grams daily has been shown to lower HTN, so that's the dose I use for all these things, and it has been life-changing in a few cases.

Greg



Emily Kane
Message 3 of 5 , Feb 14 8:23 PM
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Diastolic is not hideous for her age. Systolic HTN often helped nicely by stress management and Adrenal support.
Emily Kane ND
Juneau AK



Daniel H. Chong
Message 4 of 5 , Feb 14 10:32 PM
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Hi,
I actually would be quite concerned with the diastolic that low relative to systolic. A wide pulse pressure is likely sign of significantly advanced arteriosclerosis (vs atherosclerosis though obviously that can be present too) with arteries being so stiff they cause systolic blood pressure to rise, but simultaneously cause diastolic pressure to fall (or not rise nearly as significantly) because their capacity to recoil during diastole has become compromised.  This situation can become particularly concerning when blood pressure meds need to be dosed relatively high to adequately lower a systolic pressure that high, but then end up lowering diastolic pressure potentially too low.  Recalling that the heart muscle itself receives its blood supply during diastole, this can become very serious and potentially deadly over time, even if systolic pressure is adequately treated.

Ideally in such situations (actually all situations) the health of the artery itself should be treated to simultaneously reduce stiffness and improve recoil/endothelial function.  Interestingly, deficiencies in some foods and nutrients known to improve endothelial function and blood pressure have also been shown to be correlated with widening pulse pressures.

https://www.ncbi.nlm.nih.gov/pubmed/25852865
https://www.ncbi.nlm.nih.gov/pubmed/16002796
https://www.ncbi.nlm.nih.gov/pubmed/25320896
https://www.scribd.com/document/331702715/Jurnal-the-Role-of-Intravenous-N-Acetylcysteine-Reduces-Pulse-Pressure

The sodium to potassium ratio in her diet may also be crucial for this particular issue:
https://www.ncbi.nlm.nih.gov/pubmed/19462490

You are in a tough spot because that systolic is obviously very high and dangerous in its own right, but the above issue can be a major problem.

Aside from above info, I definitely agree with greg about taurine.

That all said, if she is still that mentally sharp and wants to stay off meds, and assuming she ain't gonna quit smoking, perhaps the most powerful thing you might be able to convince her to do would be to read or listen to the book The End of Heart Disease, especially chapter three, which goes into great detail about blood  pressure and how to use food to treat it.  in my opinion, getting her to follow the plan in that book would have the most potent effect of all.


Daniel Chong, ND
Portland, OR




Deborah Schokking-Phair
Message 5 of 5 , Feb 15 8:11 AM
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Hi Loreen,
ACE then ARB if she fails ACE (cough). Because of her age, target BP is higher.

Deborah Phair