Dear Dr. Donohue: I would like to know more about orthostatic hypotension. I am a 67-year-old man and have problems with my balance, especially on standing. My cardiologist tested my blood pressure while sitting and then while standing. As a result, he took me off two medicines.
There have been no substantial changes in my balance since the change in medicines. The systolic pressure drops as many as 20 points when I stand, and the diastolic goes up a bit.
T.W.
Orthostatic hypotension is a drop in blood pressure when one stands up from the sitting or lying position. It's a common malady of older people. At younger ages, when we change positions, reflexes kick in to maintain blood pressure. When those reflexes no longer work, a change of position causes pooling of blood in the legs. Blood pressure drops. The brain doesn't get its supply of blood. The person feels unbalanced and on the verge of passing out. A 20point drop in systolic blood pressure - the first number of a blood pressure reading - meets the criterion for orthostatic hypotension. If the second number, the diastolic pressure, drops 10 points, that, too, indicates orthostatic hypotension. Both numbers do not have to fall; one or the other is enough.
Go over your medicines with the doctor again to see if any of them is contributing to this. If your balance is poor on rising out of bed, sleep with 10-centimetre blocks under the posts at the head of the bed. That position will help you maintain your blood pressure.
If the blood-pressure drop occurs after rising from a chair, drinking two 230 ml glasses of cool water somewhat quickly prevents the drop. The effect lasts for two hours. You can go shopping during that time period without fear of losing balance. Contracting the leg muscles before, during and after you rise from a chair also keeps blood pressure up. Compression stockings work, too.
Should none of the above work, speak to your doctor about medicines. Pyridostigmine is often prescribed for this condition.
Dear Dr. Donohue: I am a 58-year-old woman. I am five feet, two inches tall and weigh 105 pounds. I exercise regularly and eat a very healthy diet. My total cholesterol is 287 mg/dL (7.4 mmol/L). My HDL is 99 (2.6); my LDL is 177 (4.6), and my ratio of total cholesterol to HDL is 2.9. Would you recommend medication?
P.E.
If you hadn't said that your diet is healthy and you exercise regularly, I would have said try both before resorting to medicines.
Your total cholesterol is too high (it should be less than 200 (5.18), and your LDL cholesterol is also too high. It's the cholesterol that clings to artery walls and obstructs blood flow. It should be 70 (1.8) for those who have had a heart attack, and values between 100 to 129 (2.6 to 3.3) are near optimal.
The high value of HDL cholesterol isn't considered as big a protection as it once was thought to be. Nor is the ratio of total cholesterol to HDL. I would put you on cholesterol-lowering medicines.
