High blood pressure !

Totally agree with JA.

As I mentioned previously BP is dynamic. Managing Essential hypertension can be challenging at times depending on other co-morbidities.

David, did your doctor set a target BP for you. Your current BP seems to be very acceptable. As we get older our arteries get "stiffer" and less compliance thereby increasing vascular resistance and increasing our BP. They have given you Amlodipine which is a non selective calcium channel blocker which acts on the calcium channels to reduce BP and arterial resistance (muscle membrane have Calcium channels). Arteries have a thick muscle layers to control vascular compliance, this constricts or dilates and as a result generates resistance or reduce resistance thereby increasing or reducing BP. Think of it as a Hydraulic system if I may site an engineering example.This is just one system that our body adjust BP. Our nervous system also plays a role as well as our kidneys and fluid balance. ACEi acts on the RAAS system (renin-angiotensin system), Betablocker acts on negative chronothropic effect on the heart, Mineralocorticoid antagonist acts on the fluids and also mineralocorticoids, Diuretics acts on the preload to the heart (fluids exchange/absorption in the kidneys), alpha channel blockers etc. Its a dynamic system and very complicated. In clinical practice you have a target BP and aim for that range. Identify the cause of hypertension,lifestyle modification and managed other co-morbidities. Most common cause of hypertension in the general population is Essential hypertension. In my practice, especially our ageing population my main worry is polypharmacy and very tight BP control that elderly patient run the risk of hypotension and causing them to fall as a result of strict BP control. This can suppress autonomic nervous system control and hypo perfusion especially brain hypo perfusion and orthostatic hypotension. My aim for target BP for the elderly will be around 140-155 systolic. Again it would be wise to get an ambulatory 24 hour BP monitoring for they can map out your BP.

Raphael

Hi Peter,

Normally we start high dose statin (in your case 80 mg of Atorvastatin) in cases of acute myocardial infarction as a higher dose (80mg) due to the pleiotropic effect of statins IE arterial plaque stabilisation, improve endothelial dysfunction and anti-inflammatory response (yes a heart attack is an inflammatory process). After which we reduce it to 40 mg as a maintenance for secondary prevention.

Folic acid is given if you have low folate. Some medication have anti folate activity such as methotrexate. One other cause of low folate is low dietary intake of folate rich food.

Raphael

Drinking coffee at work, the coffee machine was the type that dumped coffee powder and then milk powder. Never thought that the milk powder would be a problem as at home I used milk. I started to get pains in the stomach at work after the coffee so checked the milk powder source, it was the same stuff they make glue out of! I cut out the powdered milk and just drank it black and within a short time my tummy was fine.

Re milk, do you use skimmed milk? I did not like skimmed milk and preffered full fat milk and that is what I use now, dietry recommendations is 20 grms. of fat a day as i cannot stand animal fat so all my meat is fat free. I prefer fish/chicken to red meat.

Amlodipine, some years back I went for an asthma check and was asked to demonstarte how I used them, I had already that morning taken the usual two puffs of both. This bothered me as I knew it would double my intake. I did as asked and she seemed pleased but then wanted to take my blood pressure which of course was up quite a bit as the Ventolin and Formoteral increase the pulse rate. Panic, you have to see a Dr. now which resulted in me being given Amlodipne. Net result was that in three days I had a massive allergic reaction to it, breaking out in hives and red rash, itchy back and dizziness. Dumped that lot and never went back to it.

At that juncture she said I could take 12 puffs of Formoteral a day but I corrected her and she pulled out the Pharma copia and was stunned when she found I was right. I could only wonder what would happen if i took 12 puffs of Formoteral a day. I then refused any further medical visits to them.

Further to this I was at that time also visiting the Chest Clinic about every 3 months and I found if i took an anti allergy pill (over the counter sales) it reduced all my asthma symptoms and I mentioned this on a visit to the clinic and was told I need not come back anymore. So to this day I have allergies but it is not always apparent what the source is, I wash clothes in Non bio stuff, soap, I use pure soap. One item, Flucloxacillin brought me out in red rash and hives, a check shows that over 50% of Flucloxacillin users are allergic to it. I have no trouble with bee stings but Wasp stings feel like the Flu.

I had angina at 40 nearly 20 years ago even though I humped 10+ miles over a couple of munros every Sunday

When it hit me I was just like my grandad in his 60s, grab that left arm and grimace

It was work stress, I jacked my job for a different one and was angina free within 7 days, never used any medicines, never looked back since

Got a wee minor twinge again about 12months ago when the double glazing was getting put in, lifestyle/stress has a big impact on the old tickeroo

Go mine at the phramacy, it was half price because of changing stock or something

My doctor's told me to bring mine in and checked it side by side with their 'professional' ones, and told me it was spot on.

Last checkup... the nurse was using one that appeared to be the same make as mine!

Raphael,

Thanks for that.

I think, but can't confirm it, my cholesterol was in the region of 2.3 or 2.4. After the statin reduction to 40mg from 80mg, it went up to about 3 which was thought satisfactory. Prior to the heart attack, it was around 5 or more.

I confirm that before going on the folic acid, I was advised to eat more dark green food, eg broccoli. But obviously, this wasn't enough.

Peter G. Shaw