Questions on Blood Pressures & Heartburn

Dear Dr. Spence,
My blood pressures have consistently been 160/100. Should I panic?
Signed,
Headache

Dear Headache,
Great question, hypertension is the bread and butter of office practices, but an issue that is grossly undertreated. Seventy five percent of patients over age 50 can be classified as hypertensive, of which only 50% are actually being treated for their disease. Interestingly, only 50% of treated patients are at goal pressure levels! In my opinion, blood pressure is the single most important modifiable risk factor in medicine. Maintaining good blood pressure helps prevent stroke, heart attack, heart failure, kidney failure and a host of other ailments. For every 20 points above a systolic blood pressure of 115 (the top number), mortality increases two-fold. Based on your readings, you are at a four-fold risk. Guidelines recommend blood pressures less than 140/90 as a rule – I tend to be more aggressive and push for 120-130/60-80. Given the incredible number of blood pressures medications on the market, many of which are dirt-cheap, there is no reason that adequate blood pressure control cannot be achieved. Would I panic? No. Would I suggest I get my gluteus maximus in gear and see my doctor? You bet!!

Dear Dr. Spence,
Can I take medication for my heartburn forever?
Signed,
Jolly Joe

Dear Jolly Joe,
Many patients suffer significantly from heartburn or gastroesophageal reflux disease (GERD). Short-term therapy can be used in cases of documented gastritis or peptic ulcer disease. In the case of continued reflux, many patients remain on medications for years. Only recently, several interesting associations been made with their-term use. First, in some patients (mostly debilitated elderly patients), there may be an increased risk of pneumonia with the use of medications like nexium, prevacid, etc. Secondly, there has been an association between these medications and the development of vitamin B12 deficiency. B12 deficits may result in fatigue, anemia, mental status changes and other unpleasantries. The jury is still out on long-term safety. Like most medications, one must weigh the benefits of taking the drug versus the potential risks of not.

Dear Dr. Spence,
Should I get a Pap smear? I had a hysterectomy 10 years ago.
Signed,
Fireball

Dear Fireball,
According to ACOG guidelines (American College of Gynecologists), women who have had hysterectomies no longer need Pap screening. The exception is the case of hysterectomy due to cervical or uterine cancer wherein screening is generally recommended every three years after three consecutive negative yearly Paps. The same holds true for the general population. Of note, screening is not recommended after age 65 secondary to the low likelihood of cervical cancer in these women. Most men are off the hook.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.