Question: Could you please discuss labile blood pressure? My pressure varies a great deal. It is always elevated when I get up in the morning, even though I take my aten-olol before retiring. In the morning, it can be anywhere from 150 to occasionally 190 systolic, and 80s to 90s diastolic. Once in a while, it shoots up to 200 systolic and 100-plus diastolic. Not long after, it returns to normal. I am very busy, exercise and eat a low-fat, low-salt diet. Could you recommend anything?
- J.H.G.
Answer: Normally, blood pressure rises and falls throughout the day depending on what we are doing at the time, rising with manual labor or exercise, dropping when we rest.
Some people, such as yourself, have blood pressure increases that occur even when they are resting. That is labile hypertension. The labile rises are transient.
With readings as high as yours, treatment is in order. You are taking anti-hypertension medicine now, and you seem to be doing all the other things to help - such as eating properly. Still, those morning pressure rises are much too high for my liking, even if they are only occasional events.
Some early-morning blood pressure rise occurs naturally, since most pressures have leveled off during night hours. But your degree of elevation is different. It can, in fact, be dangerous, for statistics tell us most heart attacks and strokes occur in the morning.
Your doctor might want to make changes in your medicine. Atenolol can, it is true, be prescribed for once-a-day, 24-hour control. Perhaps all you need is an increase in dosage. Or, your doctor might want to add another medicine or switch to an alternate drug exclusively. Call your doctor.
For more on hypertension, see my report on the subject. Readers can order the pamphlet by writing: Dr. Donohue - No. 4, Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (55 cents) No. 10 envelope.
Question: I have been informed that I have Dupuytren's contracture. What is this all about? I have been informed that an operation is needed to correct this. What causes it? What kind of operation are they talking about? I have it on my right hand, and it is starting on my left.
- J.V.
Answer: Dupuytren's (doo-pwee-TRANS) contracture is pretty common, especially in white men older than 65. A nodule forms next to the finger tendons that run through the palms. The nodule sends out strands of scar tissue that trap the tendon and in time draw the finger itself down toward the palm.
The ring finger is the one most often affected. The problem can occur bilaterally - in both hands simultaneously.
I cannot tell you the cause.
A surgeon can remove the entrapping scar tissue. The surgery almost always produces gratifying results. In President Reagan's last year in office, he had the operation.
For R.I.: Don't be alarmed. Almost everyone has some herpes recurrences after the initial infection. For some inexplicable reason, males have more recurrences than do females. Recurrences range from one to 10 a year.
You mention preventive medicine. If you are having more than six recurrences a year, you can consider going on acyclovir, a medicine used to suppress outbreaks. Patients on acyclovir take it daily.