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Which BP Reading Is Right?

Dear Dr. Roach: I am a 70-year-old man with high blood pressure. I take a calcium-channel blocker and a diuretic to control it. I am concerned about systolic readings that can vary 10-12 points when I take my blood pressure five-10 minutes apart. A recent example: readings of 132, 143, 140 and 133, taken five to six minutes apart. My diastolic readings don’t vary more than a point or two in the mid-70s. Should I be concerned about these variations in systolic pressure? — J.S.

Answer: Having a patient who gets multiple values, thinks about what it means and cares enough to ask is a real pleasure for a physician.

This degree in blood pressure variation is well within the expected norm. Your systolic pressure (the top number, and the peak blood pressure while the heart is expelling blood from the left ventricle into the aorta) is about 136, plus or minus seven points. Having multiple readings increases the precision of the measurement and allows your physician to make better decisions about the effectiveness of your treatment regimen. Your systolic number, however, is in the range of prehypertension, so your doctor will be keeping an eye on that.

During the course of the day, systolic blood pressure readings can vary as much as 30 points. Even in the few minutes you took these, I often see variation as much or more than this.

Dear Dr. Roach: What are the methods for diagnosis and treatment of an Achilles’ tendon tear? — L.N.

Answer: The Achilles’ tendon connects the calf muscles, soleus and gastrocnemius, to the heel bone, the calcaneus. A complete rupture usually happens with a sudden, forceful contraction of the calf muscles, such as jumping, often in sports. The diagnosis usually is made by physical exam. It’s not always as obvious as it might seem: Some people with a complete rupture can still walk, and some people have no pain. Still, an experienced examiner should be able to diagnose a complete tear. An ultrasound or MRI is sometimes used to evaluate a partial tear or look for similar conditions, such as bursitis or tendinopathy.

Complete tear can be managed surgically or with physical therapy and rehabilitation. A surgeon should always be consulted. Partial tears are usually treated conservatively, with PT and rehab. Surgery on the Achilles’ tendon typically requires two to three months off of work.

Dear Dr. Roach: My wife was diagnosed with multiple sclerosis about 16 years ago. The disease has taken a primary progressive course, and she is now wheelchair bound. Several years ago, she was put on cholesterol-lowering medicine for elevated cholesterol and had good results. I have read about the importance of cholesterol to nerves and nerve impulses, and am worried that her cholesterol is now too low (122 mg/dL, 3.15mol/L). Could this worsen the MS? — B.F.

Answer: I have read arguments that low cholesterol both improves and worsens MS. I researched the evidence, and my opinion is that there is more to support the position that lowering the cholesterol tends to help prevent progression of MS. I wouldn’t recommend taking cholesterol medication just to help with MS, but I certainly wouldn’t stop the cholesterol-lowering medication for fear of making MS worse.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 3285 3-6475.