Of all my recent health issues, my biggest concern has been whether I should keep taking blood pressure medication. Ditching the pills would be a big deal, since I've taken various hypertension meds for at least 40 years.

A week ago, I summarized my blood pressure history and concerns in a letter to a doctor regarded as a top specialist in this area. It was very detailed, and I've included it at the end of this post.

Here are the keys issues I raised:

  • The acceptable blood pressure guideline for people 60 and older was recently raised to 150/90. Some authorities now argue that anyone over 80—without cardiac problems—can stop taking the pills. Most of my readings are under 150/90 but I do have occasional spikes, many of which occur in my "off" times, when the last levodopa pill is wearing off and the next hasn't yet kicked in. But the biggest spikes are caused by nervousness, stress or anxiety. I recently described one incident that produced a reading of 240/120. Can I safely discontinue blood pressure drugs?
  • I've been dealing with high blood pressure for years. But lately, I'm also having alarming drops in blood pressure—as low as 71/47. I've learned this issue is called orthostatic hypotension, and it's associated with Parkinson's. These big drops typically happen on warm days when I'm outside, standing and active. I get dizzy and come close to fainting or falling. How do I deal with this development?
  • The serotonin booster 5-HTP has helped me avoid Parkinson's common non-motor symptoms—depression, insomnia and constipation. But taking more than the smallest dose (50mg) can produce alarming blood pressure spikes. On the other hand, I've noticed recently that taking an extra 25mg of the supplement can ease other Parkinson's symptoms, like micrographia (small, cramped handwriting) and a shuffling gait. Can I find a dosage of 5-HTP that reduces PD's symptoms without sending my blood pressure to dangerous levels?

Preliminary discussion with my blood pressure specialist

I spoke with the blood pressure doctor on the phone yesterday. Here's some of what we discussed:

Pills or no pills? He suggested I try half the normal dose of Avapro, a blood pressure med I've used with some success. I mentioned that orthostatic hypotension was listed as a possible side effect of Avapro. He said he "would not lose any sleep" if I decided to stop taking any blood pressure meds, especially since the pills increase the risk of falling for seniors.

I had just seen a New York Times report on recent Yale studies that raised that same question. Here's how the issue was posed:

The Yale findings, which were published this month in JAMA Internal Medicine, mean that blood pressure management enters one of those increasingly common medical gray zones in which individuals and caregivers have to ask a lot of questions and balance the trade-offs.

Do you avoid a heart attack by using drugs associated with an almost equal risk of breaking a hip or injuring your brain?

Dealing with Orthostatic Hypotension: My doctor suggested I might wear an abdominal binder. He's found them helpful, and they can raise blood pressure by 10 to 20 points.

Orthostatic hypotension seems to be an issue with me only when I'm active outdoors on warm days. At other times, my issue is elevated blood pressure. I asked if it would work if I just wore the binder on those occasions when I seem to be at risk. He thought that idea would be OK.

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Blood pressure and 5-HTP: He said he had no expertise on this issue. I agreed that it was more an issue to discuss with my neurologist.

So, what do I do now?

I'll see him again in two weeks. In the meantime, I'll continue doing without the meds. But I'll continue monitoring my pressure at home and recording results in my journal. We'll review the numbers and discuss strategies when we meet.

I'll do an online order on the abdominal binder later today. Maybe it will also create a "slimmer look."

I also raised the issue of our continuing to operate as we started: I supply a written report on my issues and questions, then we discuss them on the phone. I know I can provide more detailed, accurate information in writing than I ever could during an office visit. After all—during typical doctor visits these days—I talk while the doctor scrambles to enter what I'm saying into the computer. It's not a personal, friendly conversation.

The doctor agreed my suggestion might work better, but added that insurance companies and Medicare favor office visits.

I'll have more to say on taking notes and office visits soon.