To Your Good Health: Doctors disagree on blood pressure target

I am a 91-year-old male. When I switched primary care physicians, my new doctor shook his head because my previous doctor had never told me about my low GFR readings and being borderline diabetic. In the past, I had assumed that if the doctor didn’t mention any low or high blood test results, everything must be OK. I no longer assume: I ask for a copy of the results and question them. The new doctor referred me to a nephrologist. My blood pressure at the time was usually in the 130-140/60-70 range. He told me that for a person of my age, that was too low. He gave me a target of 159/89. Then on my next visit to primary care, I was told that my blood pressure was too high; I was prescribed losartan. I am testing my blood pressure daily, and the past few days it has been in the 170s. So, what is a good target for my blood pressure? Which doctor is correct?

There is no absolute right answer to your question. On the one hand, overaggressive treatment of blood pressure in a 91-year-old is unnecessary and may lead to symptoms of lightheadedness, especially upon standing. Other blood pressure drugs may have additional side effects.

On the other hand, a 91-year-old has a higher risk for heart disease and stroke, and in someone with a low GFR reading, a measurement of kidney function, and borderline diabetes, which further increases the risk of heart attack and stroke, most experts would aim for a blood pressure goal that is closer to 120-130/80-85, as long as it isn’t causing annoying symptoms.

I’m not clear why the doctor wasn’t happy with your usual blood pressure, since a level of 130-140/60s seems very reasonable for a man your age if you aren’t having side effects. If 170 is the usual systolic pressure on your new regimen, I would ask about going back to the old one.

I always have had small breasts. Suddenly, in my mid-70s, my breasts grew, and now at 80 I have outgrown most of my clothes. My doctor said that it is fat, but I have gained only a few pounds. Could this be hormonal? Have you addressed this issue before?

I haven’t addressed this before. Breasts change size during a woman’s life for many reasons. Breast tissue is a mixture of fat and glandular tissue.

For young women, there’s proportionally more glandular tissue, the amount of which tends to decrease over time. After menopause, the breasts become less glandular; what is lost is replaced by fat, as there is less estrogen.

About 20% of women will notice significantly larger breasts after menopause; however, this usually occurs along with overall weight gain. Significant breast enlargement without much weight gain is not common in my experience.

Hopefully, your doctor did a thorough examination. However, I think it is very unlikely that your breast size changes represent a tumor. Very rarely, there are estrogen-producing tumors, so if there were other reasons to be concerned, your doctor might check blood levels of hormones, including estrogen.

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. © 2020 North America Synd., Inc.