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Your Good Health: Second blood pressure reading lower than the first

Dear Dr. Roach: I’m concerned about my blood pressure. I take readings twice a day, in the a.m. and p.m. I find that when I first take my blood pressure, it is high.
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Dr. Keith Roach

Dear Dr. Roach: I’m concerned about my blood pressure. I take readings twice a day, in the a.m. and p.m. I find that when I first take my blood pressure, it is high. Then, after I wait five to 10 minutes and retake it, it is sometimes 10 points lower in the second reading. If I am recording these pressures for my primary care physician, should I use the second reading?

Also, I’m on 25 mg of hydrochlorothiazide, 4 mg of doxazosin and 5 mg of amlodipine. My doctor just prescribed 80 mg of valsartan.

I’m concerned that I’m on too many drugs for blood pressure. He wants to have me monitor my blood pressure for a month to see how I’m doing. Am I being overly concerned about this?

A.G.M.

When the second blood pressure is consistently lower than the first just a few minutes earlier, that’s good evidence that you may be nervous when checking your blood pressure. The second reading is more likely to be the true reading than the first. However, I would report all the readings to your doctor so that he can have the benefit of all the data. (I suspect he will have the same feeling as I do.)

Some people do need four blood pressure medicines, but it’s worth considering whether there might be a reason why your blood pressure is high. By far, the most likely cause I see for high blood pressure that is resistant to treatment is obstructive sleep apnea. But there’s a long list of other causes, such as blockages in the artery or arteries to the kidneys, tumours in the adrenal gland, high thyroid levels and kidney disease.

A careful history exam and physical can help rule these out, but additional testing is sometimes indicated. For example, if a person tells me that their bed partner reports they snore, or they have morning headaches, or they fall asleep easily if they aren’t doing anything in the middle of the day, that’s enough for me to order a sleep study in a person who requires four blood pressure medicines.

The more data you give your doctor, the better the chance they can adjust your medicine so that your heart, kidneys and blood vessels are protected against any damage from high blood pressure. But you aren’t being overtreated.

Dear Dr. Roach: I have a sinus infection. When I read, my eyes hurt. Is it the sinus infection that causes my eyes to hurt when I read?

M.E.

There are several sinuses, which are air-filled structures inside the bones of the face and all around the eye. It is not uncommon to have eye pressure with an acute sinus infection, whether by viruses or bacteria.

Only about 2% of sinus infections start off as bacterial, but bacteria can “superinfect” a viral infection if the fluid in the sinuses does not drain within a few days. Treatments such as nasal irrigation with saline, decongestants, and anti-inflammatories like nasal steroids help reduce symptoms.

Severe eye pain, pain when moving the eyes, and redness and swelling around and behind the eye could indicate a rare complication called orbital cellulitis, which requires urgent evaluation and treatment.

Dr. Roach cannot answer individual letters, but will incorporate them in the column when possible. Email questions to ToYour GoodHealth@med.cornell.edu.