Dr. Gott: Dizziness may be connected to overmedication

Dear Dr. Gott: My husband is 76 years old. Nine years ago, he had open-heart surgery and now takes anticoagulants. He has high blood pressure, which is under control.

The problem is, he is dizzy. Every time he stands, he has to hang onto something for a few minutes before he can start walking around. He told his last two doctors of this problem, and they just ignore him. I don’t know if they are unsure how to treat it or simply don’t want to. Can you give us any suggestions about what this might be caused by?

Dear Reader: Your husband’s dizziness when standing suggests that his blood pressure is too low. He may be overtreated. This is likely related to something called “white-coat hypertension.” This simply means that your husband’s blood pressure rises, usually because of anxiety or stress, during his appointments but returns to normal between them.

Bring your concerns to his physician and propose the following, which will include a home blood pressure machine: Stop medication two or three days before his next appointment. His blood pressure should be taken during the visit, and his blood pressure machine can be calibrated to the doctor’s to ensure it is accurate. Then, after the visit, he should monitor his blood pressure twice a day at home for one or two weeks. Be sure to keep a record of readings as well as the time of day taken (morning and night). He should then return to the doctor with his results and again have his blood pressure checked while in the medical setting.

I suspect his home readings will be much lower than the readings taken by the doctor. This is not to say he does not have hypertension; he may simply have a mild abnormality that can be controlled with diet, exercise and minimal medication.

If his doctor does not agree to this, it may be time to find a new primary-care physician that is more understanding and willing to listen.

If, however, your husband does not have white-coat hypertension, I recommend that he have a special blood-pressure reading. First, he will have his pressure taken while lying down, then immediately after sitting up, then again immediately after standing, and finally after standing for several minutes. This type of reading will let the physician know whether your husband has orthostatic hypotension (positional low blood pressure).

Because hypertension and hypotension are a result of circulation problems, your husband may want to see a cardiologist.

Your husband must be careful to rise slowly and have something to aid his balance when standing. If he rises too quickly, he may lose his balance and fall, which can cause serious injury, especially if he is home alone and cannot get back up. Let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Hypertension.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.