Dear Dr. Roach: 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 (glomerular filtratrion rate) readings and being borderline diabetic. In the past I had assumed that if the doctor didn鈥檛 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?
A.L.
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鈥檛 causing annoying symptoms.
I鈥檓 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鈥檛 having side effects. If 170 is the usual systolic pressure on your new regimen, I would ask about going back to the old one.
Dear Dr. Roach: I have had the same problem forever: I don鈥檛 understand why buttermilk coffee creamer seems to get outdated faster than regular creamer. Does the butter in it have anything to do with this?
C.H.
Buttermilk doesn鈥檛 have butter in it. It was so named because it was originally made with what was left after separating butter from the unhomogenized cream that had been allowed to ferment with airborne bacteria, making it slightly acidic.
Modern cultured buttermilk is made from pasteurized, homogenized milk, usually one to two per cent fat, and inoculated with healthy bacteria, which makes lactic acid from the sugars in the milk.
This acid makes buttermilk resistant to the unhealthy bacteria that causes spoilage. It also causes a slight sour taste, which some people like and others don鈥檛.
Commercial heavy cream, and coffee creamers made from heavy cream, have a very long shelf life largely because they are pasteurized at ultra-high temperatures, so they last even longer than buttermilk. The high fat content also retards bacteria growth.
Both buttermilk-based and cream-based creamers will stay good longer than their expiration date. Your nose is very good for telling when it has gone bad.
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 [email protected].
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