Question: My doctor diagnosed me with high blood pressure (140/82), and he put me on blood pressure medication (10 mg of Lisinopril). In three weeks it came down to 110/64. Is that number healthy, and will I have to take this medication for the rest of my life? It causes me to have a dry cough.

Dr. Hibberd's Answer:

Hypertension is a chronic (long term) condition. Once medicated, it is usually maintained indefinitely. It’s not common to be placed on blood pressure medication for a BP of 140/82. Endpoints for hypertension control are dictated by age and underlying medical conditions, so I really do not have enough information to be more specific.

Recent data in treating those over 80 years of age suggested an increased mortality in those with target systolic BP of less than 140. Recently published data in the NEJM (New England Journal of Medicine) from a government-funded, randomized-controlled, double-blinded study of those over 80 years of age supported a decreased risk of fatal stroke and death from any cause in the very elderly in patients with systolic BP of 160-199, when a target of 150/80 was met. Note the systolic target was 150, not less than 140!

Lisinopril is an ACE inhibitor medication known to commonly cause dry cough. Ask your doctor to discontinue this medication, as well as to explain to you the rationale for such tight BP control. If needed, there are plenty of other medications that will be free of side effects.

It is not uncommon for younger patients to have tighter BP goals, but these are usually in high risk groups such as those with diabetes mellitus, or existing cardiovascular (heart/aneurism), or neurovascular (brain/stroke/aneurism) disease.

Always ask your doctor if you are unsure. Remember, you need a trusted partner you can rely upon. If you are uneasy, request a referral to a hypertension specialist, usually a nephrologist or cardiologist, for a second opinion.