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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is there a connection between sudden rise in BP and cholesterol and cardiovascular diseases? Is taking lisinopril apt?

I am a 55 y.o. white male. I am a heavy exerciser (6-7 days/week, 50-90 min/session, about 4000-4500 cals/wk aerobics and weightlifting) In addition to all that, I do 20-25 miles/week of dog walking). My diet is about 2500 cal/day. I am on no special diet, and have no restrictions, other than an allergy to red shellfish and raw pineapple. For at least the past ten years, my vitals have been: B.P. about 105-125 systolic, 70-80 diastolic. Both slightly lower when supine. Resting pulse 65 bpm standing, 50-60 bpm supine Total cholesterol 105-130 mg/dl (HDL 50-60 mg/dl) Fasting glucose 70-90 mg/dl PSA 0.6 ng/ml Starting in July 2013, and very abruptly, some things changed: B.P. about 135-148 systolic, 85-95 diastolic. Resting pulse unchanged Total cholesterol ca. 145 mg/dl, but HDL unchanged Fasting glucose ca. 90 mg/dl PSA 1.4 ng/ml All with no change in diet, lifestyle, or environment. All values are confirmed by repeated measurement over time. None are “one-off” values that may be dismissed as statistical anomaly, faulty lab work, or something similar. All values are measured by clinical professionals. Raw data available upon request. I have no symptoms of prostate illness (no increase in urinary frequency, no urgency, no pain (dysuria), no incomplete emptying, no hematuria, no erectile dysfunction) I have no family history of prostate disease. My father had a normal prostate (not even hyperplasia) confirmed at age 72, which I understand is unusual. The PSA values of 0.6 ng/ml were determined by a finger-stick ( The 1.4 ng/ml value was determined by Roche ECLIA of a venipuncture (ca. 5 ml whole blood collected), and is of total PSA (free+ bound). I have been prescribed 10 mg lisinopril q.d. for hypertension, and, after taking it for 12 days, my b.p. decreased, from 148/90 to 128/80. About my only other clinical symptom is a stubborn inability to lose weight (I weigh 196 lbs (~89 kg), and for my height (5 ft, 8.5 in, or 1.74 m), I have a BMI of just over 29. Yes, I know, BMI is not predictive of much of anything, but I am not an elite athlete, I’m basically mesomorphic, and I have no medical condition that I’m aware of that would impact my BMI. I always thought it was strange, though. My questions: 1.     Does the “finger-stick” PSA (the 0.6 ng/ml values) measure free PSA only, or is it total PSA? How can I find out, given that LabCorp will not talk to me, and will not tell my physician? This is a total game-changer for me. Clearly, if the 0.6 ng/ml is free PSA only, then that, plus absence of clinical symptoms, probably takes prostate disease off the table. But if it is total PSA, then the two different values may be compared, and my PSA velocity is 1.9 ng/ml/yr ( [1.4 – 0.6] ng/ml / 5 months - a value so high that I cannot find it reported after a cursory literature review). 2.     What might have caused the SUDDEN rise in b.p. and total cholesterol? I have not been able to find a clinical correlation between these two and prostate disease, but I’m willing to hear from anyone who knows better. 3.     Why was I prescribed an ACE inhibitor (by a nurse practitioner, who was kind of evasive when I asked), when I have no risk factors or family history of cardiovascular disease? I know that this is a nit-picking question, but I thought to ask, while I have the electronic floor. Are ACE inhibitors a customary first class of drugs for new hypertensive patients? I don’t even remember them being around when I was a younger man. 4.     What follow-up should I do? In other words, what other data should I collect, based on anyone’s suspicions? Many thanks in advance for your time and input. I hope that I have given enough information to make a good clinical judgment, but if you have follow-up questions, I will answer them promptly.
Tue, 10 Dec 2013
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General & Family Physician 's  Response
Hi,
Welcome to HCM,
Happy to see that you want to be well informed about your health . My suggestion for you is to avoid weight lifting exercises. Aerobic exercises are good for Hypertensive people. In Diet, you must avoid salt, and food contaning Saturated and trans fatty acids. You must avoid processed food, fried food, Alcohol and smoking. According to BMI, you are overweight. You must check your abdominal circumference, which indicates your risk to get Cardiovascular disease. For cholesterol, we need to know your complete lipogram, specially ratio of Total cholesterol to HDL ratio. There are different parameters, which help us in deciding when and which anti hypertensive will be the best for an individual person. We have to treat a person as a whole and using a tailored approach to an individual. You must undergo base line study for your Blood Glucose, Kidney function tests including electrolytes, Full cardiac evaluation, Test to rue out Microalbuminuria , and Weight, AC and BP monitoring regularly.
For prostate , finger test also detects total psa level. We should have atleast three values of total PSA, measured by the same laboratory method to interpret its level. As you are asymptomatic, you need not be panic. I would say go for another 2 tests in an ideal condition, by the same lab method, at an interval of 3 months. If it shows consistency in increase, you may go and see urologist, who will do PR test, and will advise you other specific tests, Ratio of free/total PSA, density , velocity , PSA3, etc, if he suspects according to his clinical judgement. There are chances of false positive results.
Hope, I have given you all information you were looking for.
Best wishes
Dr H Hamdani

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