No lack of blood pressure medicines

Dr. Paul Donohue
Syndicated Columnist
Published Sunday, May 25, 2008


DEAR DR. DONOHUE: Is there any difference in the different blood pressure pills? Don't they all do the same thing? -- R.D.

ANSWER: More than 60 different blood pressure pills are on the market, and that's not counting blood pressure pills that combine two or more of the 60 single pressure medicines.

Water pills -- diuretics -- are blood pressure pills. They're usually the first medicines chosen to lower pressure. They get rid of sodium (salt), which is believed to be how they bring pressure down.

The other kinds of blood pressure medicines work in a different way. A large group affects renin, a pressure-raising substance made by the kidney. ACE inhibitors block an enzyme that converts renin into another material that is a potent elevator of pressure. Vasotec and Prinivil are two ACE inhibitors. ARBs -- angiotensin receptor blockers -- make it impossible for the renin product to attach to docking stations where it has the ability to boost pressure. Cozaar and Diovan are two ARBs. Tekturna (aliskiren) is a brand-new medicine that counters renin in another way.

Calcium channel blockers, like Calan and Norvasc, lower pressure by dilating arteries.

Beta blockers -- medicines that stop the effect of beta nerve signals -- are another class of drugs that lower pressure. Tenormin and Lopressor are two beta blockers.

I'm not going into the drug combinations, because I have already bored you to tears.

Let me just say that many combinations consist of a water pill working with a pressure medicine from one of the above examples.

DEAR DR. DONOHUE: Would you please enlighten me in full detail about a vasectomy? We have four boys, and that is enough. My wife doesn't want to use the pill. She wants me to have a vasectomy. Is it safe? Does it affect my urge or performance? -- J.F.

ANSWER: The vas is a 17-inch-long, slender, hard tube through which sperm pass from the testicles into the urethra for expulsion in the ejaculate. A vasectomy is a procedure to block the passage of sperm. It is safe, has a low failure rate and shouldn't be called an operation. It's done in the doctor's office and takes about 30 minutes.

The doctor numbs the scrotal skin and, through a small incision, grasps the vas with an instrument and brings it out of the scrotum, where it can be occulted with clips, electricity or heat, or be cut and the ends sutured. In a no-scalpel vasectomy, a special instrument enters the scrotum through a small puncture and then the procedure progresses as with an incision vasectomy. No skin is cut in the no-scalpel method.

After the procedure, the man rests for a short while and then goes home. Pain meds, scrotal support and ice make any pain quite tolerable.

Recovery is fast. Urge and performance are not affected one bit.

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