ArcaMax

DEAR DR. ROACH: You recently stressed the need for at-home blood pressure monitoring for the control of blood pressure. Which brand should I buy? -- L.L.

ANSWER: Home blood pressure monitoring adds a great deal of information to in-office blood pressure monitoring, since it ensures that the blood pressure is being optimally controlled. A few readings a year in the doctor's office don't give a great idea as to the overall control, since blood pressure goes up and down from day to day, even minute to minute. So, more readings are essential to be sure that you aren't undertreating or overtreating the blood pressure. The best of all is 24-hour monitoring, but these machines are expensive and (for a variety of reasons) hard to get from your clinician, except in specialty blood pressure practices.

Fortunately, there are many excellent devices that are certified to be accurate. I found three resources that list reliable devices: strideBP.org; hypertension.ca/public/recommended-devices; and validateBP.org.

Regularly checking your blood pressures at home and bringing in the device (if it has a memory chip) or a log will be very helpful.

DEAR DR. ROACH: I'm 84 years old and in pretty good health. I've seen a doctor about excessive urination. I don't drink much liquid after 2 p.m. I had my prostate removed about 20 years ago. Is there anything you suggest? -- W.M.

ANSWER: The most important question I have after hearing this very common concern is whether there's a lot of urine each time or just a small amount many times. If it's a large amount of urine each time, then your body is getting rid of excess fluid. This can happen with diabetes (diabetes mellitus is excess sugar in the blood, while diabetes insipidus comes from deficiency of or resistance to the hormone arginine vasopressin), so your doctor should check your sugar and sodium levels. If there is concern for diabetes insipidus, a 24-hour urine collection can help sort out the diagnosis.

However, high-volume urine output at night can also happen in people with fairly mild heart failure. During the day, your heart is too busy providing blood to your muscles and brain that it can't send much blood to the kidneys. So, when you rest in the evening and night, the fluid that accumulated during the day gets removed when the kidneys get the blood flow they need.

A more common concern is when people have many episodes of voiding with small amounts. Both men and women can experience this with an overactive bladder. Men with large prostate glands also note this.

You might want to check with your urologist because 20 years ago, we seldom took out the prostate; we much more commonly reduced the prostate tissue around the urethra. Symptoms can certainly return after 20 years. The urologist can check to see if you are able to empty your bladder fully; if not, this suggests a prostate problem or, much less commonly, a neurological problem with the bladder.

Finally, the same hormone, arginine vasopressin, can sometimes reverse its secretion so that you preferentially urinate more at night. A treatment for this condition is an AVP analogue called desmopressin, but many physicians (including myself) are reluctant to give this medicine to older adults, due to it potential reducing the sodium levels to a dangerous degree.

As you can see, excess urination takes a bit of effort to sort out, and it may be time to get a more thorough evaluation from your doctor.

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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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