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Ask the doctors

Q. The July 2017 issue of Harvard Women's Health Watch spoke about the potential problems related to low blood pressure when taking blood pressure medication. My readings meet the definition of low blood pressure outlined in the article, but I don't take any medication. Should I be concerned, and if so, what should I do to raise my blood pressure?

A. In general, blood pressure is deemed too low only if it causes symptoms. A normal blood pressure is defined as a reading below 120/80 millimeters of mercury (mm Hg), and some experts consider your blood pressure low only if it dips below 90/60 mm Hg. However, a low reading can be normal for some people. Your doctor probably won't be too concerned about it unless it occurs suddenly; you have an underlying health condition that could cause low blood pressure, such as heart failure; or you are experiencing symptoms such as dizziness, lightheadedness, fainting, fatigue, or nausea. Some medications, such as diuretics (water pills), some antidepressants, and beta blockers, among others, can also cause low blood pressure. But since you aren't taking any medication, this is not an issue. If you are having symptoms related to your low blood pressure, this is something you definitely want to mention to your doctor. But if you've always had low blood pressure and you're not experiencing any problems, it's likely that this is normal for your body.

Pain from migraines, cluster headaches, and other types of headaches require very different treatments.

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Pain around the eye and throbbing on one side of the head 鈥� they're common headache symptoms, but what do they mean? "Many times people assume a headache is due to sinusitis, and they put up with it for years," says Dr. John 颅Pettinato, a neurologist with 颅Harvard-affiliated Beth Israel Deaconess Medical Center.

Understanding your pain can help you find the best approach to treatment.

One antiviral medication has drawn criticism, but it's still a treatment option.

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Bad case of the flu? Antiviral medications, such as oseltamivir (Tamiflu) or zanamivir (Relenza), may reduce symptoms and help you recover from the flu a day or two earlier. But oseltamivir came under fire a few months ago for a lack of effectiveness.

In June, the World Health Organization (WHO) removed oseltamivir from its list of essential medicines. "Their decision was based on the relatively low effectiveness of oseltamivir in clinical trials and clinical practice. I suspect this is due to a significant number of people who started therapy after their flu symptoms had been going on for more than two days," says Dr. Paul Sax, an infectious disease specialist and Harvard Medical School professor.

Research we're watching

People with cardiovascular disease who exercise regularly, don't smoke, and manage other risk factors spend far less money on medications than people who don't take such steps, a new study finds.

The study included 4,248 people ages 40 and older with clogged arteries (atherosclerosis), the most common form of cardiovascular disease. Researchers also relied on the Medical Expenditure Panel Survey, a national snapshot of health care expenses based on a survey of nearly 76,000 Americans.

While the drug therapy is becoming more widely available, the science is still not clear on how it may help.

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Medical marijuana has been approved in 28 states and the District of Columbia, but researchers are still trying to connect the dots as to how, and if, it works.

"Unfortunately, there are almost no uses of medical marijuana that have been subjected to the kind of rigorous testing you'd want for a pharmaceutical," says Dr. Kenneth Mukamal, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. "This does not mean that it has no benefits, but only that the lack of human studies prevents us from being sure if medical marijuana can really help."

Research we're watching

A growing number of older adults are misusing opioids, according to a new report by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. The 2014 National Survey on Drug Use and Health showed that the percentage of adults ages 50 and older using heroin or misusing prescription opioids jumped from 1.1% to 2% between 2002 and 2014. In contrast, opioid use in adults ages 18 to 25 dropped from 11.5% to 8.1% over the same period.

Drug use can bring particular risks to the health and well-being of older adults because they are more likely than younger people to have other illnesses and often take medications that can interact with opioids, according Center for Substance Abuse Treatment. "These findings highlight the need for prevention programs for all ages as well as to establish improved evidence-based treatment, screening, and appropriate referral services," Dr. Kimberly Johnson, director for the Center for Substance Abuse Treatment, said in a written statement.

A daily low-dose aspirin may help prevent stroke and certain cancers, but the therapy carries certain risks you'll want to discuss with your physician.

It used to be that you would reach for an aspirin only if you had a headache or an achy joint, but current research shows that low doses of the drug may reduce your risk of stroke and even help prevent colorectal cancer.

So, does this mean you should head to the pharmacy, grab a bottle, and pop a tablet every morning to ward off disease? The short answer is, maybe 鈥� but only after you have a detailed conversation with your doctor about the potential benefits and risks. A low-dose aspirin regimen is certainly not appropriate for every woman.

In the journals

The erectile dysfunction drugs collectively known as phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra), may not cause melanoma, the most dangerous form of skin cancer, according to a study published online May 19, 2017, by the Journal of the National Cancer Institute.

In 2016, the FDA put PDE5 inhibitors on its watch list of medications with possible safety issues after some studies suggested they might increase the risk for melanoma. In response to the FDA's action, researchers analyzed data from five large-scale studies of the issue, involving 866,049 men, published between 2014 and 2016.

Ask the doctor

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Q. My doctor prescribed Lovaza to help lower my high triglyceride level, which is 530 milligrams per deciliter (mg/dL). But I'm a vegetarian and don't want to take a drug made from fish oil. Are there other options?

A. You're not alone: several of my vegetarian patients also have asked me this question. But let's begin with some background. Triglycerides 鈥� which are the main form of fat found in our bodies 鈥� are part of a standard lipid panel blood test. Values higher than 150 mg/dL are associated with a higher risk of heart disease.

Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro颅intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding 鈥� a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.