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House Calls, April 19, 2012

Practicing family physicians from the UNC Department of Family Medicine have teamed up with The Carrboro Citizen to bring you a weekly feature responding to your questions about health and medicine. Send your questions or comments to yourhealth@unc.edu

This week we respond to questions about protective clothing for sun exposure and choosing a new blood pressure medicine.

Dear HOUSE Calls, Do you have an opinion about protective clothing compared to sunblock, and whether sunblock is adequate?

Much of our melanoma risk develops from sun exposure when we are children, so this is critical. Most sunblocks protect you from UVB rays but not UVA rays, and the SPF equivalent to that of protective clothing is usually much higher. That makes sense because it is hard (though not impossible) to get burned through clothing. Much protective clothing is now made with ultraviolet protection factor or UPF, and we think this is a great idea. There is a campaign in Australia called “flip, flap and flop,” which tells people to flip their hat on, flap on their shirt and flop on their sunblock. It is said in that order because you should use the things that act as physical barriers first, followed by sunblock, to cover all exposed skin. Don’t forget we can get burned on cloudy days. Avoid peak sun between 10 a.m. and 2 p.m.

Dear HOUSE Calls, I developed a cough as a side effect from lisinopril, but I don’t want to take a diuretic. What do you recommend?

We hear this a lot about lisinopril, a common drug for high blood pressure in a class of drugs called ACE inhibitors. These drugs help the kidneys lower blood pressure; they are also great for heart failure. But this cough is a very common side effect of ACE inhibitors. It is usually a dry, lingering cough that develops in 10 percent or more of patients. However, only about 1 percent of patients will be bothered enough by the cough to stop taking the medicine. It sounds like you are in that unlucky group. Why don’t you want to be on a diuretic? Sure, you will have to pee more for a while, but this side effect usually goes away in six weeks. This would certainly be our next choice for many people with hypertension, if not our first choice. There is a somewhat newer class of medications called ARBs; they are cousins of ACE inhibitors, but without the cough side effect. There is now one generic ARB (losartan), so that might be a good choice. Beta blockers like metoprolol or atenolol are good choices. This discussion will require more information about your other conditions, medications and side effects of concern. Work with your physician to come up with a best next choice.

House Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page and Dr. Adam Zolotor on behalf of Your Health and the UNC Department of Family Medicine.

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