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

Dear HOUSE Calls,    

My question is about protecting children from the sun. Do you have an opinion about protective clothing compared to sunblock, and whether sunblock is adequate?

It’s great that you are thinking about best ways to protect your children from the sun.  Much of our melanoma risk develops from sun exposure when we are children, so this is critical.

Most sunblocks protect from ultraviolet-B (or UVB) rays but not ultraviolet-A (or UVA) rays.

The SPF equivalent for clothing is usually much higher.   That makes sense, because it is hard (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.  The Aussies tell them to protect 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, too!  Use that protection whenever you and your children will be outside.  Avoid peak sun between 10AM and 2PM.

Dear HOUSE Calls,    

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

We hear this complaint a lot about lisinopril. It is a common drug for high blood pressure, and it is in a class of drugs called ACE inhibitors. These drugs help the kidneys work to lower blood pressure; they are also great for patients with heart failure.

But this cough is a very common side effect of ACE inhibitors.  It is usually a dry, lingering cough and develops in about 10% or more of patients.  However, only about 1% of patients will be bothered enough by the cough to stop the medicine.  It sounds like you are in that unlucky group.

Why you don’t want to be on a diuretic?  Sure you will have to pee more for awhile, but this side effect usually goes away in 6 weeks.  This would certainly be our next choice for many people with high blood pressure (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 ARB which is generic, (losartan) so that might be a good choice.

Beta Blockers like metoprolol or atenolol are good choices.  This discussion will require more information about other conditions, medications, and side effects of concern.  Work with your physician to come up with a best next choice.  Good luck.

HOUSE Calls is a weekly column by Dr. Cristy Page, Dr. Adam Zolotor, and Dr. Adam Goldstein on behalf of YOUR HEALTH and the UNC Department of Family Medicine.

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