Somewhat OT - Blood Pressure should be alot lower

Den, thank you for the links. I will take a look at them. Excellent advice on getting BP taken correctly in office with an old fashioned machine.

SNO - NIH sponsored this study but as someone pointed out in the comments section in the NY Times, there has been a revolving door between BIg Pharma and the government so it is understandable if people still are leery of the study. Call me cynical but I would love to know the background of the folks on this study.

Jay - I am skeptical of what your doctor said but perhaps that is my cynicism at work again? Obviously, you have to do what you feel is best but with a BP of 127/70, I would be leery of med side effects that doesn't seem worth the the trouble in getting it down to that magical level.

Sew Tired - Exactly about med side effects. WTF, taking 3 meds to get BP down to that magical 120/80 reduces the risk of death? Ok.
I have white coat hypertension by the way and now realize with doctors who throw a fit about a high reading that I need to have taken readings ahead of time to preempt their concerns. Works like a charm.

Nan - LOL at your comment that doctors would prescribe meds for a hangnail if they had the chance. Probably be an antidepressant.

Goofproof - Can you send your dermatologist my way? The last one I saw was a complete quack unfortunately.

CathyF - I am no doctor obviously but it looks like you would need something like a 24 hour blood pressure monitor to see if you had a problem or not.

Pugsy - You are right about the BP guidelines being 120/80. But I now sense that when doctors medicate patients for high BP, they are not going to be satisfied with the previous 140/90 goal which will mean more meds and more side effects.

49er wrote:Jay - I am skeptical of what your doctor said but perhaps that is my cynicism at work again? Obviously, you have to do what you feel is best but with a BP of 127/70, I would be leery of med side effects that doesn't seem worth the the trouble in getting it down to that magical level.

Yes, I agree. I think my GP was sincere in his suggestion that I consider a BP med and that's all it was a suggestion to consider it. I am fortunate that all of my providers now treat me as a member my health care team and discuss options openly with me. I am leery of the side effects and, obviously, a discussion with my cardio about the findings of this study is warranted. Also, I'm pretty sure we will hear a lot more of the pros and cons as health professionals have time to examine the results. In the meantime, it is something to consider.

Isn't this kind of the same issue as why we are here on this forum? Medical research and intervention is crucial but as patients, it is incumbent on us to do our homework.

Some people only get high BP readings in the doctor's office due to stress. Some actually only get low readings in the doctor's office as well. Some BP cuffs are not properly calibrated - I questioned the validity of my home one but my doctor affirmed that it is likely well calibrated since my readings were very similar between home and her office. And HBP is not diagnosed by a single reading or even by repeat high readings that are not consecutive within a small time frame. It can be very important to track it over time, in different places and under different circumstances.

There are also other factors to consider. My readings weren't terribly high but they were consistently above the 140/90 threshold. My doc put me on a low dose diuretic ($1.96 for a 3 month supply) and my numbers came down to the "normal" levels (still above the new threshold though). Is it really that important? In my case, it is a low dose of a drug that is not causing me side effects at a 3 month cost of less than a single cup of coffee. On the other hand, my mother had HBP that was also controlled to a level of 140/90 when she had a massive cerebral hemorrhage. I'll take the drugs (and more if needed), thank you very much.

And as for doctors and big pharma - I was in a clinical trial that was comparing 2 commonly used meds for MS to compare their efficacy. After having severe reactions to one of the study drugs, my doc (the head researcher) switched me to a different med that was not part of the study but that he could still look at comparatively. And when I had severe reactions to that one, along with taking a lot of meds to combat the side effects, he suggested a drug holiday to stop putting all of that crap in my body, and see how I might do without the drugs at all. While it's generally not recommended to not take meds for MS, my doc felt that I was sufficiently stable and not a good a candidate for these medications unless my condition should worsen and warrant another try.

All this is to say that research is constantly evolving, there are good doctors out there, and we, as healthcare consumers must work to become as educated as possible to be able to work with our docs (or find different docs) to figure out what is actually best for us as individuals.

I take my bP at home and it's invariably low. Not only do I have white coat hypertension, but they take it INCORRECTLY every time at kaiser. And electric system that leaves your arm dangling down. When I insist on a manual cuff the techs barely know how and again leave the arm dangling down. Then they want to send me to a BP "clinic" so I can rest and listen to music before they take my BP. I can do that at home!

Once I saw an on call doctor who properly instructed his tech. She took the BP correctly and --Suprise--low normal--116/72.

I refuse to let my BP be taken by techs there. If the doctor wants to take it CORRECTLY after I've been sitting with her for a few minutes I allow that. Normal.

I'd be passing out on meds, I don't have high blood pressure.

My whole life I've had a combination of low blood pressure and a fast pulse. I have a whole bunch of amusing stories of passing out! (Did I tell y'all about the time I passed out when my mom was giving blood? I got cookies and juice!)

About a year and a half ago my blood pressure started edging up to between 110 and 130 systolic, but more importantly my resting pulse had crept up to being consistently in the 90's rather than the 80's. So first my PA tried me on a calcium channel blocker, which lowered my blood pressure a bit but did nothing for my pulse, and so then she switched me to a good old fashioned beta blocker, which got my resting pulse back to the 80's -- sometimes even below. My bp didn't go down that much, so all was fine. Then last year my BP and pulse went up more, and I gained some weight, and my liver enzymes started climbing. And so they doubled the dose of the beta blocker.

Anyway, long story short, I've lost 63 lbs since January. I've also been doing interval training 3x per week.

I take my pulse while I'm exercising, and inadvertently I've run an experiment a couple of times -- exercising at 6-7 pm after forgetting to take my beta blocker at noon. When I take the beta blocker, my pulse only peaks at about 130 bpm. When I would forget, it would peak at about 160-165 bpm. When my heart is beating faster when I've missed a dose, I feel like I'm working harder, and getting sweatier, and breathing harder. As opposed to when I've taken the beta blocker and I just get too tired to push before I've done that much work. And with the beta blocker my resting pulse kept going down below 60. I did a little research on beta blockers and exercise tolerance/resistance.

I learned back in anatomy/physiology that a big part of how the body benefits from exercise is that exercise causes your cells to need more oxygen, so your heart beats faster to deliver more oxygen faster. But then if you keep exercising and stressing your heart, then your body adapts to the bigger need by upping the oxygen-carrying capacity of your blood, mainly by producing more red blood cells, so that a faster heart rate over the short term causes a slower heart rate over the long term as your heart doesn't need to beat so fast when you are at rest. When physiologists talk about exercise increasing your fitness levels, THAT is what they mean.

It turns out that beta blockers have this well known effect of sabotaging people's attempts to use exercise to increase their fitness -- and lower blood pressure and resting pulse. So it's really a 2-edged sword. If you are not going to exercise, and so your blood pressure goes up because you are overweight and out of shape, then using meds to lower the bp is a win. But if you DO start exercising, then the meds can prevent you from exercising much and so you get in this vicious cycle where you need the meds because you are taking the meds. That's another reason to be suspicious of how the studies apply to an individual... If the vast majority of people in the studies aren't exercising and aren't going to exercise, then avoiding the meds won't give them any benefit. And when you are doing statistics those people's results completely overwhelm the few who are being harmed by the meds' sabotaging their exercise.

Ok, so 3 weeks ago I cut the beta blocker in half. My heart rate now goes to about 138 when I exercise. And last week I was exercising and took my pulse and it was 150 and I realized that I had forgotten my (half) pill at lunch.

My goal is to get off the beta blocker completely and use exercise to have a resting pulse in the 70's and a peak exercising pulse of about 140-145. But I know that the mechanism is that I have to stress my heart some with exercise to get my heart rate to come down -- because with heart rate the way you get it to come down is to make it go up.

The problem with beta blockers is that they prevent your heart from beating very fast. Instead of pushing your body to capacity and then that stress causing your body to increase your capacity, your body just tires out and so you can't benefit from the exercise that you can't do.

cathyf,

When the PCP erroneously thought I had high blood pressure and heart rate which turned out to be white coat syndrome, I was prescribed coreg. I thought psych meds were evil drugs but this one waged a worthy competition. Not only did it greatly worsen my mood but it completely zapped my exercise tolerance capacity. Fortunately, I took half the starting dose the PCP had written the prescription for and was able get off of the med pretty quickly without too many problems.

When my BP and HR started spiking again before my septoplasty which interestingly returned to normal after the surgery, Bystolic was prescribed. Exercise tolerance didn't seem to be hurt as much (maybe because of the low dose) but it still worsened my mood. I decided that if god forbid, I need BP meds in the future, h-ll will freeze over before I take another BB.

49er

Janknitz,

I wish I had a nickel for all the times my BP has been taken incorrectly. I have decided to not say anything unless I get a reading that makes the doc want to medicate me on the spot.

Kaiser's strategy in sending me to a BP clinic to listen to music would not work because my BP rises as soon as I set foot in a doctor's office. It doesn't matter what relaxation technique I engage in as it doesn't come down until I leave the office.

49er

Jay,

That is good your doctors treat you as a member of your healthcare team. I can't say I have felt the same way about all my doctors and maybe that is why I have a negative attitude towards meds.

Curems, good point about weighing all the issues in working with doctors regarding meds.

I am so sorry about your mother and it sounded like aggressive treatment would have helped her. I think I am concerned that because of these guidelines that everyone who is above the 120/80 guideline will be pushed into taking BP meds when that might not be the best course of action.

49er wrote:I was prescribed coreg

See, now that's interesting. According to my meager research, beta blockers should be reserved as a first treatment option for those that have heart or CAD. Otherwise, the recommendation seems to be a diuretic first.
I, too, suffer somewhat from white coat syndrome, WCS, and I think that may be what prompted the suggestion from my PCP. On the other hand, my cardio said to ignore it, which almost immediately caused the syndrome to improve , but it is still somewhat troubling.
I know you probably won't agree because of your past experiences, but it seems one viable option to control WCS might be to take an anti anxiety med like Xanax before an office visit where blood pressure might be taken. Now, before you say it, I would not recommend Xanax or any other benzodiazepine be taken on a regular basis except in extreme cases where there were no other choices.

Jay Aitchsee wrote:

49er wrote:I was prescribed coreg

See, now that's interesting. According to my meager research, beta blockers should be reserved as a first treatment option for those that have heart or CAD. Otherwise, the recommendation seems to be a diuretic first.
I, too, suffer somewhat from white coat syndrome, WCS, and I think that may be what prompted the suggestion from my PCP. On the other hand, my cardio said to ignore it, which almost immediately caused the syndrome to improve , but it is still somewhat troubling.
I know you probably won't agree because of your past experiences, but it seems one viable option to control WCS might be to take an anti anxiety med like Xanax before an office visit where blood pressure might be taken. Now, before you say it, I would not recommend Xanax or any other benzodiazepine be taken on a regular basis except in extreme cases where there were no other choices.

Nah, I found the perfect solution to WCS. Take readings before going to the doctor. Worked like a charm with my PCP who is always ready to prescribe meds based on WCS. When I calmly asked her if she wanted more readings, she was very satisfied with what I had given her.

Then about a month later, I couldn't have picked a worst day to see her for a routine visit. I was dealing with some stress in my life that shot up my blood pressure. But I decided to play it by ear to see what would happen.

So just as expected, my readings were high. So when my PCP said that my BP was high, I laughed and said that I was sticking to the script in always having a high reading in her office. She laughed and that was the end of the discussion:)

And the next day, by the way, my BP went back to normal.

I am curious, why do you find your WCS troubling?

By the way, I don't think your suggestion to take Xanax before going to the doctor in extreme cases is off base. People do it for dental procedures so it makes sense to me. But remember, I am the same person who chose to listen to guided imagery tapes before my Septoplasty vs. taking Versed which even the Anesthesiology Resident agreed was a good choice based on my medical history.

49er

49er wrote:I am curious, why do you find your WCS troubling?

Well, troubling may be a bit strong. But after all, I think being "troubling" is what causes it. One worries about it being high and therefore, it is.
Maybe curious would be a better descriptor when not faced with an impending doctor's visit.
The fact is for those moments at the doctor's office when it is high, it is high. What does that mean? We say, "oh, it's only white coat syndrome". But what about other times when we may be anxious about something? Is it high then? How much? How long? We know that stress/anxiety raises blood pressure and we know high blood pressure is harmful (I think). When we take our blood pressure at home, we are likely not in a stressful situation and our blood pressure is "normal", so we say, "see, nothing wrong". But the fact remains, it was high at the doctor's office (assuming it was taken correctly).
So, what about people who don't have WCS. What is their BP in their stressful situation? Is it high? How high? How Long?
How do we do know what "normal" is. Is blood pressure that happens to be under 120/80 at the doctor's, but high other times normal? How high, how often is normal? How do we asses the damage that might be caused by intermittent highs? Can it be prevented?
Curious, you see?

Jay Aitchsee wrote:

49er wrote:I am curious, why do you find your WCS troubling?

Well, troubling may be a bit strong. But after all, I think being "troubling" is what causes it. One worries about it being high and therefore, it is.
Maybe curious would be a better descriptor when not faced with an impending doctor's visit.
The fact is for those moments at the doctor's office when it is high, it is high. What does that mean? We say, "oh, it's only white coat syndrome". But what about other times when we may be anxious about something. Is it high then? How much? How long? We know that stress/anxiety raises blood pressure and we know high blood pressure is harmful (I think). When we take our blood pressure at home, we are likely not in a stressful situation and our blood pressure is "normal", so we say, "see, nothing wrong". But the fact remains, it was high at the doctor's office (assuming it was taken correctly).
So, what about people who don't have WCS. What is their BP in their stressful situation? Is it high? How high? How Long?
How do we do know what "normal" is. Is blood pressure that happens to be under 120/80 at the doctor's, but high other times normal? How high, how often is normal? How do we asses the damage that might be caused by intermittent highs? Can it be prevented?
Curious, you see?

Great questions Jay. I guess the question is what would someone consider to be a too stressful situation vs normal stresses of life and how that affects BP.

I wonder if there are weekly BP monitors that could test people's BP and perhaps answer your questions. Would be an interesting study if it hasn't already been done.

Who would be good test subjects?

49er

Well, I've done a quick trip through Google land and I say with certainty that the answers to questions about blood pressure are either yes, no, or maybe!
http://highbloodpressure.about.com/od/p ... ety-bp.htm
http://www.mayoclinic.org/diseases-cond ... Q-20057792
http://www.webmd.com/hypertension-high- ... -resistant
https://en.wikipedia.org/wiki/White_coat_hypertension

49er wrote:Den, thank you for the links. I will take a look at them. Excellent advice on getting BP taken correctly in office with an old fashioned machine.

SNO - NIH sponsored this study but as someone pointed out in the comments section in the NY Times, there has been a revolving door between BIg Pharma and the government so it is understandable if people still are leery of the study. Call me cynical but I would love to know the background of the folks on this study.

Jay - I am skeptical of what your doctor said but perhaps that is my cynicism at work again? Obviously, you have to do what you feel is best but with a BP of 127/70, I would be leery of med side effects that doesn't seem worth the the trouble in getting it down to that magical level.

Sew Tired - Exactly about med side effects. WTF, taking 3 meds to get BP down to that magical 120/80 reduces the risk of death? Ok.
I have white coat hypertension by the way and now realize with doctors who throw a fit about a high reading that I need to have taken readings ahead of time to preempt their concerns. Works like a charm.

Nan - LOL at your comment that doctors would prescribe meds for a hangnail if they had the chance. Probably be an antidepressant.

Goofproof - Can you send your dermatologist my way? The last one I saw was a complete quack unfortunately.

CathyF - I am no doctor obviously but it looks like you would need something like a 24 hour blood pressure monitor to see if you had a problem or not.

Pugsy - You are right about the BP guidelines being 120/80. But I now sense that when doctors medicate patients for high BP, they are not going to be satisfied with the previous 140/90 goal which will mean more meds and more side effects.

Afraid I can't send him, I was 17 then he was probably 45, so he would be dirt by now. Strange thing, I had gotten a appointment in a bigger city 75 miles away, with the new dr, as it turned out the Dr I was to see was in a bad car accident, and I saw his replacement. This Dr introduced me to his underlings as the worst case of parent uncle Perry knuckle (sp) warts he had ever seen. For a year and a half, the local Dr had been freezing them with liquid nitrogen and acid treatments. The new dr did the same, but he put me on 150,000 units of Vit A daily, I was under control in 6 months, been taking 50,000 units of Vit A daily ever since.

That car wreck was the best thing that ever happened for me Dr wise, the right person at the right place.... jim

Jay Aitchsee wrote:Well, I've done a quick trip through Google land and I say with certainty that the answers to questions about blood pressure are either yes, no, or maybe!
http://highbloodpressure.about.com/od/p ... ety-bp.htm
http://www.mayoclinic.org/diseases-cond ... Q-20057792
http://www.webmd.com/hypertension-high- ... -resistant
https://en.wikipedia.org/wiki/White_coat_hypertension

Thanks Jay for the links.

I vote for the "no" answers. All jokes aside, with my extreme sensitivity to meds including an adverse reaction to a BP med that put me in the ER, unless a doctor can point to overwhelming evidence that wch is destroying my health, I would be a damm fool to take anything. Of course, I do keep a careful watch on my readings, particularly when I get wch spikes or after that stressful day I mentioned to make sure it is just a blip vs. a trend.

And speaking of wch, I wonder if doctors changed their waiting rooms to be more peaceful and serene, how much this could be eliminated. I mean, think about it, the current setups are not exactly conducive to relaxation.

49er