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Originally posted by ShiroKuro:

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He said something that made a lot of sense, which is this: The damage from high bp is insidious, and once the damage happens, it can't easily be fixed. He said he sees patients all the time who took steps too late, and now they are dealing with a lifetime of damage.
...cut...
But I am glad I didn't wait to see if I could turn things around without meds. There's too much at stake.

It's really helpful to hear this perspective, thank you!

+1

My bp has spiked over the past year - I'm still in the "I can fix it if I lose some weight" stage of denial, but unlike in my 30s when I lost 70 lbs, this time the weight is not budging in spite of doing all the same things I did last time. I was on propanalol for a while but it was making me really tired and exercise intolerant so I stopped. Interestingly, after stopping it, my bp stayed low for a couple months, but it has crept back up again. After reading this thread, especially Cindy's perspective, I think I will go back to the doc and ask for meds again. I'd be curious to know what the meds are that supposedly help with dementia, because lately I definitely have been feeling pretty brain fogged as well. Also, I was given the same med as Cindy (that diuretic) which I didn't take because I heard it can cause muscle cramping....so Cindy, if you want to PM me (or just post here) with some details on your experience, I'd love to know exactly how it went for you.

WTG - thanks! I'm definitely calling my doctor! And beelady - thanks for starting this thread! It was exactly the kick in the pants that I needed.

Happy to share more.

This all happened in the summer lasy year when it was hot, and taking the diuretic went poorly. I would have a private tennis lesson and could barely finish. Exhausted with pretty basic exertion. I would cramp when I got home.

Then I decided to try a few things, and the thing that worked was Gatorade Zero. I would put it in a water bottle full of ice and sip it in the car and during the match or lesson. That restored my exercise tolerance without spiking my bp.

See, the doc said what was probably going on was likely slightly decreased kidney function. Normal with aging, but just enough that the kidneys needed a little help to clear the sodium. And sure enough, if I skipped some doses, I would gain weight. If my kidneys were getting old and lazy, the last thing I wanted was to add high bp to their load.

Anyway, if the meds were skimming salt out if my body, it made sense that Gatoraid would help during exercise.

It has been a year, and I haven't had any issues or Gatorade, even during the recent heat wave. I do have some gatorade in the pantry, just in case.

Lisa, if you are gaining weight, the kidney function thing could be happening. Not taking the diuretic for a stretch will cause me to gain five pounds.

Also, I am very nervous about some of the newer meds. This diuretic has been around forever, so I figure there should be no surprises. It seemed like a good place to start.

And my copay is $2 for a 90 day supply!

So I cut the pill in half. I was given a script for 5mg of Lisinopril but my bp at home has been near normal. I worried about side effects so decided to just try half doses for the first few days to adjust to it.

Right off the bat I felt a bit woozy (I am known as the canary of side effects in my fam), but as the day went on I felt a lot better.

Later in the day I went to a school garden to haul mulch and soon found myself sweating and woozy again. I stopped and ate some early dinner and felt better. BP was 104/63 when I got home so I am very glad I didn't take the full dose.

I called my 92 year old Mom who has been on this med for many years. She had great advice, thought the half dose was a a good idea and assured me the light headedness would pass when my body got used to the med.

So if the bp continues to be in this low range, I will buy a pill splitter and then look to get a lower dose for the next refill.

Astonishingly, my copay was $0.

I could write a lot about my own experiences but it’s late…maybe tomorrow.

One thing I don’t get is why you’re supposed to be so relaxed when taking a reading, yet one is not normally so relaxed during the day’s activities. Unless you’re vegging out in front of the TV or computer. Your daily life IS your “normal,” isn’t it?

Late to this thread but as someone who was a "professional patient" for many years I can confirm that nurses are horrible at taking your blood pressure. They do it the very second you walk into the exam room, when you might be winded (like if you have lung disease), they usually have you hold your own arm up, don't notice if your legs are crossed, etc.


Don't start medication if your pressure is fine everywhere but in the Drs office. The proper treatment for white coat syndrome is to ignore it.

I should add that part of the problem is they have to take everybody's blood pressure every visit, per guidelines. It's a regulatory box checking exercise so they treat it as one. Their objective is not to understand your blood pressure so much as to put a number in the system.

I wonder if it would be better if it were done less often, perhaps based on some prior indications.

It's like when they question you about your meds and write them down in the EHR system - they do it so perfunctorily and imprecisely. I bet they'd do it better if they only did it when drug interactions made a medical difference to the appointment's purpose.

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Originally posted by RealPlayer:
One thing I don’t get is why you’re supposed to be so relaxed when taking a reading, yet one is not normally so relaxed during the day’s activities. Unless you’re vegging out in front of the TV or computer. Your daily life IS your “normal,” isn’t it?

Hypertension is defined as resting blood pressure over a certain level. We'll set aside the fact that there are different views on what levels constitute hypertension (there are different guidelines from various organizations).

BP definitely fluctuates depending on activity. As you can see from the guidelines for what should be done/not done when the measurement is being taken, having a full bladder, having eaten or exercised recently, crossing your legs or not having your arm supported will all change the reading. This is why you're looking for a measurement taken when the parameters are uniform among all patients, namely minimal activity. Otherwise the reading is meaningless, because it isn't what the standard definition of hypertension is based on.

I think for some people, "white coat syndrome" can be a case of "the BP measurer didn't follow the standard rules".

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Originally posted by jon-nyc:

Their objective is not to understand your blood pressure so much as to put a number in the system.

That depends on the doctor.

I have had doctors, when they see that my blood pressure is high, re-check it themselves during the exam.

I have (on more than one occasion) had a nurse tell me to stop crossing my legs, because it leads to a higher blood pressure reading.

I've even had a nurse say, that looks a little high, I'll come back in five minutes and take it again.

Home cuffs are great, but some are not, and some people don't use them correctly. Plus, they should be checked against a doctor's office readings.

The risks of high blood pressure are invisible and insidious, and you shouldn't trivialize them.

From what BL described of her experiences, I thought it was important to share information about what *should* be happening so she could make the best decision regarding whether she needs meds because she's hypertensive. From the description, it didn't sound like the BP measurement in the office followed the guidelines. Her nurse practitioner can prescribe meds; it's essential that the prescription be based on a real need. I'm not suggesting she ignore things, but rather confirm the accuracy of the measurements.

I've only had a couple of doctors in my life. I always wondered why my first doc supported my arm the way he did when took my BP, but none of the nurses did. Decades later when I read the measurement guidelines, I realized why he was doing it. My current doc does the support thing too; his nurse not only doesn't support my arm, but measures over clothes and talks during the measurement. Both docs did the second measurement approach if the first one was on the high side. They were doing the measurement according to the guidelines; their nurses were not.

I certainly take hypertension seriously. So does the medical community, and they recognize that that there seems to be a widespread problem with medical professionals taking BP incorrectly. There are many studies done all over the world that look at the problems with getting an accurate measurement. Turns out measuring BP is a complex process requiring a bunch of things to be done correctly in order to be accurate, and that process often is not followed.

The more information you have as a patient, the more you can make informed decisions. Medical people are not infallible. If hypertension is determined by following a defined measurement methodology that I know the practitioner isn't following, that's a problem for me.

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The more information you have as a patient, the more you can make informed decisions.

+100!!!

And this thread is helping me have a better understanding of all the details!!

(Long)

Blood pressure is expressed as two numbers: systolic and diastolic. It is noted as systolic/diastolic, but it's not a ratio, it's two separate readings. Systolic is the pressure when your heart is contracted; diastolic is the pressure when your heart is relaxed. Some sources explain it that systolic indicates your blood pressure at that moment; diastolic indicates your overall cardio-vascular health. However, they can go up and down together, so if the diastolic indicated your basic health, you'd think it wouldn't change over the span of a few minutes.

What I have found recently is that if I check it as soon as I sit down, I get one reading, say 138/87. If I sit and think zen thoughts and check it five minutes later, I might get 130/90: one goes up and the other goes down. My current doctor cannot explain that.


I am reluctant to share a whole bunch of personal medical information on the open interwebz. I'll share a few details, though.

I am in my late 50s. My mother always had high BP. My father always had low BP. Diabetes runs in the family.

I give blood regularly, so I was getting my BP checked regularly. Some years ago it started creeping up to the point where the systolic was around 150. I discussed it with my doctor at the time, but he didn't think it was time to start drugs.

I went through a couple changes of doctors at my HMO, then a change of insurance and started over with a new doctor. She was awful. I only saw her once which mostly featured her yelling and scowling. The second time I tried to see her she completely refused to listen to the reason I was seeing her, so I got up and walked out. When I saw her the first time, my BP was like 160/100 which was not surprising because just walking into that office stressed me the hell out. Nevertheless, I started taking 10 mg of Lisinopril (which she said was the smallest dose, but now I see she was lying). That was three or four years ago.

I went to a new doctor. I don't know if she was doing aromatherapy or had good feng shui or just nice carpeting, but my BP at her office was always about 130/80. Or maybe the Lisinopril was working.

For reasons, I stopped seeing her and a few months ago changed doctors again. This one wants me to be under 120/70 or some such... numbers I don't think I've seen since I was in my 20s or 30s. I'm still around 135/90. She upped my Lisinopril to 20mg, then after a month, to 30. I have been checking it at home and brought her my log. Over the last month, it has been all over the board... as high as 150/95 and as low as 115/80. It seems to depend a lot on the time of day. It's high in the morning. It's lower in the afternoon. She thinks that is because I take the Lisinopril in the morning (I am on another drug that should not be taken at the same time as Lisinopril, so I do the Lisinopril in the morning and the other in the evening.

I am also on the cusp of retirement and the last few months have been very stressful as I get stuff in order for my departure. I think my stress and hence my BP will go down once I am retired. My job has been extremely stressful for the last 10 years or so.

I agree that the whole idea of telling you to relax for a few minutes to get your BP down before they measure it yields an incorrect picture of what your body is actually doing. (One of us mentioned something similar: his doctor runs a non-fasting lipid panel to see what's going on on a normal day). If your goal is to stay off the drugs, sure. Relax and think zen thoughts for a few minutes before they check your BP. If your goal is to get an actual measurement of your normal condition, don't.

I have found that after exercise or activity, I get something like 130/90. I would have expected the systolic to be high and the diastolic to be low. But I'm not a cardiologist, so maybe that does make sense.

I am also thinking about going back to doing some meditation and other mental exercises... now that I have the time and don't need them as much! I hear playing the piano is also good for your BP and mental health. I wonder if banjo is the same.

If you are not into mediation per se, one calming exercise a friend does is every evening she just sits quietly and watches a lit candle for ten minutes.


The bottom line is that in my mother's last year, she had about 18 pill bottles lined up on the bathroom counter. Pills for this, pills for the side-effects of the first pills, pills for the interaction of the second pill and something else, vitamins for the effects of taking so many pills, and so forth. And insulin twice a day. As she started to have memory problems, she could not keep track of what she had taken that day. It was a challenge. I am up to about six bottles of pills and iron and vitamins.

My goal when I'm done working is to get some exercise, lose some weight, get my stress down, and get off the BP meds.

Wish me luck.

And I wish all of you the same.

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I agree that the whole idea of telling you to relax for a few minutes to get your BP down before they measure it yields an incorrect picture of what your body is actually doing. (One of us mentioned something similar: his doctor runs a non-fasting lipid panel to see what's going on on a normal day). If your goal is to stay off the drugs, sure. Relax and think zen thoughts for a few minutes before they check your BP. If your goal is to get an actual measurement of your normal condition, don't.

I agree with you about it not being the full picture. And so does medical science, with its acknowledgement of white coat syndrome.

But....

The guidelines measure a resting BP, which basically normalizes measurement across people. Apples to apples. I guess you could have someone run X distance at Y speed for Z minutes, and then take their BP (call it oranges to oranges), but clearly that's not practical.

Hypertension is a serious problem, and medication is often the answer. But it isn't necessarily the only answer. If there are a) reasonable alternatives and b) a determined patient, there are often things that can be done that a particular doctor may still not recommend. Or even may not know about.

Some doctors will immediately push meds because they solve the problem with a minimum of disruption (for them, at least - I hear you on the number of meds and pills people end up taking). Much easier to call in a prescription than to take the time to walk you through any alternatives or to discuss ideas you might bring to the discussion. The system isn't built to support that kind of interaction; you have to fight for it.

From experience they probably know the vast majority of people don't have the discipline to try other things to reduce their BP, and that the patient will ultimately end up on meds eventually. Time will have passed and the patient may be worse off than they might have been. So they do what's expedient. My doc looked at my log of home BP measurements taken over a month's time and was satisfied that I'm in good shape as far as BP is concerned. Other docs might just write a prescription and be done with it.

I'm happy to say that my doc is open and willing to work with me when I have ideas about how to approach a problem. He takes the time to listen. He tells me his professional opinion but respects that it's my body and my decisions.

I can't ask for anything more.

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Wish me luck.

Always.