anxious about high blood pressure

Discussion in 'Medical Topics' started by pilot guy, Feb 7, 2020.

  1. pilot guy

    pilot guy Guest

    Hello new guy here. I have been flying for 20 years and just the over the past few years I have been experiencing high blood pressure. Since then I have been put on two different types of medication which helps for the most part but whenever its time to see the Dr I get super nervous which elevates my blood pressure. Any one else experience this or have any advice?
     
  2. AggieMike88

    AggieMike88 Touchdown! Greaser! PoA Supporter

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    The original "I don't know it all" of aviation.
    Yes to having higher numbers at the doctor office versus at home. Google white coat syndrome.

    Appropriate and significant lifestyle changes are needed to reduce the damage hypertension can and will cause. Get working on that right away
     
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  3. gdwindowpane

    gdwindowpane Pre-takeoff checklist

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    I used to experience white coat syndrome but have found a cure for me. When you get called back to the "room" what's the first thing the nurse does? Take your blood pressure. You've been in the waiting room, already sweating about the potential high blood pressure, you take the dreaded walk down the hall to the scale and get weighed (more stress because the scale can't possibly be accurate). Of course your blood pressure is going to be elevated.

    Here's what I do (at the advice of someone, I don't remember who). I take a seat and literally tell the nurse that I don't want my blood pressure taken for 5-10 minutes. I explain to her that during this time I do not want to talk to anyone and would prefer she leaves the exam room and comes back in 5-10 minutes and takes my blood pressure immediately without any conversation before or during. During this alone time I meditate (relax). I had never done this and don't do it regularly. I simply breath in through my nose and exhale through my mouth. Nice deep breaths. Keep eyes closed and think of a happy place, flying above the clouds, along the beach, whatever will relax you. When the nurse comes back hopefully she remembers to come in and just takes your blood pressure. I **** you not, your numbers will be lower. My doctors office is now acclimated to my shenanigans and I don't even have to explain the procedure anymore. lol.

    I used to regularly take my blood pressure at home and would bring in the reports to show my doctor that my blood pressure was usually quite normal. It's fairly common. Anyway, give it a shot and see if it works for you. Now if you take your blood pressure at home and it's high you really need to get it taken care of.
     
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  4. Salty

    Salty Final Approach PoA Supporter

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    White coat syndrome assumes your entire life has no anxiety events other than going to the doctor. Reality is we’re subjected to anxiety by many events every day. I wouldn’t try to get a better number. Wouldn’t you rather be wrong on the high side than the low side?

    -not a doctor
     
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  5. wrbix

    wrbix Pattern Altitude

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    Granted “white coat hypertension” can complicate our Medicals for flying, but keep in mind that the great preponderance of studies linking hypertension to mortality/morbidity were based on in-clinic BP readings. Want to negate the negative health consequences of hypertension?....then ones BP should be controlled both at home and in the office.

    -am one
     
  6. PaulS

    PaulS Touchdown! Greaser!

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    Yup, happens to me, I'm on the meds because my numbers were too high. It's no big deal taking blood pressure meds, don't fall for the horror stories you will read on the internet, ignoring blood pressure will bring your own horror story. For me worrying about it makes it worse. Generally I've found the best way to eliminate worry is to do something about what you are worrying about. I try to keep my weight down and get 1 hour full out aerobic exercise at least 4 times a week, haven't had a high reading in the doctor's office in a long time.
     
  7. Half Fast

    Half Fast Final Approach

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    Have you tried taking your BP at home and at work? At various times during the day? You really need to do that in order to get an accurate picture. It’s silly to try to treat high BP based on a single reading at the doctor’s office.

    Take your machine to your doctor’s office and compare the readings with what he gets, too.
     
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  8. 40YearDream

    40YearDream Pre-Flight

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    I agree with Half Fast and gdwindowpane, and BP readings should be taken as an average of several. All sorts of things affect BP. Activity, nerves, caffeine, food, etc. A doctor I used to see would leave me sitting in the exam room for 1/2 an hour, then take a reading.
    A home BP machine is not that expensive. Just make sure your doctor will believe the readings you get from it - bring it to the office so they can compare readings.
     
  9. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    If your doctor thinks you need BP medicine, you can try a second opinion, but your health should come first. You can check the list of approved medications, but most of the BP meds are allowed by the FAA and the approval for your condition is fairly routine.

    Yes, there are some real problems with BP screening (especially on the FAA side). Not only is there a white coat syndrome, but I've seen probably fewer doctors than I can count on one hand who can properly take a blood pressure in decades of medical exams. The sad side is that the errors almost always pile up on the "too high" side of the reading. This isn't so bad if you have a doctor that is looking at the whole patient in making a decision about what to do next (hopefully your primary provider or specialist is doing this). The problem comes with the FAA setting a capricious limit and then using a doctor who has less than an hour to evaluate your entire life's history.
     
  10. Morgan3820

    Morgan3820 Pattern Altitude

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    I take a shoot or two of vodka before. Works great
     
  11. Larry Vrooman

    Larry Vrooman Pre-takeoff checklist

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    There's a fine line between a white coat effect, and actually having high blood pressure and you need to be honest in your self assessment. At an absolute minimum if you are chalking up high BP in clinic visits to a white coat syndrome, you should be checking your blood pressure at home and keeping a log so that you have an honest assessment of what your BP is really doing over your work, home and play environments.

    You'll probably discover a few things, like your BP is usually higher in the morning. It's counter intuitive but it is what it is. It'll also cue you in about other things that might make your BP rise. Some folks get upset in traffic and that'll increase BP. If you start to see patterns in what raises your blood pressure, it'll pointing a giant flashing arrow at some potential lifestyle changes you need to make. Some are simple, like just not choosing to get upset when someone cuts you off in traffic. Others are much more difficult, like diet and exercise, or perhaps changing to a lower stress job or career.

    Over time you'll also note longer term changes that may also suggest you need to get on an exercise program, start eating right, taking off extra weight, etc. Getting older generally means your metabolism starts to slow down and you just can't eat like you did when you were younger. It also means you have to make a point to exercise - and it helps if you can find exercise activities that you enjoy, that also don't beat you up.

    Now...here's where I'll stray from the herd a bit. My wife is a nurse and she's a "med" person, and a good counterbalance to my general preference to not use meds unless other more conservative approaches don't work. But unfortunately, those more conservative approaches require a lot of motivation and self discipline. We live in America, where we prefer our fixes to be quick and easy and high blood pressure meds are by and large quick and easy fixes. The doctor will suggest diet and exercise, and perhaps some lifestyle changes - and then prescribe meds because he or she knows compliance with a diet and exercise program as well as life style changes will be low.

    However, that's also putting a bandaid on the problem rather than addressing the underlying issues. So if someone is on BP meds and is overweight, and/or working in a high stress job, and/or has a raving type A personality - and isn't willing to address those issues and make constructive changes - BP meds will just extend the glide farther to the inevitable stroke or heart attack.
     
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  12. Stewartb

    Stewartb Final Approach

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    Most doctor's staff use BP machines now. Every machine I've used is a little different. I wouldn't take those results for anything more than a trend. My GP agrees with that. If your pressure truly goes up when in a doctor's office? Go early and find a way to relax. Think about a warm beach. Whatever calms you.
     
  13. DFH65

    DFH65 Pattern Altitude

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    Went on a visit to the doctors with my wife and the nurse took her BP right away over her sweater and it was a little high. The doctor is a good friend of the family and we were over his house the other day and I told him he needed to talk to the nurse about that practice unless he just wants to sell BP meds. Give the person at least five minutes to relax and preferably remove cloths appropriate to taking your BP.

    The way I understand it BP is a wear and tear thing. Think about it, if you are exercising or working out hard your BP could be 180 or even 200+ that is not a bad thing necessarily but that is also a small percentage of the time and is actually having other benefits. If it was 150 or 160 all the time 24/7 that is more wear and tear with no other benefits.

    Also if you have bigger arms make sure they are using the appropriate size cuff. Buy a machine for home. Even at home I try to take mine after sitting for at least 5 minutes feet on the floor with your arm about heart level.
     
  14. Lindberg

    Lindberg En-Route

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    I have this machine. My doc was skeptical of home machines, but has checked this one side by side in his office several times and now recommends it to his patients:

    Omron 10 Series Wireless Bluetooth Upper Arm Blood Pressure Monitor with Two User Mode (200 Reading Memory) - Compatible with Alexa https://www.amazon.com/dp/B00KW4PO82/ref=cm_sw_r_cp_apap_1LzlIyokLVx28

    It's possible I just have a particularly accurate example, but it seems to work. It's also great that i can take or send him a list of all my readings.

    I also have a fairly pragmatic doc, and now that I'm stabilized on meds, he's advised me to only take my BP randomly no more than a few times a month.
     
  15. Lindberg

    Lindberg En-Route

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    And as far as the FAA medical exam is concerned, the FAA is pretty tolerant with hypertension. If your BP is too high for the FAA, even with white coats, it's way too high.
     
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  16. WDD

    WDD Line Up and Wait

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    When I started my pilot journey, my BP was a bit high. So I committed to 30 min of cardio 5 times a week and loosing a few pounds. The first month or so - well, I needed to get in shape to just try to get in shape. It was bad. But I had a plan and stuck with it. Got easier after time went by. My BP with a little bit of medicine is now great. Had a full physical with my doctor before my AME visit, and had my doctor write a nice letter explaining that I was solid on BP. No problem getting the 3rd class.

    BTW - a side effect is that it formed a habit that I've stuck with - not a bad thing. White Coat Syndrome? Taking a positive step / doing something will change your mind state - you'll have confidence in your head you've addressed this problem, and as a result lesson white coat syndrome as well.
     
  17. Sac Arrow

    Sac Arrow Touchdown! Greaser! PoA Supporter

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    My blood pressure hangs right at the FAA limit. My doctors have wanted me to go on BP meds but I refuse. I have a family history of high blood pressure, and nobody has died of a heart attack or a stroke.

    And I'm in good shape. I to half an hour of weights in the morning followed by an hour of cardio, and I'll often either swim 50 laps afterwards, or bike 20+ miles later in the day.
     
  18. PaulS

    PaulS Touchdown! Greaser!

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    Sac, get on the drugs, they are no big deal. Took me a couple days to get used to taking them. The studies point to a very bad outcome for you. The problem is not when you die from a heart attack or stroke, but when you live needing a drool bucket for the rest of your life. There is pretty much no downside to taking the meds. Ignore the internet warriors who claim otherwise.
     
  19. Sac Arrow

    Sac Arrow Touchdown! Greaser! PoA Supporter

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    I think they are a big deal. They almost killed my dad. His doctors gave him six months to live, and he said screw it, I'm going off these meds, and he suddenly got a lot better. That was about five years ago.
     
  20. PaulS

    PaulS Touchdown! Greaser!

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    Old folks are different, meds can screw them up much easier and usually they are on many. Best advice I got from a doc when he wanted me to start a bp med and I was like you, I had told him I didn't want to deal with side effects, he told me, "those are other people's side effects, not yours, and they are rare, if you have a problem, call me and we'll fix it." I trusted him and have never had an issue.
     
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  21. Kenny Phillips

    Kenny Phillips En-Route

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    That story is what we call "anectdotal".
     
  22. Isosceles

    Isosceles Pre-Flight

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  23. WDD

    WDD Line Up and Wait

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    Get on the meds please.
     
  24. PaulS

    PaulS Touchdown! Greaser!

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  25. wsuffa

    wsuffa Touchdown! Greaser!

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    I believe it. There are a couple of types that have major adverse effects on folks in my family.

    At some point one needs to balance quality of life vs potential length. Toxicity is real.

    I’m not saying don’t take them if they’re needed, but be prepared to insist on an alternative if there are adverse effects.
     
  26. Larry Vrooman

    Larry Vrooman Pre-takeoff checklist

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    I have two concerns with that study.

    The first is simply a built in survivor bias in the sample. The 85 year old starting population of the study by definition reached age 85 without dying of cardiovascular disease, and were arguably at lower risk than average in the first place.

    The second is discussed in the study, where it is hypothesized that subclinical heart failure may have resulted in low blood pressure. In short, high blood pressure lead to sub clinical heart failure, which lead to low blood pressure, as a an accompanying condition, but not the cause of the increased mortality rate.
     
  27. chemgeek

    chemgeek Pattern Altitude

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    Hypertension is a silent killer. Individuals usually feel fine until long term damage to kidneys, brain, etc. reveal themselves. These negative outcomes are largely preventable with early treatment. For mild hypertension, diuretics or low doses of beta blockers have virtually no side effects, and there are many different drugs to choose from to find one that is satisfactory for each individual. In some individuals simply shedding some extra pounds allows them to come off antihypertensives.

    Severe hypertension is a whole 'nother issue, and is often secondary to more serious underlying issues. Treatment of these conditions will be more challenging and will require types and dosages of drugs that cause noticeable side effects. I got to see that up close and personal with a parent. But this situation is nothing like treating mild hypertension.
     
  28. wsuffa

    wsuffa Touchdown! Greaser!

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    I agree with most of that, but even diuretics and low doses of beta blockers can have adverse effects - and may or may not be effective for various reasons. As an example, before the FDA cracked down on anything - even just automated searches of medical literature - that could make it possible to consider the effectiveness of certain drug types relative to genomics, I saw some literature where research studies (more than one) showed beta blockers ineffective for hypertension control in certain genomic types. I know someone with one of those genotypes where the doc went to max strength of beta blocker with zero effect on the BP, yet another class of drug dropped the BP by 20 points at the lowest dosage. I know someone who had adverse effects to one type of diuretic. Likewise a certain type of CCB that caused massive fatigue and listlessness.

    Hence my point about working with doc to find something that works but has tolerable side effects. Lowering BP with a certain class of drug I s kinda pointless if one is so listless that they can't get out of bed.

    I agree with all your other points, just that even diuretics and beta blockers are not always effective and side-effect-free. As you said, there are a lot of alternatives that will act differently depending on the individual.

    Yes, but again the right combination of drugs and a doc that's willing to look at both lowered BP and quality of life together will yield the best possible results.
     
  29. chemgeek

    chemgeek Pattern Altitude

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    Because humans aren't clones with identical side-effect responses, it's important for physicians to work with patients to maximize treatment while minimizing side effects. Just because a drug works well for "most" patients doesn't mean it will work well in a particular individual. I think physicians are more aware of this today than a decade ago. Having said that, there are many choices for mild hypertension so the likelihood of finding an effective and tolerable treatment plan are very good.
     
  30. wsuffa

    wsuffa Touchdown! Greaser!

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    No disagreement. Most physicians may be aware of it, but there are still a significant enough number - in some cases pushed by payers - that do trial-and-error then stop when something works, rather than finding an optimal solution. Since "solving the problem" trumps "optimized solution" the patient really needs to be their own advocate for care. Especially when "solving the problem" creates other problems, which require more and more drugs. For example, certain drug types might lower BP, but raise cholesterol and a1c, and some docs will simply presecribe more pills to lower cholesterol and a1c, which might cause leg pain, requiring analgesics. And so forth. And it can be much worse with certain other pharmacological solutions to other medical conditions. I've seen it happen with a parent.

    My comments are NOT intended to encourage folks to avoid treatment, they are intended to work with their medical provider to find the best solution for their particular circumstances. As you note, there are a lot of options out there these days.
     
  31. -KLB-

    -KLB- Pre-takeoff checklist

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    Since I don’t remember anyone pointing out this reason to manage your BP:

    https://www.mayoclinic.org/diseases...symptoms-causes/syc-20374314?page=0&citems=10

    As for readings, my Dr office still has mercury manometers in at least half the exam rooms. You don’t do much better than an instrument that directly reads against the standard. Though I’ve had the nurse comment that she shouldn’t be scary, and shouldn’t be causing a BP increase, I maintain that she does raise my heart rate and BP for another reason I’ve never mentioned to her.
     
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  32. Slayer

    Slayer Filing Flight Plan

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    let me tell you my story. In my 30s, I weigh 145 pounds being 5’ 8”. I don’t drink, I don’t smoke, I jog 3-4 times a week, I eat healthy diet. No history of blood pressure on any cardiovascular problems in my family. I never had high or elevated BP. One time I went to an urgent care for an unrelated reason and nurse told me my BP is high, I brushed it off saying “I just did my medical a week ago and AME didn’t mention anything about BP being high or even elevated”. After that urgent care visit I purchased 2 different BP machines, I got obsessed with measuring my BP: reading were all over the place. With a lot of research I realized that no medical office and staff is taking BP measurements correctly. You’re supposed to be seated and be still and relaxed with a back support for 5-15 minutes, don’t talk and then have it measured. That never happened. So every time I’d go to a doctor (for whatever reason) I started developing this white coat syndrome. Last year while passing my 1st class my AME told me “you might just have high BP, out of nowhere, you’re still passable but you’ll need meds real soon”
    I was shocked, thinking “just high BP out of nowhere???” I went and established a GP and he told me that most likely I have labile hypertension, so it fluctuates during the day with certain occurrences.... and he prescribed me a medication. I’m taking it, while maintaining my usual healthy lifestyle. But my biggest problem is - I still get anxious when it comes to the doctor visit and I still think of the worst scenarios that can play out during a medical, which by the way is scheduled very soon....
     
  33. Stewartb

    Stewartb Final Approach

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    Wife has been on BP meds since she was 19. 40 years later she decides to try a no animal products diet to help control pre-diabetes blood sugar. Coincidentally her BP improved and she's off BP meds. Sometimes managing health doesn't require taking pills.
     
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  34. Salty

    Salty Final Approach PoA Supporter

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    I've been on the keto diet for 6 months. Have dropped a lot of weight, and my BP has improved. And I'm eating a LOT more animal products on this diet. So it's not so simple.....
     
  35. TCABM

    TCABM Pattern Altitude

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    Knowing you have this fear is half the battle. While on active duty, I was keenly aware of the impact that high BP would have on me and I was routinely measured 135/78 or so.

    Then I started with just letting the doc know I was a white coat syndrome person, so he recommended some things to just standardize the process...always got my BP checked at same time of day, for me it was first thing in the morning; no strenuous activity or workouts before hand.

    Then, we usually had an off-topic conversation in the office, talking about things that relaxed me. I’ve got a great memory of floating on my boat at Crab Island that is just really relaxing. Deeper, steady breathing, eyes closed, feet flat and ankles not crossed, arm at heart level just reliving that memory. Then he’d take a second reading after a few minutes as well.


    Very quickly, I dropped to low 120s/70s every time as it became a routine.
     
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  36. Stewartb

    Stewartb Final Approach

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    Different strokes for different folks. You have to pay attention to what works for you. The only time I have a blood pressure problem is if I take Ambien. Easy solution. Don't do that.
     
  37. Lindberg

    Lindberg En-Route

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    If your hypertension is well managed, you'll have to be really nervous to be over the FAA max of 155/95.
     
  38. Velocity173

    Velocity173 Touchdown! Greaser! PoA Supporter

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    Coffee works better.
     
  39. Morgan3820

    Morgan3820 Pattern Altitude

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    Really, I would have thought the opposite
     
  40. Velocity173

    Velocity173 Touchdown! Greaser! PoA Supporter

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    No, do not drink coffee before your flight physical. That’ll most likely make BP worse. Although I do drink it before every physical and never had a problem. I’ve never suffered from “white coat syndrome” either so there’s that.