Any Blood Pressure Specialists Here?

U

Unregistered

Guest
So here's the deal:

I'm in my early fifties, could stand to lose about 10# but am in relatively good shape and health. I'm 6'-2", 205#.

I've always been a 125/75 guy. I have a good record of my history because I give blood religiously, every 8 weeks, and was always in that range. (Well, at least I did give blood regularly until I went on BP meds three months ago.)

Then three years ago my pressure began slowly climbing. Again, the check when I gave blood every 8 weeks blood provided a good record. It got up to 145/90.

Then comes this year's physical in February, my pressure is 140/85, I tell my primary physician that it's actually been ranging a little higher than that and he prescribes 20mg lisinopril. I bought a BP cuff and started tracking it. Immediately my pressure drops back down to about 120/70 but then slowly starts creeping back up. Within three weeks it's right back at 145/90.

So, I make a follow up appointment with my doc and he doubles my prescription to 40mg. Again my pressure immediately drops to 120/70 but, again, slowly starts creeping back up. Slower this time and not quite all the way to 145/90 but, six weeks after beginning the higher dosage, I'm averaging around 135/85.

All above readings are at rest with a pulse of 65 to 70.

Thankfully, my pressure has never made it to the FAA's limit of 155/95 but I'm still concerned, not for flying but rather for general health.

Any ideas from the medical professionals here?
 
You might have "white coat hypertension". Take you BP once a day at different times of the day after sitting quietly in a chair for 15 minutes. Don't take it for a couple of hours after exercising. Take an average of 10 or more readings.

In the meantime start exercising regularly. Cut down your sodium intake and increase your potassium intake. Cut down on excess fat intake and lose weight. If you consume alcohol limit your intake to less than 10 drinks a week and less than 2 a day.
 
Gary F said:
You might have "white coat hypertension". Take you BP once a day at different times of the day after sitting quietly in a chair for 15 minutes. Don't take it for a couple of hours after exercising. Take an average of 10 or more readings.

In the meantime start exercising regularly. Cut down your sodium intake and increase your potassium intake. Cut down on excess fat intake and lose weight. If you consume alcohol limit your intake to less than 10 drinks a week and less than 2 a day.
Click to expand...

It is interesting. I was an ovo-lacto vegetarian, but was still prehypertensive. I looked up keywords "vegan" and "blood pressure," and most of what I found was that vegans have problems with LOW b.p. I checked my diet, and noted that I ate an egg every day, and also had lots of cheese and salty foods.

So, the past week, I've moved to a 90% vegan diet. I am also planning to get that resparate thing that people have talked about here.

I'll report back. Hope I can stay on this diet! (I already exercise about 5 hours a week.)
 
Fortunately, Lisinopril is on the FAA's approved list based on the standard FAA hypertension evaluation. However, when you go for your next FAA medical, the AME is going to go through the FAA Hypertension Worksheet to decide if s/he can issue or not. You might want to review it yourself with the physician with whom you are working on your blood pressure issues so there are no surprises at the FAA exam. In fact, you should do that now in order to confirm that you are still fit to fly per 14 CFR 61.53. If you need more information on any of that, the real expert is Dr. Bruce Chien, whom you can find either on the AOPA Forums (medical section) or at http://www.aeromedicaldoc.com.
 
Last edited:
Gary F said:
You might have "white coat hypertension". Take you BP once a day at different times of the day after sitting quietly in a chair for 15 minutes. Don't take it for a couple of hours after exercising. Take an average of 10 or more readings.

In the meantime start exercising regularly. Cut down your sodium intake and increase your potassium intake. Cut down on excess fat intake and lose weight. If you consume alcohol limit your intake to less than 10 drinks a week and less than 2 a day.
Click to expand...

I eat a banana every day, and take a multi-vitamin. Is that sufficient for increasing potassium, or are you talking something more significant than that?
 
nddons said:
I eat a banana every day, and take a multi-vitamin. Is that sufficient for increasing potassium, or are you talking something more significant than that?
Click to expand...
I've been told the average Banana has about 1 mEq per inch. The daily intake of potassium for the average person (not those not on a potassium restricted) diet is 50 to 100 mEq per day. Wegmans NoSalt has about 34 mEq per teaspoon if my calculations are correct. http://www.wegmans.com/webapp/wcs/s...play?productId=351678&storeId=10052&langId=-1


The usual dietary intake of potassium by the average adult is 50 to 100 mEq per day. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 or more mEq of potassium from the total body store.
Dosage must be adjusted to the individual needs of each patient. The dose for the prevention of hypokalemia is typically in the range of 20 mEq per day. Doses of 40 to100 mEq per day or more are used for the treatment of potassium depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose. Because of the potential for gastric irritation (see WARNINGS), potassium chloride extended-release capsules 10 mEq should be taken with meals and with a full glass of water or other liquid.
Patients who have difficulty swallowing capsules may sprinkle the contents of the capsule onto a spoonful of soft food. The soft food, such as applesauce or pudding, should be swallowed immediately without chewing and followed with a glass of cool water or juice to ensure complete swallowing of the microcapsules. The food used should not be hot and should be soft enough to be swallowed without chewing. Any microcapsule/food mixture should be used immediately and not stored for future use. http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=16484
 
Gary F said:
I've been told the average Banana has about 1 mEq per inch. The daily intake of potassium for the average person (not those not on a potassium restricted) diet is 50 to 100 mEq per day.
Click to expand...
That's a lot of bananas -- I suspect there would be other issues arising if you ate that many. But it would give you plenty of time to catch up on your aviation magazine reading.
 
Bananas are a good source of potassium, but nowhere near the best. See this list: http://www.healthaliciousness.com/articles/food-sources-of-potassium.php

If you eat more dark greens and beans, you'll be good. You might not have any friends, but your potassium will be just fine. Don't forget magnesium, by the way.


Gary F said:
I've been told the average Banana has about 1 mEq per inch. The daily intake of potassium for the average person (not those not on a potassium restricted) diet is 50 to 100 mEq per day. Wegmans NoSalt has about 34 mEq per teaspoon if my calculations are correct. http://www.wegmans.com/webapp/wcs/s...play?productId=351678&storeId=10052&langId=-1


The usual dietary intake of potassium by the average adult is 50 to 100 mEq per day. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 or more mEq of potassium from the total body store.
Dosage must be adjusted to the individual needs of each patient. The dose for the prevention of hypokalemia is typically in the range of 20 mEq per day. Doses of 40 to100 mEq per day or more are used for the treatment of potassium depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose. Because of the potential for gastric irritation (see WARNINGS), potassium chloride extended-release capsules 10 mEq should be taken with meals and with a full glass of water or other liquid.
Patients who have difficulty swallowing capsules may sprinkle the contents of the capsule onto a spoonful of soft food. The soft food, such as applesauce or pudding, should be swallowed immediately without chewing and followed with a glass of cool water or juice to ensure complete swallowing of the microcapsules. The food used should not be hot and should be soft enough to be swallowed without chewing. Any microcapsule/food mixture should be used immediately and not stored for future use. http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=16484
Click to expand...
 
I liberally use Nosalt instead of table salt. It has a bit of a metallic taste which takes some getting used to. Morton makes Lite Salt which is half sodium and half potassium. Not everybody can safely use potassium containing salt substitutes. Those with reduced kidney function or taking certain medications. The ratio of sodium to potassium intake may have an effect on blood pressure.

In your battle against high blood pressure, sodium (salt) is your enemy. Controlling that enemy is your primary weapon, but you also have an ally that many people don’t know about: eating more potassium.
“More and more, we’re realizing how important potassium plays a role in lowering blood pressure,”
http://www.heart.org/HEARTORG/Condi...um-Salt-More-Potassium_UCM_440429_Article.jsp
 
Gary F said:
Not everybody can safely use potassium containing salt substitutes. Those with reduced kidney function or taking certain medications.
Click to expand...

I'm on spironolactone and was told to avoid salt substitute products.
 
Bill Jennings said:
I'm on spironolactone and was told to avoid salt substitute products.
Click to expand...
That is a potassium sparing diuretic and if you consume excess potassium your levels could increase to dangerous levels. Many other medications affect potassium levels. If unsure ask your physician or a pharmacist.
 
Gary, please correct me if this is wrong, but isn't it true that if most of what one eats is plant and legume-based, with a good variety, and if one avoids processed foods, that the daily intake of potassium and magnesium shouldn't be an issue?
 
spiderweb said:
Gary, please correct me if this is wrong, but isn't it true that if most of what one eats is plant and legume-based, with a good variety, and if one avoids processed foods, that the daily intake of potassium and magnesium shouldn't be an issue?
Click to expand...
You are probably correct. The problem is that very few people in this country eat anything that resembles a healthful diet.
 
If you want to read more into it then you will ever need look up the "JNC 7 report on hypertension" You can browse through the many sections that pertain to treatment or prevention.

Although the JNC 8 report is now out, I think 7 would be best as there is a lot of confusion and disagreements regarding the 8 edition.

Good Luck
 
Gary F said:
You are probably correct. The problem is that very few people in this country eat anything that resembles a healthful diet.
Click to expand...

Seems about right. When I first became a "vegetarian" 20 years ago, I really was a non-meat-eater. I ate mac and cheese, pizza, things dripping with sauce, etc. I wasn't eating meat, but I sure wasn't eating healthy!
 
spiderweb said:
Seems about right. When I first became a "vegetarian" 20 years ago, I really was a non-meat-eater. I ate mac and cheese, pizza, things dripping with sauce, etc. I wasn't eating meat, but I sure wasn't eating healthy!
Click to expand...
I was a vegitarian for about 2 years. I ate a lot of bagels and gained weight and my cholesterol numbers actually got worse. I think one could eat a 5 lb bag of sugar each say and still technically be a vegan but that's not a good diet.
 
I recommend try walking 30 min every day, cut out caffeine entirely unless via green tea product (due to overwhelming additional positive health benefits with green tea) and cut out white sugars as much as possible.

WEEK before FAA Medical, NO sugar NO caffeine of any type and lots of water every day. Also walk every day

re-check BP, will likely be much improved
 
Also be sure to get an AME who knows how to measure blood pressure. In thirty years since I learned how to do proper blood pressures (read a good AMA article on the subject when I was in paramedic training), I've found I think exactly ONE doctor who ever did it properly. The problem is that errors from bad procedure all mount up on the high side (sort of like the right turning tendency in aircraft) and this is bad when the FAA sets an arbitrary line in the sand. (We as paramedics on the other hand are sensitive to false high readings, hypertension won't kill you while you are in our care, but hypotension certainly will).
 
Gary F said:
I've been told the average Banana has about 1 mEq per inch. The daily intake of potassium for the average person (not those not on a potassium restricted) diet is 50 to 100 mEq per day. Wegmans NoSalt has about 34 mEq per teaspoon if my calculations are correct.
Click to expand...

I use potassium chloride instead of sodium chloride in my water softener. I'm not sure how much potassium I get in my diet as a result but surely it's better than the sodium by product.
 
flyingron said:
Also be sure to get an AME who knows how to measure blood pressure. In thirty years since I learned how to do proper blood pressures (read a good AMA article on the subject when I was in paramedic training), I've found I think exactly ONE doctor who ever did it properly. The problem is that errors from bad procedure all mount up on the high side (sort of like the right turning tendency in aircraft) and this is bad when the FAA sets an arbitrary line in the sand. (We as paramedics on the other hand are sensitive to false high readings, hypertension won't kill you while you are in our care, but hypotension certainly will).
Click to expand...

You mean like sitting still for 15 minutes prior? Usually the drill is the "assistant" comes into the exam room and after running through some other tasks ("pee in the cup " (why?), "get up on the scale, come over here and read this eye chart through a machine, now jump up on this table so I can get your blood pressure".

Maybe it's just me, but I get a little worked up with the cuff cranked tight on my arm and then I feel the pulsing. I wonder if that reaction unduly results in a higher reading. Maybe that's part of the "test".
 
flyingron said:
Sorry, brain fault on my part. Left turning tendency, right rudder correction.
Click to expand...

I did the same thing this morning, typed "north" of Dillon when I meant south. Woke up and caught it before posting but it was a near thing. Anyway, thought this one was funny mostly because it's something we drill in during primary then rarely discuss again.
 
Common sources of error (in order of occurance by my opinion):

Failure to support the arm properly.
Failure to properly center the cuff bladder over the artery.
Excessive inflation.
Repeated inflation.
Patient not at rest.
 
Gary F said:
I was a vegitarian for about 2 years. I ate a lot of bagels and gained weight and my cholesterol numbers actually got worse. I think one could eat a 5 lb bag of sugar each say and still technically be a vegan but that's not a good diet.
Click to expand...

A great point.

I've been a vegetarian for 25 years. It took about five to obtain a skill you must have if you want to stick it out--learn to cook and prepare appealing meals!
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top