One more time for the blood pressure

[Unregistered]

Ok, I was watching the other thread on BP and I have a question that wasn't answered.

I have been watching my BP creep up over the last couple of years and it is finally time to start doing something about it. In fact I HAVE started doing something. I have started walking at least a mile a day, sometimes two. I don't have the physical fitness to do it at a jog, but I hope to work up to it. I am more than slightly over weight, again, but I am down about 10 pounds from my top and going down.

Now for the question(s). Should I put myself on medication now to get the BP down to a more reasonable level, or should I give diet and exercise and weight loss a chance first? If I start on medication, am I tied to it for the rest of my life, or when the weight comes off, and the fitness is better, can I stop taking the BP meds?

Please no judgements, and keep it civil.

 

[frfly172]

Why wouldn't you give the diet and exercise a chance before you go to medication.

 

[Unregistered]

Hypothetically speaking, my flight physical is due soon and I don't want to blow it. Also, I get the feeling from the posts in the other thread from at least one individual that it is best to knock it down NOW.

But I agree. In an ideal world, that is exactly what I would do.

 

[bbchien]

Medical certification with hypertension right now is so dumfoundedly easy. All we need is a note from your doc that says, "I am satisfied with unreg's BP control for the last > 2 weeks". NO EKG, no lab, no HTN worksheet.

Just make a judgement that your history shows that you can/cannot GET IT OFF and KEEP IT OFF. If you can delude yourself into saying, "YES", then let it go.

You can always stop a hypertension med. You are not gong into the "forest of no return".

 

[dtuuri]

Should I put myself on medication now to get the BP down to a more reasonable level, or should I give diet and exercise and weight loss a chance first?

A little over two years ago I was placed on metoprolol following a stent procedure. It made my heart all goofed up. Hard to explain the symptoms, other than at night before falling asleep my pulse was below 50. As I remember I felt like a car engine with the ignition advanced too much. I had to keep cutting the dosage in half until I felt right and my pulse wasn't too slow while sleeping. Now I just take 12.5 mg once a day in the morning and would like to get off it altogether. The reason, you see, is because I suspect my dietary changes were enough. It's the no-oil vegan diet you may have seen me mention in the past. Since I'm on the meto, I can't say for sure whether diet is enough. The combined numbers over the past five days for me and averaged from 15 random readings is 110/65 mmHg (I've been motivated to check it because of these threads too ). I'd see what diet can do before seeing the AME, but I'd see your regular doc and find out if you are considered hypertensive already. I think 140/90?

As far as walking, not jogging--I do it a lot. Someone recommended I get a treadmill and use it. I took their advice. I try to do a modified Bruce Protocol of at least 20 minutes every day at a constant 10° grade (the maximum my treadmill goes--it's old). Plus, I do a 20 minute powerwalk through the woods with my dog, up and down some hills twice a day. Oftentimes it doesn't work out to do all three walks. Sometimes weeks can go by where I cut back to a half mile per day when I'm not staying at home. But walking is my sole exercise, although I'm trying to incorporate some resistance training too. Since they stuck that restrictor plate in my carburetor, I can't seem to jog no matter what. At 66, I'm not too worried about it. More concerned about my knees. You probably can build up to it though.

dtuuri

 

[GBear286]

Ok, I was watching the other thread on BP and I have a question that wasn't answered.

I have been watching my BP creep up over the last couple of years and it is finally time to start doing something about it. In fact I HAVE started doing something. I have started walking at least a mile a day, sometimes two. I don't have the physical fitness to do it at a jog, but I hope to work up to it. I am more than slightly over weight, again, but I am down about 10 pounds from my top and going down.

Now for the question(s). Should I put myself on medication now to get the BP down to a more reasonable level, or should I give diet and exercise and weight loss a chance first? If I start on medication, am I tied to it for the rest of my life, or when the weight comes off, and the fitness is better, can I stop taking the BP meds?

Please no judgements, and keep it civil.

Discuss this with a good primary care physician. Get a home BP cuff and check it a few times a week at different times of the day and take these readings to your physician. This forum is provide general medical information and not to diagnose or treat individuals. The guidelines previously referenced provide the basic information. I may be willing to expand or clarify something from the guidelines that you or others have difficulty understanding.

 

[Brad Z]

The thing is, it's needs to be controlled no matter what. Start with the meds. Meanwhile, drop weight and increase your exercise regime. Eventually you'll be able to dial back the meds. Consider the medication a wake-up call for making some changes.

 

[NineThreeKilo]

Why wouldn't you give the diet and exercise a chance before you go to medication.

X100!

It's both amazed me and bothered me, while riding with EMS we would ask the pt to bring in their meds, 3/4 of the time it was a BAG full!

How about eat like a sane person (both quantity and quality) and be active!


Seems like nowdays no matter the issue, there is ether a pill or a app for it

 

[bbchien]

X100!

It's both amazed me and bothered me, while riding with EMS we would ask the pt to bring in their meds, 3/4 of the time it was a BAG full!

How about eat like a sane person (both quantity and quality) and be active!


Seems like nowdays no matter the issue, there is ether a pill or a app for it

Absolutely reasonable to try weight reduction, but note there are guys who keep saying they'll lose weight and ten years later the still haven't.

Which one are you is the individuals question?

 

[Geico266]

The thing is, it's needs to be controlled no matter what. Start with the meds. Meanwhile, drop weight and increase your exercise regime. Eventually you'll be able to dial back the meds. Consider the medication a wake-up call for making some changes.

Pretty sure this is going to be my course of action. I'm too pretty to be drooling.

 

[GBear286]

I don't understand why people are so hesitant to take meds for hypertension, high cholesterol or mild diabetes. You might be able to discontinue them if lifestyle changes are effective. If you ignore risk factors then don't be surprised if you end up taking a boatload of medications to treat some really nasty diseases.

 

[bbchien]

I don't understand why people are so hesitant to take meds for hypertension, high cholesterol or mild diabetes. You might be able to discontinue them if lifestyle changes are effective. If you ignore risk factors then don't be surprised if you end up taking a boatload of medications to treat some really nasty diseases.

...or drooling and inhaling your food as you fight to chew.

 

[GBear286]

...or drooling and inhaling your food as you fight to chew.

No shortage of people like these residing in nursing homes. Some of them are fairly young.

 

[DFH65]

Absolutely reasonable to try weight reduction, but note there are guys who keep saying they'll lose weight and ten years later the still haven't.

Which one are you is the individuals question?

Or there are guys who have lost the same 50-60 pounds 10 times.

 

[dtuuri]

Attn, OP:

I ran across this article tonight: http://www.drjohnm.org/2013/08/the-...g-opportunity-on-the-basics-of-heart-disease/

I wish the Federal Air Surgeon would read it. He certifies pilots everyday who are at risk of sudden incapacitation (just about everybody over 50 I'd say), but denies those who make lifestyle changes to preclude it.

When it comes to learning how to fly, give me a real good flight instructor, not a real good aeronatical engineer (but I LOVE engineers!). By the same token, when it comes to learning about heart disease, give me a doc who can explain it well--not necessarily a cardiologist (but I LOVE cardiologists!). I think Dr. John (whoever he is) did a fine job and you might benefit from the article. If your blood pressure has your attention, don't wait for chest pains! Chest pains are what got my attenton, not blood pressure--it wasn't considered high. In retrospect, maybe it was, since it was rising within the normal range over the previous years, like yours. Same with cholesterol--normal, but at the upper range limit.

My no oil vegan diet (together with a small dose of metoprolol) has my BP under control, but it also dropped my cholesterol numbers way down. I went off statins for a two month trial early this year and total cholesterol was 124 on diet alone just prior to going back on. It was around 180 at the time I started getting the chest pains.

I'm convinced the diet works. Research www.heartattackproof.com .

dtuuri

 

[Geico266]

I don't understand why people are so hesitant to take meds for hypertension, high cholesterol or mild diabetes. You might be able to discontinue them if lifestyle changes are effective. If you ignore risk factors then don't be surprised if you end up taking a boatload of medications to treat some really nasty diseases.

I have heard there are sexual side effects to BP meds. Any truth to that?

I'm pretty active ( if you know what I mean) and I would hate to disappoint.

 

[douglas393]

Everything written is good advice. However, you do not mention how high your blood pressure is and is this based on one reading or many readings. As Dr. Bruce and the other physicians on this forum can tell you, blood pressure is not a static number, it is dynamic and changes with all sorts of exterior and interior stresses. If you pressure is high then getting it down for your flight physical is fine and dandy, however, that does not solve the issue: you have high blood pressure and need to keep it down for reasons other than flying. You need to see your primary doctor, and discuss this with him/her. Then your appropriate options of keeping your blood pressure down can be discussed with you as they pertain to you and are SAFE for you. Dieting with an appropriate exercise regimen may be all you need, or not; only be consulting your family physician can you KNOW what is appropriate and SAFE for you.

 

[GBear286]

I have heard there are sexual side effects to BP meds. Any truth to that?

Beta blockers and diuretics have been known to cause problems. This is probably less of an issue with the newer beta blockers. I avoid prescribing high doses of diuretics as the antihypertensive effect does not increase linearly with dose but the side effects get much more problematic at higher doses. ACE inhibitors (lisinopril), Calcium channel blockers (amlodipine), and ARBs (losartan) are usually not an issue in tems of sexual function. The good news that ARBs may actually help.

Drugs known as ARBs (angiotensin II receptor blockers, like Losarten) are not only unlikely to cause erection problems, but they may actually improve sexual function in men with high blood pressure.
A study published in the American Journal of the Medical Sciences looked at the drug Cozaar, an ARB. At first, just 7% of men and women in the study said they felt sexually satisfied overall. After 12 weeks of Cozaar, about 58% said they were sexually satisfied. The percentage of men who reported having erectile dysfunction dropped from 75% to 12%.
Another study compared the drug Diovan, an ARB, with Coreg, a beta-blocker. The study compared the effect of the two drugs on blood pressure and frequency of sexual intercourse.
The drugs controlled blood pressure equally well. But people who took the ARB reported having sex more often during the 16 weeks of treatment. They said they had sex about eight times a month before, and 10 times a month after. People taking the beta-blocker had sex much less often: eight times a month before, and four times a month after. http://www.webmd.com/erectile-dysfunction/medicine-ed

Atherosclerosis is a major cause of ED and treating hypertension should reduce one's risk of developing that disease. This is another reason that smoking is really bad.

Here's some more info: http://www.mayoclinic.com/health/high-blood-pressure-and-sex/HI00091

 

[rwellner98]

I don't understand why people are so hesitant to take meds for hypertension, high cholesterol or mild diabetes.

High cholesterol in the absence of a previous heart attack is a pretty different beast from those other two. Serious people sometimes make the decision not to take statins in that circumstance.

 

[PaulS]

I have heard there are sexual side effects to BP meds. Any truth to that?

I'm pretty active ( if you know what I mean) and I would hate to disappoint.

Not in my experience, (beta blocker) I think something to consider when reading about those side effects is that these drugs are sometimes used to treat pretty sick people who may be predisposed to these problems from their illnesses. Plus I believe high blood pressure and the ensuing difficulties from having it untreated are pretty much a guaranty that you will have those types of problems.

I'm not a doctor nor in the medical field, but I did once have a doctor admonish me for hesitating to take a medicine because of what I read on the internet. He told me that those were other people's side effects and not to worry about it unless it happened to me, which the odds of having a problem was very small. He said if I had a problem we would adjust, I've never had a problem.

 

[GBear286]

High cholesterol in the absence of a previous heart attack is a pretty different beast from those other two. Serious people sometimes make the decision not to take statins in that circumstance.

I agree that for most people who do not have known vascular disease lifestyle changes, especially diet and exercise, are the first step. The exception is that many physician believe that all diabetic patients should be treated with a statin unless there is a contraindication. The rules for primary and secondary prevention differ unlike the rules for hypertension.

Many patients are very interested in avoiding the first heart attack and may be inclined to have a low threashold for taking a statin. There is some evidence that this might be a reasonable approach.

Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins. http://www.ncbi.nlm.nih.gov/pubmed/23440795

Here is a summary of the official guidelines: http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdf

If you want to understand the reasoning behind the recommendations look here: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04.pdf

 

[steingar]

Problem is what has to change isn't diet, it's lifestyle including diet. If one doesn't go into the program with the expectation of permanent life style change, one will fail. Might as well skip the hardship and hit the meds.

Or get really serious about living healthy.

 

[AggieMike88]

I don't understand why people are so hesitant to take meds for hypertension, high cholesterol or mild diabetes. You might be able to discontinue them if lifestyle changes are effective. If you ignore risk factors then don't be surprised if you end up taking a boatload of medications to treat some really nasty diseases.

Hindsight has me wondering the same thing, and about myself especially.

Before getting the desire to get my PPL, I had not visited my PPC for a thorough physical in a very long while. Knowing that I needed to get records for my existing sleep apnea, what was in my mind a short visit with the doc to get the records turned out into a full physical that discovered the real reason behind a recent unexplained 20-25 lb weight loss and why I was as thirsty as a dehydrated camel. Doctor made the diabetes diagnosis, got me on Metformin, Pravastatin, and Lisonopril. So in a sense, my desire to fly saved some internal organs, possibly a foot and my eyesight, and definitely my long term life.

Fortunately, it's all under under control and my numbers are on track to possibly qualify for the CACI issuance for DM2.

But I agree with what you're saying, Gary. If I had been more willing to go to the doc, more willing to be on a preventative prescription, I might be in a considerably healthier situation.

I have no direct information about comparing today to past decades/generations, but my observation is that we as a culture have become considerably more complacent about being proactive for our health. I guess you could say the "living in the now" financial point of view has definitely set up shop in the personal health realm.

 

[AggieMike88]

Problem is what has to change isn't diet, it's lifestyle including diet. If one doesn't go into the program with the expectation of permanent life style change, one will fail.

+1 to that.

One Type 2 I know of has already had 2 or 3 cardiac events requiring hospitalization, has already had 2 or three toes on one foot amputated, is in danger of losing the foot, told me he has an A1c of nearly 14%, and still eats the same quantity/type of foods that likely got him into this situation, and refuses to exercise. And recently his wife informed me he is in stage 2 renal failure. He is my #1 poster boy of where I do not want to be with my Type 2.

His wife is also Type 2, stable on meds, but not really doing much to improve things due to a "we make too little money to afford healthcare so we are not able to change our selves" attitude.

And what makes me sadder is that they hav 2 kids 8 and 5 years old. What are they being taught by example and might be doomed to repeat?