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Health See other Health Articles Title: High Blood Pressure: How Low Should You Go? Article at link. Following are selected comments: James I worked in an ICU for 14 years. When we would admit someone with "high blood" the doc would intravenously lower the BP. Some 60 year old guy that had a history of a systolic BP in the 150 - 160s and we would lower him to 120 -130. Next thing ya know his urine output was falling ( which set up a whole different medical treatment) and the his kidney labs would get out of order. If he stayed in the ICU and on that low of a BP next thing we saw was the beginning of kidney failure. His kidneys were used to functioning of the higher pressure. bring his BP back up to his "normal" and the kidney output picked back up. Treating numbers without treating the patient can be fatal.+27 [Factsnotbull] well...you don't know everything about the treatment. Lowering BP in ICU was due to HEART FAILURE not just the high bp. The BP and serum volume had to be lowered to save the patient's life. And yes, this very often in heart failure cases results in renal problems.+6-3 [Arnold] My wife used to work for a European-trained doctor, and he used to tell new residents that, when it comes to treating older people, "Don't try to make them too young". In other words, there is a normal range for such things as blood pressure that varies by age, and trying to lower BP below that in an older person will cause more problems than it fixes, from dizziness on standing up, to actual kidney failure.+6 [Factsnotbull] both are bad. The top number, if high, WRECKS your heart muscle. The bottom number, if high, damages your arteries.+3-2 [Brain_Salad] Medical physiology is grounded in science so there's a lot of common sense (for the most part) behind the way the body operates and does what it does to maintain overall equilibrium (or homeostasis, to use the appropriate medical term). So these findings should not necessarily be a surprise. The kidneys are a vital organ for survival and a given range of blood pressure is required to push things through the resistance the blood flow encounters as it passes through the glomeruli (those microscopic bunched up little filtration units in the kidneys). Too low a pressure is going to be impeded by the back pressure resistance in the kidney vascular bed so filtration is going to be compromised. Too high a pressure will damage these fragile glomeruli and bigger molecules like proteins will get forced out, among other things. A good analogy would be a reverse-osmosis filtration system. It requires a pump operating at a high pressure to filter the passing fluid. I'm assuming that you shouldn't lower BP too much in older people in general because their arteries tend to be stiffer and thereby create enough back pressure throughout the circulatory system, requiring greater pumping force from the heart to push things along. Simple plumbing and fluid mechanics, that's all. My in-laws are in their nineties and have an average systolic of greater than 140 and between 85 and 90 diastolic. I had thought once of telling them to cut the salt and fat and other things to trim that BP but that'll probably kill them at this point. (There are overcooked veggies-yuck-along with fruits and olive oil in their diet though) Eye of Horus The big problem is that doctors don't follow the guidelines for taking BP properly. The body and the heart must be relaxed prior to taking the 1st reading. This takes anywhere from 5 to 15 minutes. After the 1st reading there is a 3 to 5 minute wait before taking the 2nd reading and another 3 to 5 minute wait before the 3rd reading. Then the readings are averaged out. It is also known that the BP readings taken at home are closer to what the BP actually is. Further, the only way to get the best idea of the BP is to have the portable cuff for a day. What is generally done in the doctor's office is one reading is taken and that is considered correct. To assume that someone has HBP with one reading taken in a doctor's office is incorrect. The readings must be taken over time not at one instance. Research has found that a lot of things can affect BP. One of the most common is the environment (e.g. doctor's office). Studies done in Australia and Spain have found that the BP taken by a nurse can be as high as 19 points higher than what it actually is and BP taken by a doctor can be as high as 27 points above. What this all means is the getting the correct BP is not that easy. The best thing is to keep track of your own BP so you can show the doctor the differences you get.+12 [Factsnotbull] that's VERY true. They send a "nurse" in to quickly check your pressure. I've seen them drop the pressure by about 10-15mm/hg per second (2 is correct). Then quickly say "yep, you have high blood pressure.....I'm writing you a script for xxx" It does happen too often.+5-1 [JimR] After raising your blood pressure by making you wait for 30 minutes past your appointment time, they rush you to an examining room and immediately put the cuff on your arm while you are still catching your breath from the fast walk. Yep, you have high blood pressure.+4 [Steve] Apparently I have this "white coat hypertension". When I was a baby my kidneys got damaged and as such have high blood pressure - now 39 year old. I'm currenly on Lercadipadine, Losartan & Bispropolol (sp?? - oh and Allupurinol) - my BP is usually about 145/93 when it gets taken at the docs. I recently had a 24 hour BP monitor fitted and apparently while not at the docs during the evening it dropped to about 110/60. The doctor told me to act as normal as possible so I went about my usual routine. Strangely I have also lost 5 stone in weight and I'm now about 82kg and swim 5 days a week and my BP has gone up slighly and my colestorol has gone through the roof. My heart rate is around the 50bpm mark too. >p> xena If you read older encyclopedias, blood pressure was tied to your age, not insurance companies schemes to saddle you with 'pre-existing conditions' so they could weasel out of coughing up what you paid them for. The old rates were tied to your age, more or less. If you were 40, blood pressure of 140 OK, 50, pressure of 150 just fine. Now everyone has to have the same blood pressure they had when 20, 120. Oh-and notice how this fits the older number system, but leaves out the rest? Another scam? One which will sell expensive medicine, for sure+13-1. [Howard K] That's why before Lipitor, cholesterol had to be under 300. Now with Lipitor it was 200. When sales went down, it was 100 and now they are trying to use it for other problems. If the FDA says it's OK - - -Run the other way. FDA and pharmaceutical companies have way too close a relationship.+8 [abeil2] xena BP used to be the norm 140/80 before 2003, 100 plus your age if you are 70 YR BP would be 170. to make more $ it was changed.+5 Arnold The usual reason for higher blood pressure in older people is simply the accumulation of arterial plaque is greater in that age group than in younger people, so a higher BP is needed to push the required amount of blood through the system. +2 Factsnotbull Another thing to consider is that blood pressure under 140/90 is not considered dangerous, in and of itself by ANY qualified and educated medical professional. So...the whole premise of this study seems rather disingenuous. I know of exactly ZERO qualified medical professionals who say 130/80 is harmful in and of itself. The statement about "pre-hypertension" is this- "pre-hypertension increases the risk of developing hypertension in the future". So...does this study somehow show that pre-hypertension doesn't raise the risk of hypertension? Seems like a study in search of a headline to me.+6-1 [Phobiafrenzy] Bring your BP down by drinking Hibiscus flowers tea. Just add two or three pieces of dry flower in a mug or teapot and add a little boiling water to it. Let it soak for at least 15 or 20 minutes then add more water up to a cup and squeeze the flowers with a teaspoon to the wall of the cup and discard them. Add a little sugar or honey if you would like and drink this twice, in the morning and in the evening. It brings your BP down by 10 or 15 points. You can make this drink and let it cool down (keep it in the fridge) for one or two days and the cold drink is very tasty (Hibiscus flower has a sour taste). Physicians, although they claim to know a lot, they don't. They just regurgitate what they have learned from the books to the patients. They have no critical thinking skills and they try to make money for themselves and Big Pharma. Take your health into your hand.+5-2 Jim I would like a doctors opinion, if any are reading this. In marginal cases, aren't the known and unknown affects on the other body organs a factor in blood pressure control? I mean, if you are at systolic 140, and looking forward to 40 years of being on BP meds, do you agree THAT risk may outweigh the risk of marginal BP?+3 [SleepyDoc] Jim: First I am a cardiometabolic specialist (I am a physician manage patients with diabetes, heart disease, high blood pressure and dyslipidemia). I am going to type a bit since I am given to long windedness. First: at one time we called high blood pressure that came with age "essential hypertension" because we thought it went up because your body needed more pressure to perfuse the organs. In other words the increase in blood pressure was "essential". Many people will get high blood pressure who never had high blood pressure. At the age of 55 or so even if the person currently does not have high blood pressure there is greater than 90% chance that they will develop high blood pressure. There are risks to blood pressure medicines but they vary greatly and there doesn't seem to be any significant risk to long term use of most of them without any inciting factor like dehydration. One thing the article mentions is "heart disease" not strokes. We do know that going lower with blood pressure reduces the risk of strokes. In fact, when it comes to hypertension everyone seems to worry about heart attacks but you are more likely to have a stroke from high blood pressure than to have a heart attack. The people we have to be careful with in lowering blood pressure are people with significant heart disease. The "coronary arteries" are the small arteries that feed the actual muscle to the heart itself blood. For people with significant plaque and on several medicines it is a concern if we drop the blood pressure too much it might incite a coronary event. With all that being said here are what you have to determine. 1) if you have more than 40 years of life left your blood pressure is likely to continue to increase. The damage from high blood pressure is an "area under the curve" effect, meaning the longer the pressure is elevated the more likely damage. It is sort of like a kink in the water hose. Damage from that won't happen in a day, but keep it kinked while running water and you will eventually have a problem. 2) the small problems from hypertension are (this is not inclusive): erectile dysfunction, ischemic damage to the brain (small infarcts) that lead to early dementia, slowly enlarging your heart because the heart has to "hypertrophy" or increase in size to fight against the pressure. Headaches. Slow kidney damage. As you can see some of the small problems become very big problems 3) the big problems from hypertension: stroke, heart attack, renal failure, ischemic damage to the vessels in your legs causing peripheral vascular disease (especially if you smoke or have diabetes) 4) risk from blood pressure medicines are mostly small. Check labs occasionally to make sure everything is ok. If you don't drink a lot of water and you take a diuretic (like HCTZ/hydrochlorothiazide or Chlorthalidone) you might get dehydrated (This happens more in the elderly and frail because they have a decreased thirst response). Check labs to make sure your potassium isn't too high if taking and ACE or ARB inhibitor. If the potassium is elevated it is normally minor. In general the opposite of what you are suggesting is true. The longer you have the elevated blood pressure the more important it is to treat. However, the converse of the argument is what we debate about at meetings. Basically, if you are 85 years old and we just diagnosed hypertension would you actually treat this person? The answer.....it depends. That is why history is so important as well as other risk factors and medical issues.+3 [Cat] You can help me Doc. My BP goes very high at the DR. Whitecoat syndrome. I take propranolol 20mg 2x's a day. My BP at home. 136/100. Mind you I get nervous looking at a BP machine. My DR upped my med to 30mg 2x's a day. My problem is I have a phobia. The only med I take is propranolol. I'm afraid to take the other 10mg. This has been going on for over a month. Everyday 2'xs a day I freak out and won't take it. I'm afraid it's going to make me tired. I'm just afraid. I've had my bp as high as 175/115 at the dr I get so nervous. Thanks to a dentist who scared me to death. I have no real health issues. I'm a 56 year old women. Help please. [SleepyDoc] Cat: Be patient with my long windedness. First it would be important to know your family history. Does/did your father/mother/brother/sister have high blood pressure, diabetes, high cholesterol/ heart attacks/strokes or any other medical conditions? Second do you smoke? Do you have any other medical conditions? Do you take any over the counter medicine, herbal medicine or vitamins. Now I will talk briefly about hypertension in america vs england. White coat hypertension is real and some people get over treated because of it, in England they have found it cost effective to do at home blood pressure monitoring to see if the elevation of blood pressure is white coat syndrome or not. In the US we try to get patients to take their blood pressures at home or at a drug store or something to check (which is very different from what england does). Another important point that is often missed is "how" is the blood pressure being taken. First you have to have the correct "cuff" size. If you are either small or rather large they might be using the wrong cuff size. Second your arm should be at heart level and resting, not elevated in the air and not above or below the heart level. If it is above the heart (a trick some people try to pull with life insurance companies when they do physicals) the pressure will be artificially low. IF your arm is below heart level it will be high. third make certain you have rested for about 5 minutes. You want to be relaxed. many offices are so rushed that they take your blood pressure as soon as you sit down after they weigh you (and nobody is relaxed after seeing their weight). fourth: I would check to make certain you aren't taking NSAIDs (Alleve, ibuprofen, naproxen, naprosyn, advil bc/goody powders etc) for some people this can elevate their blood pressure especially with chronic use. Not tylenol. Those are some basics to look for. now, about propranolol. Propranolol is a beta blocker. It is "non selective" so it hits the two main type of beta receptors. It really isn't used as a blood pressure medicine very often. It is used for anxiety sometimes because it controls the heart rate, and it is used sometimes in persons with rapid heart rate leading me to another question. How fast is your pulse? Some people will take propranolol when they have to do public speaking because it keeps them from sweating a lot and getting light headed. It sounds like your doctor may be using it to decrease your anxiety hoping that it will control the blood pressure. You may want to discuss that with your physician. In the meantime I would suggest you check your blood pressure often at home (if you can afford/get a machine the arm cuff is superior to the forearm/wrist cuffs) or at a local pharmacy. You may need to do this often so that you become relaxed around the machine itself. Since Jim was asking about side effects I feel that I should mention them. Propranolol (the beta blockers in general) typically aren't used as a first choice for blood pressure control because they don't work as well and they have clear side effects. Since they slow the heart rate down they can act like a governor for the heart and not allow it to speed up when you want. For instance if you run up a flight of stairs you may find that you simple don't have the energy because beta blockers (propranolol and others) take the steam out of you. Some can lead to depression because of their action. If you are on thyroid medicine or have diabetes they have other problems. That is NOT to say they are bad drugs. If you have a rapid heart rate the benefit outweighs the risk. If you have had a heart attack beta blockers help protect from another heart attack (typically use metoprolol or carvedilol) I do have to say that I am giving you food for thought and NOT suggesting you stop any medicine or change anything. If you want to answer some of the questions I posed I might be able to say more [Keith] At 68 my BP is usually 125/55 & 48 pulse, chlos= 88-95 with good chlos. on the high side. How? eating 2 cup veggies every meal and 3 cup fruit daily. No not a vegan--they are disgusting. I eat only real foods, fresh/fresh frozen. No white bleached flour/no wt. refined sugar. Stevia sweetner and whole grain flour & breads. No man made garbage chemical lased foods. rugbyfox Interesting study however, they give no indication of the diastolic blood pressure which is more important because systolic blood pressure will change depending on activity - if your in the gym working out systolic blood pressure will increase and vary depending on whether you are under stress/anxiety. People can have higher blood pressure readings when a Dr is taking their blood pressure. Another point is the pharmaceutical companies are very powerful and love drug dependency. Its interesting that they don't invest in drugs that cure or solve a health problem with a course of medication. Instead they like life dependency which increases revenue and profitability. The other problem with these drugs is that they can cause serious side effects which no one really takes any notice of in the medical profession. When you consider that the medical profession does not know why people get hypertension e.g..if you eat healthy, don't drink alcohol, low salt diet and there is not hereditary reasons they cant tell you why you have hypertension. It seems there is little research in finding out what causes it as they rather make billions on drug dependency Post Comment Private Reply Ignore Thread
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