Blood Pressure Variations and Correct Measurement

[Cody]

Dear Cleveland Clinic Physicians,

Background:  Male Age 65, high blood pressure, daily medicine doses: atenonol(50mg), vasotec(25mg), hydrochlorothiazide(25mg), imdur(30mg), lipitor(20mg), and aspirin(81mg).
When I measure my blood pressure I take three consecutive measurements about 30 to 45 seconds apart.  The first measurement is always highest(150/80), the second measurement(138/75), and the third measurement(125/72).  What is the correct blood pressure?  Is it the first measurement, the average of the three measurement, or the average of the second and third measurements?  Also, I take these measurements three times a day and there is a variation.  In the morning it is always highest and about an hour after dinner(6:00 PM) it is always the lowest.  During the day the highest measurement may be 155/82 and the lowest measurement may be 106/60.  Is it unusual for blood pressure to vary this much during the day?  It seems as I am aging my systolic is beginning to creep some; however, my diastolic seems to remain normal.  Is it time to tweak some of my medications to lower the systolic or should I wait to see if this continues for a few weeks?  I first started noticing these changes for the last three or four days. Also,  my blood pressure will be lowest about two hours after a 30 minute daily jog.  Is there a blood pressure medication that would just treat the systolic and not the diastolic?

Thanks,
Cody

[Barbarella]

Cody,

Didn't want my previous post get to long so this is why I'm adding this now.

I also asked the Hypertension Specialist about the new guidelines i.e. below 120/80 - normal, 120/80 - 140/90 pre-hypertensive.  This is what he said:  For a person below the age off 55 and especially a young person he'd see to try to get the BP down below 120/80 either with life style changes or maybe with meds.  For a person 60+ yrs the cut off # WITHOUT meds for him (Hypertension Specialist) is still 140/90.  He said my arteries are not as elastic as in a 25 yr old woman.  He also told me to disregard the first reading and sit quiet for 15 minutes otherwise I would wonder what my first reading will be the whole 15 minutes I would sit there.  He said "take it, get it over with, and disregard it if its high".  After 15 minutes take it again UNLESS I still feel anxiety or feel high stressed.  

He also said it takes yrs, sometimes decades for high BP to damage your heart.  

I also asked him "why he recommends to get a TRUE reading when sitting for 15 minutes".  He said what I already mentioned in my post above, and said if a continues reading for example in a calm state is 150 syst. or more he knows the person needs to be put on meds.  But if he doesn't know the BP in a calm state, but only gets the BP# when the person is afraid at the doctor's office that doesn't tell him anything.

Last but not least, I inherited this BP problem from my grandma.  Her BP get ready for this was at times OFF THE MACHINE, when at the doctor's office it was sometimes 280 syst.  I went with her.  She lived in the country and didn't drive.  This was BEFORE BP meds.  The doctor used to tell her and me "walk home real slow".  Now a days the doctor would call an amublance.  My grandma had these episodes since she was 50 yrs old, and died at the age of 83 in her sleep.  Her at times severe high BP did not kill her.  But she was extremely lucky.  I would not recommend or dare walk around with a BP like she had at times.

[Barbarella]

Cody,

I've the same problem, am 63 yrs old, live a healthy life style, not overweihed, exercise every day and eat healthy and am on 3 different BP meds.  I saw a Cardiologist I was referred to because of severe white coat hypertension and I also saw a Hypertension Specialist.  This is what I was told:  If you are concerned about your BP the first reading even at home will always be elevated. People at times can feel calm and the first reading still can be elevated.

Here was my question to both of them:  Some doctors say your TRUE reading is what you have at your first reading because life is not always calm and we need to see what your BP is like when you are not sitting calm in a chair.  Other doctors say your TRUE BP pressure is when you are relaxed.  I'm confused, what is it and who is right??

This was the answer I got from the Hypertension Specialist and the Cardioligist agreed with him: Throughout the day nobodies BP, even people with normal or low BP will stay the same.  Your BP can rise temporarely even if you go through a very happy experience, or if you are ready to move a heavy piece of furniture, looking at that heavy chair or couch will temporarely raise your BP.  A constipated bowel movement can temporarely raise your BP and the list goes on, there were more examples he gave me but these are the ones I remember right now.

The Hypertension Specialist also told me, and this was VERY interesting to me:  Your BP meds are doing the job to keep your BP under control on a daily basis, BUT if you are extremely angry about something, have extreme anxiety about something at this very moment your BP meds will not keep your BP meds at a normal level.  It keeps the high edge off, and causes your BP to come down quicker than if you were not taking BP meds, but your BP at these extreme moments will still rise.

The next thing was VERY comforting to me, and I know you can see 10 different doctors and you will get 10 different opinions, but this was a Hypertension Specialist and this is what he said:  Its VERY rare that during a severe spike you will have a stroke.  They researched and tested body builders and during weight lifting their BP goes to 240/130 or higher and none of the weight lifters had a stroke or heart attack during weight lifting yet.  Of course he also said people with NO clogged arteries or heart disease should NOT worry about a sudden stroke during a severe spike, but should get professional help to get it down.  

Now I know there will be doctors who think different, but this was a Hypoertension Specialist who did not make light of high BP, did NOT say I should go off BP meds, but assured me, and set my mind at ease what really is going on with BP.  

[Cleveland Clinic]

Cody,

Thanks for the post.  

Its normal to have some cyclic variation in blood pressure, so the differences in the pressures are not that surprising. Sometimes, its possible to try to alter the time you take your medicines or change the dosing of medicines to try to even out the swings.  I would keep a journal in order to more precisely quantify the variations.  I wouldn't worry about the variation. Diuretics such as thiazides are good medicines to treat isolated systolic hypertension.

Inflating a blood pressure cuff on the arm can cause changes in blood pressure. That plus you relaxing as you take your pressures could both havee the effects you are seeing. If you are consistently getting a high pressure, I would believe that -- as it is most likely higher at other times of the day when your stress level is increased.

good luck