Blood pressure

  Could you please elaborate on blood pressure fluctuations. 37 y/o m, overweight, but losing. 2 a-fibs 2 years ago, none sense. BP has been hard to regulate. Meds are: Zoloft (25), Cardizem LA (180), Lisinopril (0,10,20- This is where we adjust most), & HCTZ (25). When all this began a couple years ago, I had all the test to rule out secondary hypertension. The problem is I seem to be having trouble getting the BP regulated. I know fluctuations are normal, but frustratingly, mine will go to high, we adjust, then too low, adjust, and so on. Cardio and GP have been wonderful to work with.
  Interestingly, losing weight so far has not helped BP (40# so far). I realize there is no magic # where weight loss helps, but??? What other factors should I possibly consider with BP changes. No fried stuff, minimal salt intake, and relatively no caffeine for a couple years now. Also non-smoker.
    It is not unbearable, but very aggravating. It would definitely be worse if the 2 Dr.'s were not working together or with me as they have been. I guess my question is what else can I do to get this a little more stable, and, how wide a variation in BP is acceptable before something else could be causing it? By the way, I feel fine when my BP is say 140's/90's. How do you determine what is the BP that is ideal for you as an individual? The standards are set for a reason, but are they applicable to everyone or not? Like how lower BP is fine for some but not others?

Thank you  

[Forum-M.D.-ppb]

Typically we tell our patients that the lower the blood pressure, the better, as long as the patient does not feel dizzy or lightheaded or fatigued or has no urine output.  You should make sure that your doctors checked for renal artery stenosis as a cause for labile HTN.  Weight loss is big and will help quite a bit to control your pressure, as will routine exercise and of course diet high in fruit and vegetables.  Stay away from pain pills such as NSAIDs (ibuprofen, advil etc), they can cause fluctuation in BP.  Also, alcohol consumption has a similar effect.  Stress is always on the differential for labile blood pressure.  We would like our patients to have a resting blood pressure of less than 140/90, ideally, less than 120/80.  Unfortunately, high blood pressure does not cause any pain or discomfort, therefore, going by how you feel is not very sensitive for knowing what effect Blood pressure will have on your body.  Multiple studies have shown that patients with lower blood pressure, even in the normal zone have a lower risk of heart attack or stroke.  Again, the lower the better without any symptoms of hypotension.