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Heart Disease (Expert Forum)
How low should my BP be?
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How low should my BP be?
by Christie2004, Aug 07, 2005 12:00AM
I was diagnosed as mildly hypertensive a few years ago (now 47 y/o, ns, nd, normal weight and lipid profile). I ran about 150-160/90's before, now run 130-140/mid-upper 80s on 20 mg Lisinopril qd.
I feel like this isn't low enough. I recently had an MRI/MRA of my head for unrelated reasons, and the report came back with changes "most consistent of involutional small vessel white matter changes beyond upper limits of normal for patients age. Consider small vessel ischemic risk factors such as untreated hypertension."
Does this mean I need better control of my hypertension? When I am at rest or in the docs office, it is always about 120-130/mid-low 80's. At work, however (night shift RN, busy unit) it runs 140-150/mid to upper 80's to 90. My pulse is rarely lower than mid 90's (80's at rest). Thyroid functions ok.
My doc says not to worry, that this is fine. I say that as I work fulltime, my BP's at work reflect my usual state more than resting or office BP's. My family history includes several relatives with longstanding hypertension, stroke, MI, and aortic stenosis.
What is your opinion? Aim for lower, or ok as is? What would be the next usual agent to add if a lower BP would be desirable?
I feel like this isn't low enough. I recently had an MRI/MRA of my head for unrelated reasons, and the report came back with changes "most consistent of involutional small vessel white matter changes beyond upper limits of normal for patients age. Consider small vessel ischemic risk factors such as untreated hypertension."
Does this mean I need better control of my hypertension? When I am at rest or in the docs office, it is always about 120-130/mid-low 80's. At work, however (night shift RN, busy unit) it runs 140-150/mid to upper 80's to 90. My pulse is rarely lower than mid 90's (80's at rest). Thyroid functions ok.
My doc says not to worry, that this is fine. I say that as I work fulltime, my BP's at work reflect my usual state more than resting or office BP's. My family history includes several relatives with longstanding hypertension, stroke, MI, and aortic stenosis.
What is your opinion? Aim for lower, or ok as is? What would be the next usual agent to add if a lower BP would be desirable?
Doctor's Answer
by CCF-M.D.-MJM, Aug 07, 2005 12:00AM
Hi Christie,
I agree with your reasoning. If you blood pressure is elevated during your work, this probably is more reflective of your baseline blood pressure. As you know there is no lower limit for lowering blood pressure accept symptoms and the studies show that lower is better but there is a significant increase around 140 systolic and 90 diastolic.
In your case I would try a combination pill that included 40 mg po lisinopril and 12.5 to 25 mg of hydrochlorathiazide (HCTZ). That way you can take one a day of one pill and get more bang for your back at a reasonable price.
You are very appropriately pointing out an important medical fact: HYPERTENSION IS THE SILENT KILLER. It does damage to your blood vessels that are not obvious in everyday life but with significant cummulative effects. Blood pressure in general is not treated aggressive enough.
Good luck.
I agree with your reasoning. If you blood pressure is elevated during your work, this probably is more reflective of your baseline blood pressure. As you know there is no lower limit for lowering blood pressure accept symptoms and the studies show that lower is better but there is a significant increase around 140 systolic and 90 diastolic.
In your case I would try a combination pill that included 40 mg po lisinopril and 12.5 to 25 mg of hydrochlorathiazide (HCTZ). That way you can take one a day of one pill and get more bang for your back at a reasonable price.
You are very appropriately pointing out an important medical fact: HYPERTENSION IS THE SILENT KILLER. It does damage to your blood vessels that are not obvious in everyday life but with significant cummulative effects. Blood pressure in general is not treated aggressive enough.
Good luck.
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Hi,
I think you have the right idea in getting your B/P pressure lower, for example I thought my B/P was controlled also, it was to a certain extent, but was not at a desirable level, my cardio motto is lower the better once no symptoms are present.
I went from borderline LVH to mild in 5 years, yet this time my cardio seemed less concerned, I have no leakages of any of the valves, not even trivial, normal EF, a resting heartrate of 58-64 bpm, and normal wall motion.
I thought my B/P was controlled, at the doc's office it was 140/85, at home it is usually around 115/75 every time I take it.He said throughout the day it probably keeps mildly elevated more than I think, I was already taking 100mg of atenolol daily in divided doses, he agrees with taking it like that and cozaar 50mg once daily. He upped my cozaar to 50mg twice daily and added hydrochlorothiazide 12.5mg daily, but kept the atenolol the same , now my B/P pressure is 105/60 most of the time going to low as 90/50.
I called him and advised him of the lower reading, he said that is exactly how he wants it, once no symptoms are present, I have none whatsoever, also one other thing I noticed since I upped the cozaar and added the hydrochlorothiazide, I had only one PVC that I am aware of in about 3 weeks, now that's plus, don't know if it's the extra medication or coincidental, but definitely a signifiacnt reduction, at least in the awareness.
Definitely it is a desirable to keep your B/P below 120/80, according to the new guidelines this is the new normal.
Do you ever have difficulty getting a reading from your bp machine? I have a digital machine (I checked it for accuracy at the doctor's office and it was right on target), and sometimes it just shuts off before giving me a reading - I know that ectopics can mess with the readings, but I'm not having enough of those for that to be the problem. When I called the manufacturer, the rep told me that people with murmurs can have some trouble, and that the machine needs 15 beats to record data.....Just wondering if you've run into that since your readings are low also.
Hi,
No I never run into that problem ever, I use both digital and manual to check the difference and accuracy, there is no significant difference, since the digital is accurate I use that most of the time unless i get a strange reading, and my B/P has been as low 88/45 on the digital and no problems with the machine whatsoever.
I understand frequent ectopics, especially PVCs can adversely affect a reading or even fail to register a reading, I have never heard of murmur causing such a problem so I really don't know what the problem could be, I would get a manual one and use that if I were you, usually its pumped to 200 , then slowly deflated, the number that it is on when the first beat is heard is the systolic reading and the number it is on when the last beat is heard is the diastolic. Many doctors have no faith in the digital B/P machine that is why I check mine manually at least once a week against the digital, personally I think a good digital B/P machine is very accurate and more precise.
I don't know the significance of a murmur either, other than I think it interrupts the flow. Maybe because of that, the machine can't accurately reflect bp. I'll try to remember to ask the nurse/doctor at my next appointment.
Have a great day.
Sitting for at least 5 minutes will give a much more accurate reading or should I say a lower reading because persons with hypertension tend to have a higher B/P right after sitting down , while persons with normal B/Ps the change in 5 minutes is very little, if any at all after sitting for that long, this is why a much more aggressive approach needs to be taken in persons with even mild hypertension to prevent long lasting damage and the silent devastating effects of prolonged uncontrolled hypertension.
Same here!! Sometimes I take it several times and give up. Other times, I'll eventually get a reading, but it's low. Do you take any medicine for bp? Any chance you have mitral regurgitation? I'm just wondering since the service rep. said that could be the problem.
Tickertock,
Have you ever heard of taking bp in all four extremeties. I read somewhere that that is actually the way it should be done...??? I tried it on my leg (ankle) and I almost always get a reading, but it's higher than that of my arm. Just curious....
Chayes, usually it is advisable to wait 3-5 minutes to take your B/P , you get a more accurate reading, persons with mildly elevated or elevated B/P, their B/P will usually always be higher if they take it right after sitting down rather than waiting 2-5 minutes thats why ultimate control is so important for us hypertensives, in persons with normal B/P there is little to no significant change after sitting 2-5 minutes, their B/P will usually be within the norms either way, anyway that is what has been explained to me by my cardiologist just 3 weeks ago. Also persons with the so called white coat hypertension, persons that their B/P is usually only high in the docs office are usually mildly to moderately hypertensive most of the day and white coat hypertension is usually not an acceptable diagnosis without true 24 hour monitoring of the B/P anymore.
Momto3, as far as i am made to understand usually B/P is taken in each arm to check if any significant differences are present which could point to other disorders of the circulatory system, this is usually done every few months by your personal doctor or when consulting with a new one, other than that just checking taking your B/P in your right or left arm for monitoring purposes should be just fine , the difference between each one is of no significant value unless other diseases that can affect that measurement is present. As always rely on your doctors advice and guidance only.
What can I say , I feel your pain, I too I am sick of feeling not the best that's the way i'll put it, not really because of heart problems as my palps and B/p seems well controlled though i too have tachy and PVCs, but because of a chronic CTD that will be with me for life , but is not life threatening!! Hang in there and never give up or give in!