ISH

[edb]

I am a 27 yo male, previous smoker, exercise 4-6x/week(endurance and resistance), and a health-conscious eater.  I have a family history of hypertension (father)...I monitor BP at home with an oscillometric device.  Lately my BP has been averaging around 145/50(at rest).  The diastolic pressure is sometimes as low as 40, making the pulse pressure much higher than the "normal range".  During exercise, there is not much change in systolic, and the diastolic rises to 70-80...Concurrently, I have had left upper quadrant pain for the past 4 months, which has been alleviated somewhat with Aciphex.  An upper GI endoscopy revealed only a couple of areas of inflammation (bacterial presence is being confirmed).  

I think it is obvious that I have a mild form of ISH, but the low diastolic pressures bother me somewhat(cardiac perfusion).  I also wonder if the two aforementioned situations are linked.  Any thoughts on this would be much appreciated.  Thanks.

[CCF-M.D.-CRC]

Dear edb,

Isolated systolic hypertension (ISH) is a pattern of elevated systolic pressures (SBP) with normal or low diastolic (DBP) pressures. It is due to arterial stiffness and is usually seen in elderly persons.  I doubt this is really what you have and would question the accuracy of your blood pressure monitor.  I would suggest bringing the machine to the doctor's office with you on your next visit and calibrate it against a mercury manometer cuff pressure.  

I know of no link between GI reflux/ulcers and hypertension.

[edb]

Should mention that the pain I get is alleviated during exercise, and that I can maintain a HR of ~160 during maximal aerobic exercise...

[pikamom]

What is cardiac perfusion?

[edb]

Although I am not an M.D, I do work in medical research (physiology and endocrinology).  Perfusion is a term used to describe blood flow to a given anatomical area.  Thus, cardiac perfusion means blood flow to the heart through the coronary arteries.  From what I've read, the heart muscles and other heart tissues depend on an ample diastolic pressure to deliver blood through the coronary circulation.  A low diastolic pressure could therefore decrease oxygen/nutrient (via blood) supplies to the heart.

Hope this helps.  Perhaps an M.D. could better clarify this.

edb

[pikamom]

Thanks, it helps. The only stuff I know about medical matters is what I learn online and since I posted a question here a while back I read most of the messages and am learning alot! Great site! Sometimes I'm reading a message and wonder what some of the terms mean.

[kd re: longstanding MR]

I have ISH and the explanation given for my low diastolic is what the cardiologist here mentioned.  Many times my diastolic has been as low as 0 and has been since the mid-1970s.  Sometimes my hypertension specialist notices a double diastolic.  The loud noise changes at lets say 50 but the heart beat is heard all the way down.  Once a nurse could hear it with the stethescope before she even put it on my arm.  I rarely have the diastolic go above 60.  When I have had stress tests, the systolic will not change much and may even come down while the diastolic will rise.  I asked about it once but the doc didn't seem to know and brushed me off.  

One thing that you might look into is a blood clotting disorder.  Cardiologists will sometimes look into this for you but I have found peripheral-vascular specialists to be most helpful followed by neurologists in attacking this question.  After many years of docs being perplexed, I checked out antiphospholipid antibody syndrome (because of a post someone made on the internet).  This is a blood disorder that can cause atherosclerosis at an early age.  All of these years, all they needed to do was to go one test further and they didn't.  Now, I have strokes and clots showing up all over the place.  The test that showed my problem was in the Cardiolipins - the IgM.  They only checked the IgG and IgA.  There are also other coagulation tests they can do and unless you are having other major problems, they may only suggest daily aspirin as the treatment of choice.  Aspirin is considered a "blood thinner."  Other meds they may suggest is Plavix, Pletal, Coumadin, etc.

It wouldn't hurt to check it out.  I hope you check back here.
kd