Labile Hyypertension with low pulse rate

I am 78 years young, began running in my 40s, have run 8 marathons, and from what was described probably have essential hypertension. It was labile hypertension and even in my 40s could be 160/105 one time and 130/80 another. My pulse rate is very low. It was about 30 when in my 40s and is as low as 40 now.  Several years ago I was advised to medicate labile HT as if it were chronic HT and I did so beginning with low doses of Diovan.about a year ago my pressure was measured at 160/105 again and my dose was doubled but that only helped modestly. Now I am on Atacand HCT  32/12.5 and my pressure is under control being about 130/80to 85. I
still run several times a week and last year raced a hilly 5K in 31 minutes. I wonder if the hypertension  is related to the low pulse rate and is therefore more benign than it would be otherwise. However I am concerned about  the recent worsening. Will an ICG test provide more diagnostic insight?


This discussion is related to High BP but Low pulse rate.

[Len613]

P.S. I also have Essential Tremor and a doctor relative advised switching to a beta-blocker which could help control both the HT anf tremor. However my physician rejected that advice becauuse a beta blocker would lower my already-low heart rate and hinder my workouuts (I also do strengthy training.).

[kenkeith]

QUOTE:  I wonder if the hypertension  is related to the low pulse rate and is therefore more benign than it would be otherwise. However I am concerned about  the recent worsening. Will an ICG test provide more diagnostic insight?

>>>>An ICG test can be a proxy for coronary artery disease, but not definitive.  Heart rate increases when the demand for blood/oxygen increases.  If the heart rate is normally low (less than 60 at rest), that would indicate a strong beating heart that is able to meet the oxygen demand easily with each heartbeat, the result is a lower heart rate.

Hypertension is not directly related to heart rate. Hypertension is the amount of resistence the heart pumps against (constrictred vessels).  Dilated vessels reduces system  pressure. If cardiac output is reduced, there will be a constriction of vessels and an increase in heart rate..  This phenomenon happens with reduced blood flow as it is the system's method to protect vital organs brain, heart, kidneys with an adequate blood supply.  The low cardiac output is the sytem's reaction as though there is a loss or losing blood.  

It is true the beta blocker maintains a lower heart rate, but it also stabilizes the heart rate to prevent arrhythmia (very fast heart rate that can harmful for some individuals).

[Len613]

Thank you for your prompt and illuminating response.

Vessels can be constricted for at least two reasons: plaque blockage or inflexible arteries that dilate minimally.  In response to the requirement for more oxygen it would seem that the heart could beat more rapidly, increase the pressure, or both.

What is confusing is the implication that the "system" decides to increase pressure rather than heart rate; even at rest.

Another personal fact is that, during stress tests or exercise, my pulse rate increases slowly, and it is reduced quickly when the stress ends. I was told by a physician that this is a criterion for a healthy CV system that permits strenuous aerobic exercise.  Noaerobic exercise such as strength training, is another matter. I understand that hypertense people are better off avoiding strain of heavy resistance and substituting more repetitions.

[kenkeith]

I'm not clear on your question.  What has to be considered is the mean arterial pressure and that would include the combination of  1/3 systolic + 2/3 diastolic since the heart spends slightly more time is diastole (rest) that it does in systole (contracting). As a formula: MAP = 1/3 systolic + 2/3 diastolic.

Therefore, an increase in either systolic or diastolic will increase the MAP. Additionally, under physiological conditions, an increase in heart rate WILL increase blood pressure. Increased HR leads to increased cardiac output, among other things, which increases blood pressure.  Your contemplation is high blood pressure results in less cardiac output and therefore the heart rate should compensate with a faster heart rate. High hp does not necessarily reduce cardiac output, but it does cause the heart to work harder by dilating.  The left ventricle dilation and increased contractility relates to the Frank/Starling law of physics.  
Heavy lifting spikes the blood pressure, and that can be a risk for an aneurysm rupture, etc.

[Len613]

Thanks again.

I did not say that high BP reduces cardiaac output. What I said was "What is confusing is the implication that the "system" decides to increase pressure rather than heart rate; even at rest. "

IOW, if more circulation is needed why doesn't the pulse rate increase instead of the blood pressure?

[ed34]

The heart responds mostly to hormone response and so the arteries will be the first line in controlling pressure. When oxygen gets low (or CO2 gets high), the respiration rate will increase, hormones will be released to increase heart rate with it. Some people have high blood pressure with no apparent causes and they are never explained. I used to do a lot of cross country running when I was in my teens, and my blood pressure was always high, very similar to yours. I wonder if it has to do with muscle type, if there's a trend. Apparently there are two muscle types and these are very different in the way they work. Some people have muscles like a cheetah, where it burns energy very quickly but can only work for short periods of time before they burn out and produce too much waste for the body to handle, giving serious cramps. Others have muscle which burn less fuel and are not so reactive, but can be active for a much longer period of time. I wonder if those of us with the stamina have higher blood pressure. My older brother has much lower blood pressure than me, and has the type of muscle which burns out quickly. He has no heart trouble either. He tried running with me once, he sprinted ahead showing off, and after just half a mile he was collapsing on the floor drooling for air. I used to run 10 miles but could have managed more. This is why I am stunned everytime I read "exercise is important to help avoid heart disease". How much more did I need to do? 300 miles a day perhaps?

[kenkeith]

I did not say that high BP reduces cardiaac output. What I said was "What is confusing is the implication that the "system" decides to increase pressure rather than heart rate; even at rest. "

>>> At rest as you ask, it is the autonomic nervous system trying to keep your cardiac output and circulation the same as if your BP was normal.  It is BLOOD PRESSURE that is the dominant mechanism, other mechanisms adjust to the blood pressure accordingly. "These mechanisms are controlled by the sympathetic division of the autonomic nervous system (the part of the nervous system that regulates internal body processes requiring no conscious effort) and by the kidneys"..

For review, the body has many mechanisms to control blood pressure: The body can change the amount of blood the heart pumps, the diameter of arteries, and the volume of blood in the bloodstream. To increase blood pressure, the heart can pump more blood by pumping more forcefully OR more rapidly (in my prior post i referred to the Frank/Starling mechanism).  More forceful contractions the less need to increase heart rate.

Other mechanisms small arteries (arterioles) can constrict forcing the blood from each heartbeat through a narrower space than normal. Because the space in the arteries is narrower, the same amount of blood passing through them increases the blood pressure. Veins can constrict to reduce their capacity to hold blood, forcing more blood into the arteries. As a result, blood pressure increases. Fluid can be added to the bloodstream to increase blood volume and thus increase blood pressure. Conversely, to decrease blood pressure, the heart can pump less forcefully OR rapidly, arterioles and veins can widen (dilate), and fluid can be removed from the bloodstream.  

"The kidneys also respond directly to changes in blood pressure. If blood pressure increases, the kidneys increase their excretion of salt and water, so that blood volume decreases and blood pressure returns to normal. Conversely, if blood pressure decreases, the kidneys decrease their excretion of salt and water, so that blood volume increases and blood pressure returns to normal. The kidneys can increase blood pressure by secreting the enzyme renin, which eventually results in the production of the hormone angiotensin II. Angiotensin II helps increase blood pressure by causing the arterioles to constrict, by triggering the sympathetic division of the autonomic nervous system, and by triggering the release of two other hormones, aldosterone and antidiuretic hormone (also called vasopressin), which cause the kidneys to increase the retention of salt and water. The kidneys normally produce substances that cause arterioles within the kidney to dilate. This helps balance the effects of hormones that cause constriction of arterioles".

Hope this helps, if not followup.   You pose an interesting question.

[cath911]

I notice you copy and paste large sections of text from sites which are copyright and  such acts are obviously illegal. You must be getting permission from the owner of the material or the site to copy it, and I was wondering how you obtain this information? ie how do you find the contact on each site? I have seen some very interesting facts which can be of interest to people on here, but I need permission to obviousy copy it. Any help would be appreciated.

[Emily_MHModerator]

Just to clarify - if you copy something from another site, you do need to cite the source here.  All you need is the link to the page.  No need to get permissions, etc., but you might want to check out the site to make sure they don't say anything about not copying their info at all, even if you give the source.

Hope this helps,
Emily

[Emily_MHModerator]

Oh and to clarify even more - you can give the link to those sites, as long as they are not commercial sites, spam, porn, etc.  If it's from another site with a forum, we ask that you not link to the forum, but to the actual article itself.

If you have any questions, just ask.

Emily

[kenkeith]

As the moderator states that is my understanding as well. However, my reading of the rules a couple of months ago, stated one should get permission to link to another forum and the example was WebMD...I may have misread.   I E-mailed a member recently about not providing a link to another forum, the alleged accusation just posted may have a connection with that E-mail. It seems very coincidental, as I have been participating on forums for more than 10 years...thousands of posts and never attacked on a thread about the legality of my posts nor questioned by management.  

My method often provides a snapshot of infomation sourced, and then I quote the source if further information is of interest, and that would include government studies, etc.

[kenkeith]

I don't know the law in the UK, but here in states it is the following:

For those that may still be confused: "The "fair use" exemption to (U.S.) copyright law was created to allow things such as commentary, parody, news reporting, RESEARCH AND EDUCATION about copyrighted works without the permission of the author. That's vital so that copyright law doesn't block your freedom to express your own works -- only the ability to appropriate other people's. Intent, and damage to the commercial value of the work are important considerations. Are you reproducing an article from the New York Times because you needed to in order to criticise the quality of the New York Times, or because you couldn't find time to write your own story, or didn't want your readers to have to register at the New York Times web site? The first is probably fair use, the others probably aren't".

I argue there is "fair use" exemption, and no laws have been broken.  

[Claire_MHModerator]

I agree with Emily -- it's enough to acknowledge the source and not present the work as your own.  I like to include a link to anything I quote because it just makes me look smarter than I really am :-)   But including a link to a reputable source is also an effective way to give the words added credibility in the readers' eyes.

[kenkeith]

"I agree with Emily -- it's enough to acknowledge the source and not present the work as your own. I like to include a link to anything I quote because it just makes me look smarter than I really am :-)  But including a link to a reputable source is also an effective way to give the words added credibility in the readers' eyes. "

Exactly, and putting quotation marks around the information indicates it is not your own work.  The objective is to communicate, and the quotation marks gives some additional credibility is true... Unless, English course study has changed that is acceptable. I often include a link for those that may want more detailed information...that would be a judgement call how interesting and length, etc.  I may have missed a few quotes, but it is not intended to deceive anyone.  The objective is to help educate a poster regarding a stressful medical problem and frankly, I have little interest in impressing anyone. Can't speak for anyone else, but  I'm past that stage in life a long time ago.

[Len613]

How come doctors don't know that?

[kenkeith]

There is no issue under the circumstances of a heart forum that dispenses medical information to patients, patient family, etc.  " It is a code of best practices that helps educators using media literacy concepts and techniques to interpret the copyright doctrine of fair use. This guide identifies five principles that represent the media literacy education community’s current consensus about acceptable practices for the fair use of copyrighted materials, wherever and however it occurs"

In reality, before there is any lawsuit there has to be provable damages and that is fair to prevent someone else to profit from another's work poduct. The Fair Use standard takes that into consideration as it should.

Thank you for the link.