Question on the 'J' Curve in Hypertension

[jerry1978]

Can you please expand on the so-called "J" Curve, and the newly released INVEST study that suggests that lowering Diastolic too much can actually cause a cardiac event.

I have read that INVEST and also the JNC study says that at levels below 85 mm, the risk of a cardiac event can increase.

Am I reading these reports incorrectly?  I hope so, because with my hypertension under control, my Diastolic is averiging in the 60's.....is that good(as I thought), or Bad?
Thanks

[Cleveland Clinic]

jerry,

The study you are quoting was presented at the recent heart meetings. They found in this particular analysis that the risk of MI and CVA did increase when DBP was lower. There are some physiologic factors which could cause this relationship and cloud the actual interpretation of the data such as sicker patients having lower BP.

Also, the study was a post hoc analysis performed retropectively on the patients from the trial. So the results must be interpreted with some degree of caution since the study was not designed to determine this particular question.

These type of analysis really serve more to generate questions for future study instead of changing clinical practice.  I will wait for further analysis on other trials or prospective data before actually changing my practice.

[Poli3]

I read that also.I am 70 ,had an ekg and was told I had LVH,so the doc cahnged my BP meds to an angiotension 11 pill and my diastolic is also in the 60's.

It is bad enough I have to worry about the LVH without worrying about a low diastolivc.

I hope the Doc answers bfore my blood pressure goes back up

from stress.

[Barbarella]

If only the doctors at least could be on the same level.  I have seen a Cardiologist because of abnormal EKG's and severe white coat hypertension.  He put me on meds, fine with me, no problem, I worry about side effects later should they come.  I'm on two BP meds, a water pill and a potassium pill. My problem however is that my BP is still in the 135-140 upper range most of the time, and in the 80-85 diastolic range.  Once in awhile it goes below 80 diastolic and below 130 syst.  I was very concerned, being on meds and still these numbers, especially when I read about the "new" research where it says it should be below 120/80.  The Cardiologist said to me (I took my BP at home for 3 weeks and wrote down my BP numbers as he requested)when looking over my BP readings he said "I'm very pleased with your BP, don't worry your BP is fine".  My family doctor however got all hyper and increased my meds.  My husband said "the Cardiologist is the Specialist in that field, listen to him", and pay no attention what the family doctor said".  Well, my insurance company only gave me so many visits for my cardiologist, and I now have to go back to my family doctor.

[Poli3]

I sure agree with you on that about all these change in Bp numbers.It is very frustrating.
I am on a angiotension 11 pill and it took 6 weeks to get my Bp at130/65,and I am afraid my systolic won't go down any lower given my age.If it does my diastolic will be too low.If it does not go down,I don't know how fast this LVH will progress.
I monitor my pressure at home because of white coat syndrome and have finally decided there is nothing else I can do.
I was told I have had LVH for about 2 or 3 years so don't know if this is a long time,have only had an EKG.
I hope your pressure gets better,and your family doctor can explain things better.If you can it would be a good idea to go back to the cardio doc once in awhile.Good Luck

[Barbarella]

Believe me I know how you feel.  I'm a 60 yr old Female.  When I found out 30 yrs ago that I reacted hypertensive when going to the doctor I developed a phobia of having my BP taken.  I was put on tranquelizers, they made me feel washed out, but when I came to the doctor's office my BP still went sky high despite that I felt tired and washed out.  Then came the reactions from the medical staff and doctors i.e. "oh my god, we need to get this pressure down" etc. the panic in the pit of my stomach got worse by the minute like a big hot flame, and the BP kept kreeping up higher and higher.  I then was sent for therapy sessions, biofeedback and after the biofeedback my BP was normal, but as soon as I had a doctor's appointment and they called my name the hot flame in the pit of my stomach started again, and my BP was sky high.  I started to worry about it at home, and I could not even take my BP at home anymore.  I stopped going to doctors for 7 yrs, I could not take this phobia any longer.  I then had an emergency with my BP and the rest is history.  I forgot to mention that my Cardiologist said since I still have some fear taking the BP at home that is probably why its not around 120/80 or lower.  He said he was "pleased with my BP" so I try not to worry any more.  

Now get ready for this:  My husband who does not worry about anything, but has high BP from years of smoking I guess, but has no anxiety about doctors whatsoever.  His upper number sometimes goes to 170, but his lower number is always in the 60's.  HIS Cardiologist told him "don't worry about it, you are on BP medication".  My husband firmly believes that even though they might don't admit it that some doctors take the Peoples ages into consideration.  My husband is 62. He keeps on telling me that were we in our 20's or 30's they would get a lot more hyper about our BP numbers.  He could be right.  But its very confusing  to say the least.  The latest research I read about today is about high BP and coffee, "Its not the caffeine whats bad for your heart, but the coffee itself, even the decaf-coffee can be bad for your heart the article stated".  Give me a break, I give up!

[Poli3]

Well, I guess I am doomed.Went out to a church supper and had 2 cups of de caf coffee and thought I was doing the right thing.
just when you figure you have your BP under control,they change the numbers while you sleep,and put them lower.I get to the point where I feel like quitting my meds and let nature take its course.
Maybe your husband has a point about ages.But his systolic is a bit high so I wish the doctor would take it seriously.
My doc is pretty good,it is just that I can't seem to get my pressure as low as he wants it,I get upset and up it goes.
But I have had the same problem as you reactive Bp for about 30 years also.

I hope Jerry gets his question answered.
I am new to this forum and appreciate all the comments.Gives one a bit of comfort.
Take care hope to talk to you again.

[Barbarella]

I too am waiting for the answer for Jerry's question.  I have a hard time to get my lower number below 85.  My husband's lower number is always in the 60's.

Worrying about your BP can make it go up.  Even at home my first reading is always elevated, but NOT like at the doctor's office.  Within 2 minutes I can drop as much as 30 points from my top number.

As for the coffee, I started to drink half and half.  I mix it. Half real coffee and half decaf.  I don't care what they came up with about this new coffee research, I know that to much caffeine gives me anxiety.  Whether its from coffee or coke. And I'm not going to worry what it is in the coffee that is suppose to be bad for you.  I like my coffee, and I will not give it up.  I only drink about 2 cups a day anyway.

I feel like you do at times, and want to let nature take its course,  so far the meds haven't bothered me yet, but I dread to go for the doctor's appointments.  This is a nightmare for me.  I work myself up weeks and days before the day of the appointment.  I'm not afraid of needles, pain or blood, I'm afraid of what my anxiety will do to me and my BP.  Afraid of the "unknown" what will he find or found out from my tests.  

But I still try to look at it from the bright side.  Other people are not afraid as I am, but they have other issues in life I don't have.  Nobody's life is perfect.  And I always tell myself "things could be worse" as in having cancer or being paralyzed.

Don't get to upset about your EKG.  I had 3 "abnormal" EKG's.  False diagnostic printouts.  The first one showed that I had a "previous heart attack" which I never had.  My Cardiologist said that lots of these computerized EKG's print out false results.  He did more tests after the EKG's.  Whatever the EKG's printed out none of it was true in my case.  I'm telling you I screw up all my tests with my high anxiety when having these tests done.

Take care, and feel free to chat with me again.  I have an idea how you feel.

[Barbarella]

Dear doctor,

Thanks for your info.  What you said made a lot of sense, but I just wish whoever does these "researches" they would wait until they have more data, and more research before they post/print it for the whole public to read.  I know you have no control over this, and this is not your fault.  They should generate this information first to the doctors/cardioligists and people in the medical field, but not to the public, this causes great confusion, and anxiety in lots of people.  We are already confused by doctors having different opinions i.e. my Cardiologist said my BP was fine and he is "very pleased", my family doctor however got hyper about the VERY SAME BP readings, and is not pleased at all. We don't need to be confused about certain researches which are not even 100% yet.

[Colonelsandi]

I feel your frustration and I can't get a question on the board after trying for weeks. I am taking .25 mg in the am and .12 miligram of in the afternoon and .25 mg of lanoxin for atril flutter. Then my systolic bp started going up and I was told to go up to two .25 mg of atenolol a day. Didn't work. Then I was put on Sular, a calcium channel blocker, 10 mg a day. It has worked wonderfully for the systolic pressure - back down into the 110-124 range. But no one can tell me why, all of a sudden my diastolic has dropped. After years of staying about 68, within a month it had dropped to the low 50's and sometimes down to the high 40's. This was before the sular addition. No one seems to be concerned as long as I'm not dizzy or anything. I'm not, but then we read about pulse pressure and that we're not supposed to have more than 40 points difference between the systolic and diastolic. My regular doctor's nurse told me a couple of months ago that my systolic was perfect and it was 150/60! On the atenolol, lanoxin and sular websites (company sites), they say don't take a calcium channel blocker (sular) with a beta blocker (atenolol) or it may cause too much of a retention of the lanoxin. The atenolol site says not to take with a calcium channel blocker. Yet, when I ask - it's ok. All I want to know is if there is a way to get my diasolic prssure back up or, at age 64, female, I have hardening of the arteries due to age! And if a diastolic pressure that low is safe. Everyone gives me a different answer. It is maddening and the left hand doesn't know what the right hand is doing! SandiG

[Barbarella]

My husband is 62 and has the same BP issues you have.  His systolic is between 135-170 and his diastolic is like yours VERY low at times, but never over 60.  His Cardiologist said "don't worry you are on the BP pill now".  My husband is only on one Calcium Channel blocker, that's it.  My husband firmly believes that even though they say "age" is not considerend anymore when it comes to BP readings they indeed do take people's age into consideration.  My husband says if he was a guy in his 20's or 30's the Cardiologist would take his BP readings a lot more serious.  But what do you do?  Our insurance company only gave us so many visits when we got the referral, and they told us who to see, we could not pick a Cardiologist, they picked him for us. If we want to have a second opinion they wont cover it, and we can't afford to go for second or third opinions.

[Colonelsandi]

I understand! In closing - I don't even have insurance - couldn't afford it any longer and short of being on Medicare. Every visit is well thought out and I can't just run in every time they want me to unless it's critical. There are about 5 doctors in the practice I go to plus a nurse practioneer (a dear friend) and a physician's assistant. The latter two are the only ones who give me any information at all - the doctors (sorry to say) just run in, write out a prescription, and run out. And they are the best doctors in town! If I'm in doubt I ask my pharmicist, he usually knows more about the meds! No web site explains if you're supposed to be concerned if the diastolic is low - I've been told once that 50 is low but "safe". I get below that but feel fine. With atrial flutter I can't get off two of the meds tho I had them before a bout of atril fibrillation 5 yrs ago. So, I just take each day at a time and thank the Lord I'm still breathing! Best wishes to you ... SandiG

[Poli3]

Hi,I too am glad that the doc answered jerry's question.Thanks for being so friendly to us new folks here.I read this morning that the latest research says the coffee is good for you.No more than 3 cups though.supposed to help your heart,Parkinson's disease and Type2 Diabetes.Go figure
How many times do they let you post to chat?It is good to talk to you,and others,but I don't want to hog the board.
I went into the archives and found some good info on my condition which makes me feel somewhat better.I guess it takes time to progress,and the main thing is to get the BP under control.Easier said than done!I wonder why systolic pressure is harder to control than diastolic?
Anyway,blessings to you.

[Barbarella]

Hi there!  Thanks for the compliment, but I am new myself.  I too thought about not posting to often, but I haven't read anything in the regulations how many times you can post.  Just to talk to people who have similiar or the same stuff I go through makes me feel better.

I too read the "latest" research about coffee.  Some of these researches are a trip.  If they only would not change later on. I can understand as time goes on they find out more and more information, but what bothers me is when they go back with their findings where they started at i.e. "coffee is bad for your heart", and now "coffee is good for your heart".  "Diastolic BP should be below 80" the latest research "diastolic BP should be at 85".  

Oh well, I try not to read these researches, but always read them anyway, and then I have something to either worry about or be happy about. :)

I meant to ask you, how do you take your BP? The Cardiologist I saw for a short while told me to sit for at least 15 minutes before I take my BP at home.  If its high (my case due to anxiety of what the BP numbers will be) he told me to take it again a few minutes later for my BP will go down, and he is right. I can drop 30 points in less than 5 minutes. He said never stop what you are doing, and sit down and take your BP.  He said sit still for 15 minutes, and then take the BP.

Good luck with your BP!

[Poli3]

Hi,hope all is okay with you.I guess if we post too much they will let us know.I sit for about 10 minutes before taking my BP.Then I take it again after another 10 min.wait,it usually is down a bit.All one can do is take their meds and excersize if they can.
I thought that poster Pluto had some good comments.Thanks to him or her.
I live in Canada,our medical system is different,but we have problems also.I am lucky to have had my doctor for 15 years,because it is hard to find one now.
My daughter just moved to Georgia and was telling me about the  insurance.
Isn't it a shame when health is the most important thing,that some in both our countries are denied medical help,or find it hard to get.
I hope you and your husband keep well,will be in touch.
Blessings

[Barbarella]

Hi, where in Georgia did your daughter move to?  We lived for 10 yrs in Augusta, GA and LOVED it.

Yeah, tell me about health insurance.  I really liked my Cardiologist, but our Insurance company only gave me 3 visits, I could've gotten an extension, but only if the Cardiololgist would have needed to do more tests etc. but he didn't which means I now have to go back to our Family doctor.  He is kind of on an ego trip.  He referred me to a Cardiologist, but whatever the Cardiologist said or prescribed for me the Family doctor says the opposite. Why refer me if HE has all the answers?? I mean I don't mean no disrespect, but the Cardiologist is the "Specialist" when it comes to heart and BP, not the Family doctor.  I follow his orders when it comes to general health, but when it comes to heart and BP I let him talk and follow the orders of my Cardiologist, and remember what he said.  So far the family doctor has not changed my meds yet, but increased them.  The Cardiologist said my BP was fine (I still have the same numbers) so I continue with the amount of meds my Cardiologist prescribed for me.

We are thinking of switching doctors, but I heard people telling us that some doctors don't even listen to them and are "in and out".  At least the one we got listens, and doesn't walk in and out the door.

Take care, and good luck with the BP.  Try not to worry to much about it, and maybe it will go down.  Look who is talking, I'm the queen of anxiety over BP :)

[Poli3]

Good day.My daughter is in Marietta.Just went in November so I am hoping to go this fall and visit.
Have decided not to worry about my Bp.I was talking to the pharmacist about it not seeming to be working,and,get this,he told me that this particular pill is very good but takes about 3 or 4 months to get into your system.He said my pressure will start dropping slowly at first but the stabalize.He said for this LVH condition this is the best drug.It is called Teveten.So,we will see.I think from now on I will just go to the pharmacist,never mind the doc.LOL.
Is there nothing they can do for your anxiety?It is a terrible problem isn't it.One seems so helpless,as it just seems to come over a person.
Please take care of yourself and hubby too.

[Barbarella]

Hello there!  Yes, medication can take that long.  I was put on a patch called "Catapres" (chlonidine) this is a total awsome patch.  Its not just for high BP, but also for people who want to stop smoking, drinking, and for women who have hot flashes.  Well, I don't smoke, don't drink (booze even beer gives me headaches) and never had any "change of life" symptoms, BUT the patch curbs my graving for sweets.  I lost 5 pounds so far, have no gravings for sweets whatsoever.  I tell you I LOVE this Cardiologist who put me on this patch, wish I could keep seing him, what a sweetheart :) he didn't know how happy he made me with this patch :) DOCTORS ARE YOU READING THIS? You might make more ladies beside me happy if you prescribe this patch.  Never had any side effects from it.

Then I have Lasix (water pill) no sife effects.  A potassium pill, no side effects.  Now get ready for this pill:  I'm also on a low dosage (5mg) of Minoxidol.  After 2 months I started to get a slight mustache, and facial hair.  Not like a man, and not as frequent, but I do have to shave it off once in awhile. My eyebrows turned coal black, but I get lots of compliments, people think I "made" them black.  My Cardilogist (when I still saw him) warned me about these side effects, and kind of was cocerned how I would react and I told him "I have no side effects other wise from all the other meds, what the hell so I shave once in awhile, no big deal, you can't see it, its not like when a man shaved :) But this "Catapres" patch was the best meds I ever got.

You asked if nothing could be done about my anxiety.  I've been to biofeedback, therapy sessions, group therapy, EMDR, but to no avail.  Tranquelizers leave me washed out (I've been on several)I was also on Paxil, all I got was this tired washed out feeling, but the anxiety still kicked in at times.  I always took the meds like I was suppose to, and for as long as I was suppose to, went to my therapy sessions as I was supposed to, then I found 3 books by a Psychologist (Dr. Claire Weeks) who deals with this problem, I read these books over and over, and I have my anxiety under control, no more agorophobia, I can go on airplanes all the way to Europe, I have my anxiety under control.  If I could get rid of this BP phobia my life would be complete, but I will not give up.  

My Cardiologist also told me that people with "leaking mitral valves" (I got a minor leak) are more prone to anxiety, panic attacks and the whole nine yards.  He said I needed help with my BP phobia, but did not know anybody he could refer me to.  So I will do the search, but you know the Insurance companies, ours charged us 50% the last time I went for therpay sessions about my anxiety. Isn't it funny? I can't tolerate tranquelizers and beta blockers, but can tolerate these BP meds, except for the mustache :)

I've never been to Marietta, GA, be glad you go in the Fall.  Georgia gets VERY hot and VERY humid in the summer.

Take care, and thanks for your kind words also for my husband.