How low should my BP be?

[Christie2004]

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?

[shawnyboy]

discontinued ramipril  , started lysinopril 10 mg split pill in half take morning and noon. frontal chest pain gone but some tingling episodes in my left back remained for a few weeks . 200 mg metoprolol I split into 4 and take every two hours,. also I take lorazapam for anxiety, in the evening my blood preasure goes up to 140/ 90 Ive tried adjusting the timing of the pills and adding and subtracting but the evening blood presure increase always happens. I then I get a panick reaction with mild chest pain, burning and tingling in my left back,and I cant sleep.Lorazapam and sleeping pills put me to sleep I'm going to try a glass of wine tonight and see if that helps. Any thoughts? Shawn

[shawnyboy]

I'm 33 yo male,  at ten years old I complained of heart pain stinging, sharp pains,. I would notice my heart when I would sit or stand up fast. In my 20s it became worse with pvcs at night. I would get out of bed and run around the house to stop them, and nibble on aspirin,for some relief. I always felt exausted, even as a teen and child.  Doctors listened to my heart, used ekg and took xrays and did not identify anything wrong. Deep morning pain that was burning and aching, worsened and in juse I asked for an echo, a acending aortic anurism was identified 5.8 cm. I was put on metoprolol. blood preasure wnt down to 103/ 60. pvcs and some chest pain remained. added ramipril 5mg. pvc and pain went away. but then i had frontal chest pain with dizzyness

[Colonelsandi]

I've tried for 2 years to post a question, can't get through so thought I'd add a comment at least. I'm a 65 yr old female, smoker, good weight. I had an attack of atril fib 6 yrs ago and put on meds - atenolol and lanoxin. It kept me from from having another attack all these yrs, but I still had constant "flutters" and palpitations at night. When in the doc's office, my bp (never a problem before) was always high so Sular was added. About a month ago I spoke to my regular md about my diastolic being low (48-55) and she suggested I cut my atenolol down to .12 1/2 in the am and same in the evening. Well, it really hasn't raised my diastolic but it did something wonderful! It stopped almost entirely my fluttering and the palps. It has been a little adjustment to have my pulse rate go back up at times (normally 60 bpm - now up to 71 average) but to be over those flutters has been a miracle. My bp is now quite low - and I worry sometimes that it's too low. It can run from 90/48 to 125/60. I don't get dizzy or light headed but feel more sluggish. I can get it up by moving around and "doing something" rather than sitting at the computer - which is my job. I'm wondering if I should talk to my doctor about lowering my dosage of Sular (10 mg) ... she is trusting me now that my bp is always higher when the nurse takes it with no resting period (130's) than what it is at home.

[tickertock]

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!

[Duchess47]

My story is this:  I'm almost 48, have Graves Disease with hyperthyroid and take methimezole for that.  I have high cholesteral and am on Lipitor. Several months ago I had an echo stress test becasue my resting H.R. was over 100 on a fairly regular basis and since my thyroid is under control it should not be because of that.  Strange thing is I'm 118lbs., don't smoke or drink.  The results of the echo stress indicated abnormal ekg but normal echo.  Basically my H.R. went up too fast too quickly 170 in 6 minutes and I was too winded for my age.  One doc says out of shape and to exercise more and other says take beta blocker for possible hyperkinetic heart disorder, producing too much adreniline. I have had Holter monitor which indicated benign skipped beats and an event monitor which showed the high heart rate but no abnormal sinus rythm. I take my B.P. and pulse daily and also when I'm just not feeling "right".  The B.P. in my right arm is always lower than my left arm. Sometimes too low.  My H.R. has been as low as in the 40's and my B.P. 100/50.  PAIN, stress, fear, anxiety can raise H.R. and B.P. Recently I have been having chest pain that radiates from my chest through my back.  I had a CTSCAN of chest which was normal and doc says it my be thorasic in nature and may need MRI next.  I am just sick of being sick!!!

[tickertock]

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.

[chayes]

I was wondering if when you take your bp at home if you sit and rest for a few mins, or take it right away as soon as you sit down. I find that if I wait about five mins that the pressure will go down, sometimes as much as 15 to 20 points. Which would be the right way to take it?

[tickertock]

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.

[Momto3]

Duchess,

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]

I have had hypertension for several years, most of them untreated due to my own stubborness about taking meds. I have had it under control for about 2 years, but still occasionally it goes high, and I also suffer with pvcs. I was given a test called a CVProfiler (tests the elasticity in your arteries) and found out that I have early stage of hardening of the arteries, pretty scary I'm only 43. This is why I want to make that I keep my blood pressure under control, so just to be sure you are saying you should wait a few mins after sitting down to take your blood pressure? I appreciate your previous response and any advice you or anyone else has. I have tried to post questions to the Doctors, but am never able to get through.

[Duchess47]

I have the same problem with my blood pressure machine shutting off wtihout a reading. I wait and take it again and then it is very low.  This may be why it isn't picking up a reading.

[Momto3]

Thanks!  

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.

[tickertock]

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.

[tickertock]

[Momto3]

My BP was not technically "high", but it was considered borderline when my doctor put me on lisinopril for optimal control.  She started with 2.5mg and titrated the dose until my bp was considered optimal.  It took me about 4 months to get the dose up to 10mg (dizzy spells), but now I am adjusted to it and my bp is excellent.  My doctor said that her bp generally runs 90/60, and she would love to see mine at that level.....She got her wish!!  I'm generally in the low 100's over 50's or maybe 60ish.  However, lately, some of my readings fall into the 80's over lower 40's......I'm told that as long as I feel OK, the low bp is fine.  

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.

[tickertock]

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.

[CCF-M.D.-MJM]

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.