31 Male Occasional High BP

[Jansell84]

Hello everyone.

I'm on here right now just kind of looking for some input. I have an Omron BP monitor at home which is accurate. I take my blood pressure daily since going to the doctor last year and my blood pressure was extremely high (170/110). Every time I go to the doctor's office now my BP is still high, usually 150-160 over 90-100... I have taken my monitor with me to check for accuracy and it's pretty spot on. Now at home when I take my BP it's never that high. I'll have an occasional 140 systolic or 90 diastolic, but it's usually between 100 and 120 systolic and 70-85 diastolic. My average BP for this month was 119/78.

What I'm concerned about is this "white coat syndrome." I'm worried that it may not be just the doctor's office that gets me worked up. I know it isn't particularly dangerous for the blood pressure to spike at times, but I don't check my blood pressure say when I'm shopping or in traffic, or any of the other things I do. I absolutely have issues with nerves. I don't like crowds, I hate driving in traffic. I'm generally an easily irritated person so it was no surprise that my BP sometimes spikes. But I'm concerned that my BP is high a lot more often than not, and perhaps my home readings may be misleading.

I'm in discussions with my GP, and he has asked in the past if I would like to try BP lowering medications. High blood pressure tends to run in my family and I will likely wind up on them in the future anyway, but I worry about long term effects. How would the meds effect someone in later years if they are started so young. I'm only 31. My mom just started BP meds and she's 51. My grandparents have all lived to be 80+... my grandfather was 97 when he passed. I could potentially be on these meds for more than 50-60 years if I started them now. Am I overreacting to this or what? I'm kind of lost as to what to do here. I know inactivity has a lot to do with this. I work on a computer all day with minimal movement. I've altered my diet and dropped almost 50lbs already. I'm 6'3" and 205lbs. I take Remeron 15mg at bedtime for anxiety/depression. Should I go for the medication? Thanks for the responses in advance.

[Jansell84]

Now just to clarify... when you take your blood pressure, I've read that your elbow needs to be at heart level, back needs to be supported, can't talk, feet flat on the floor? If this is the case I've never had my blood pressure taken correctly at a doctor's office haha. They're either talking and asking me questions the whole time, have my arm supported on my leg which puts the cuff a good several inches from being heart level, have me sitting on the exam table with my legs dangling and back unsupported... It's no wonder my readings are ok at home and not in the office. I make sure to do everything correctly here. I sit in a sturdy chair with my back supported and my arm supported straight out. If I'm at a table that's a little low I prop my arm up using a pillow to make sure it's at the right level. And my readings are always decent. 110-130 systolic/ 70-85 diastolic. Both arms.

[tacolino]

Hi there. Go for the 24ABPM. It will give you a much better idea of where you are at. As I said before, even go to one of the larger Pharmacies, and see if they do them. In Ireland they do it at a minimal cost. Its non invasive and worthwhile for your peace of mind

[Jansell84]

Absolutely, thank you for responding. That's just what I need is someone who's had experience with these things to give some guidance. They didn't do an echo of my carotid actually. My sister is currently in ultrasound school, though, and she can check me anytime so I'll make sure to get that done. I have not had a 24 hour ambulatory and I'll definitely ask for it at my next appointment.

As for angina, I do sometimes get pain in the left side of my chest but it feels more like muscular related. It's localized and I can point to exactly the spot I'm having it, so my doc wasn't concerned about it being cardiac related. It also comes while I'm at rest and not with exertion. I never become short of breath. I often feel my heart beating heavily in my chest. I'll sometimes feel it in my back when lying in bed. Seems to beat too strongly at times. I've checked my blood pressure when I get that feeling and it's normal. It happened just a little while ago and my BP was 114/71.

As for treatment, my doctors can't seem to see beyond my age. I would like to have been checked for coronary blockages but they don't see any need even though I've exhibited symptoms that could potentially suggest CAD. They just don't seem to be taking me seriously, or to be on top of things, which is one reason I've come to this forum... in hopes of talking to folks who have been where I am now so that when I go to the doctor's office I have some knowledge and can suggest or even insist on taking steps towards finding out what's going on with me.

[tacolino]

Hi there, a lot of your tests seem very good, which is great news. Having mentioned the seizure, I presume you had a carotid echo too? Was this ok? Do you ever get any symptoms of Angina or get short of Breadth? Just one thing. You display high BP numbers. Did you get a 24hr BP monitor or not? If so what were the averages? I ask because your numbers as quoted above indicate High BP. So you should insist on the test. And I definitely suggest you look at it, because you say you had mild LVH. Yes that often can develop because of high BP. But I would think that if it is being caused by high BP, that they would promptly initiate a BP medication programme. This would probably help to reverse the LVH over time with better BP control with you taking the meds. Im not a doctor as you know, but hope my experience helps you

[Jansell84]

Thanks for the reply. I've had a full blood workup and urinalysis and all was fine. Cholesterol was 160, though my HDL was low so working on bringing that up now... kidneys good, no sign of diabetes, and I had an echo as well... on the echo I had mild left ventricular hypertrophy and my cardiologist stressed that it was nothing severe at all but did say it was probably due to prolonged high blood pressure... he didn't even suggest blood pressure medication, however. My GP is the one who has suggested meds. Anyway, my ejection fraction was normal at 53%-55%. I had some "trivial" leakage in areas, but he said that's common even in a healthy heart.

I also had a tilt table test and tested positive for orthostatic hypotension, though I didn't become symptomatic until they administered nitroglycerine so I think that diagnosis is bogus.

I have been having runs of PACs for a year now. I get them when my heart rate increases above 130bpm so when I exert myself I'll get them occasionally or when I take a hot shower or eat a large meal. Had a 3 week ambulatory ECG to determine what it was and they're supposedly benign.

This all came about in September when I fainted in the bathroom and had what appeared to my wife to be a seizure. All of my doctors believe it was a vasovagal reaction and the seizure was due to me not being able to fall flat so that blood could reach my brain. So they've been investigating since and ruling out other possible causes.

[tacolino]

Hi there. Im not a doctor, but can offer my experience of bp problems. Firstly the gold standard test for BP is a 24 hour ABPM test. Its a very simple test and you should do it. It even allows an amount of time at start and finish to take account of the White coat period. This would give you a fuller picture of your BP averages. Often BP meds are for life, so once they start. . .. . Its a big decision to take. And you have the Side effects to deal with too. Always doctors will give you the walking lecture when you have BP raised. Its the first query. Of course they will hone in on your weight too. A body Mass lecture will happen!!!! Your home averages are good and the Omron is ok as a monitor too. Do you have any other ailments? Have you had bloods done? How is your Kidney function? What about Blood Sugar levels? Did you have a heart  Echo test? If so what was your EF percentage like?
50LBS is a great start. If you keep it up and start a walking programme, you could be ok without meds. Of course your doc has all your medical history and is best placed to advise you, but its worth weight loss and exercise to try beat it first. Keep us posted