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Old 06-02-2012, 01:18 PM   #1
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Pulse Pressure 60 to 65 - Why?

I'm on Lisinopril/HCTZ 20mg/25mg for hypertension (was diagnosed at 17 with a reading of 170/110).
Granted I've had plenty of ECG's, blood tests, worn a holter monitor for 24 hours, had an ECHO test, etc.
I'm told my heart and organs and such are doing just fine.

So, while I'm still on my quest to figure out WHY I have hypertension... for now my question is, considering my readings are something like...
136/72 - PP 64
142/79 - PP 63
128/78 - PP 50
146/87 - PP 59
...are these pulse pressure readings a matter of concern? Should I look a bit further into this? What might be some possible causes of this?

P.S. - My pulse ranges between 65 to 82.

Also, I rarely eat canned foods, I eat plenty of veggies, not big on red meats so mostly chicken for my meat consumption and fast foods are also a rarity.
And I walk for 20 mins everyday OUTSIDE, not on a treadmill lol.
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Old 06-02-2012, 04:52 PM   #2
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Re: Pulse Pressure 60 to 65 - Why?

Wide pulse pressure can be due to many causes:
hyperthyroidism - thyroid hormone potentiates norepinephrine action leading to increased cardiac contracility which increases systolic pressure, more than diastolic

Increased cardiac output seen in essential hypertension - often in part from elevated sympathetic nervous system outflow.

Pheochromocytoma - the catecholamines produced by the tumor yield an effect similar to the items above

Reduced vascular compliance - stiff vessels do not have normal elastance, thus systolic elevates abnormally with each stroke volume delivered to the aorta, and lack of recoil of the aorta in diastole produces a lower diastolic pressure.

Aortic Regurgitation - aortic valve regurgitation can produce profoundly elevated systolic pressure and quite low diastolic pressures. Your ECHO was normal so this isnt your case.

Your pulse pressures are perhaps somewhat elevated above that of a normtensive, but I dont think this is an unusual pulse pressure given that you are a young, hypertensive.

Last edited by atengnr; 06-02-2012 at 04:54 PM.

 
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Old 06-02-2012, 06:53 PM   #3
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Thumbs up Re: Pulse Pressure 60 to 65 - Why?

Quote:
Originally Posted by atengnr View Post
Wide pulse pressure can be due to many causes:
Increased cardiac output seen in essential hypertension - often in part from elevated sympathetic nervous system outflow.
What might cause an "elevated sympathetic nervous system outflow" that isn't a result of anxiety or exercise?


Quote:
Originally Posted by atengnr View Post
Reduced vascular compliance - stiff vessels do not have normal elastance, thus systolic elevates abnormally with each stroke volume delivered to the aorta, and lack of recoil of the aorta in diastole produces a lower diastolic pressure.
Which tests are there to determine if this is a possibility?
And are there other signs or symptoms to help support this as a possibility?
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Old 06-03-2012, 06:01 AM   #4
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Re: Pulse Pressure 60 to 65 - Why?

[QUOTE=Inquisitive1too;4991569]What might cause an "elevated sympathetic nervous system outflow" that isn't a result of anxiety or exercise?

Well, this is commonly occurring in essential hypertension. It is one of many abnormalities evident. If you indeed have essential hypertension, I think that there is currently no answer as to why this occurs.

As far as vascular compliance, yes there is a test that some dr. have the capability to do, its done in the office. Ive forgotten the name of the product used to do this testing. It is more informational than anything right now, because the results do not change the management of the high blood pressure.

So, since it sounds like you have been to the doctors over the years, I presume that you have been worked up for hyperaldosteronism, pheochromocytoma, renal artery stenosis, coarctation of the aorta (ruled out because you state you had an echocardiogram)?? You have normal kidney function? Thyroid is normal?

 
Old 06-03-2012, 03:48 PM   #5
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Re: Pulse Pressure 60 to 65 - Why?

Quote:
Originally Posted by atengnr View Post
Well, this is commonly occurring in essential hypertension. It is one of many abnormalities evident. If you indeed have essential hypertension, I think that there is currently no answer as to why this occurs.
Ahh. Well that is a bummer. BUT, the bright side of this is that at least we understand it this far. Surely in time we will learn more.

Quote:
Originally Posted by atengnr View Post
As far as vascular compliance, yes there is a test that some dr. have the capability to do, its done in the office. Ive forgotten the name of the product used to do this testing. It is more informational than anything right now, because the results do not change the management of the high blood pressure.
Hmm, I'll have to ask my Dr. then and see if he knows the procedure in question.

Quote:
Originally Posted by atengnr View Post
So, since it sounds like you have been to the doctors over the years, I presume that you have been worked up for hyperaldosteronism, pheochromocytoma, renal artery stenosis, coarctation of the aorta (ruled out because you state you had an echocardiogram)?? You have normal kidney function? Thyroid is normal?
Oddly enough, my kidneys have been no cause for concern by any of my Drs. Except in one isolated occurrence in which I used to powerlift A LOT and consume a good deal of whey protein and creatine monohydrate and my Dr. at the time noticed my creatinine levels were slightly up.
Ever since I stopped, my kindeys have been no cause for concern by any of my Drs.

But, of all the testing I've had done... I can safely say I haven't had my Thyroid or my Adrenal Glands tested. I mean, I've had the typical 'throat checks' where they feel for an enlarged thyroid but from what I've read, not everyone who has hyperthyroidism necessarily has an enlarged thyroid (or large enough to feel it).
But, I do sweat at room temperature, typically have a raised body temp (not outside of the normal range, though), insomnia, raised metabolism, odd moments of a lasting spiked pulse (usually in the 80-90's as opposed to my average 60-70's) without a known cause, restlessness (could be attributed to my ADHD, though), fatigue (could be attributed to my hypertension itself, or the side effects of Lisinopril), anxiety, as well heart palpitations (also could be attributed to my hypertension itself).
And at times my blood pressure has risen to 150-160 over 90-100, again without a known cause and while on my medication that usually controls to 120-130 over 75-85.

Granted I don't know the likelihood of my having hyperaldosteronism, hyperthyroidism or a pheochromocytoma but... what do you think (based on the shared info) seems likely of my situation?

P.S. - Tyvm for the shared info, thoughts and generalized brainstorming. Much appreciated.
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Old 06-03-2012, 06:40 PM   #6
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Re: Pulse Pressure 60 to 65 - Why?

hyperthyroidism probably most likely, statistically speaking, hyperaldo next, and pheo exceedingly rare. The symptoms you describe fit more with hyperthyroidism or pheo. Seems worth getting a TSH just to be sure youre not hyperthyroid.

 
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