Hypertension: Do I have it or not?

[manlyman]

When I was 19, I got diagnosed with hypertension. At that point, I was about 208 pounds, and my BP was about 145/85 at the doctors, creeping up to 150/85. My doctor told me to lose weight at that point. I didn't. And I was with a girlfriend who wasn't into being very active either, but convinced me to take medicine for it. Because of this, I let my weight get up to 250-260. At this point, it was high (the BP).

First of all, I have never really had diastolic hypertension. My hypertension has ALWAYS been systolic, even before meds. 150/80, 160/80, perhaps a bit higher at the doctors. Just as a side note.

Well, that was two years ago since I was at the 260 pounds at age 22. Now, I'm 24, and I've lost almost all of it. I'm back down to 195. I've been pulled off one of the medicines I'm on (Calcium Channel Blocker), leaving the Angiotensin II Receptive Blocker (Avapro) as the only one left. Pulling me off the CCB showed no change in my BP, its still just as the following:

1) When I wake up, its 115/75, perhaps lower. Sometimes, its 125/82. Never higher.
2) When I sit down for a period of 3 minutes or more, in my own home, its less than 130/80.
3) When I'm up and walking around, and then if I take it (like perhaps at the doctors), its sometimes, AT MOST, 140/90. I have not had a blood pressure reading over 140/90 in about 6 months, minus an anxiety attack I had about 4 months ago which left it at 180/90, but that was food poisoning combined with an anxiety attack (which came out of no where and was for a specific reason, I don't get those often at all).

I just don't understand if I still have the high blood pressure "badly" or not. Like I said, I wake up normal. I can lay in bed and be normal. I work out 7 days a week at this point (lots of running). There are three reasons why I'm worried:

1) Every time I go to the doctor, its a bit higher. Sometimes 150/90.
2) If I take it after walking around (for instance, if I go downstairs to get the mail and come back up, and have my friend who is a nurse immediately take it, it'll be around 140/90, or 138/88. Of course, this is just after I walked up two flights of stairs and my heart is beating faster, but... they claim this shouldn't raise it that high.
3) I have an ECG (and have had an ECG) which shows higher voltage and borderline LVH. For those "technical people", the highest V1 and the highest V5 QRS total around 30-35mm, and they say "> 35mm is indicative of LVH". I work out a lot, though, and they say that athletes can have higher voltages, and also, I had a test dont last December (9 months ago, echocardiogram) which showed no thickening of the heart walls at all - but I wonder what could change in 9 months?

So that's where I stand. I'm trying to decide if I should keep letting my doctor take me off the medicine (I've got one left!). I'm wondering if my 140/90 spikes while walking around are dangerous, or if I should stay on this medicine until I lose a bit more weight first.

Any suggestions would be great!

[flowergirl2day]

Hi,

Some people can and do discontinue their blood pressure meds. It's usually those with mild hypertension. Weight loss and proper diet combined with other lifestyle changes can have that much of an impact on hypertension.

You've lost weight and maintain your present, much healthier weight. That is important. It's up to your doctor to decide whether or not you need any blood pressure medication. They say that most of us will have high blood pressure for life. Maybe your are one of the lucky people for whom lifestyle changes resulted in a satisfactory reduction in blood pressure. The only way I can think of to determine this is to get off your medication with your doctor's help and under his strict supervision.

The fact that your blood pressure always seems higher at the doctors office probably means you have "white coat hypertension". Do some reading about it. Blood pressure fluctuates a lot during the day, so any temporary increases should not be considered scary and attributed to hypertension. Everybody's blood pressure fluctuates during the day.

2) If I take it after walking around (for instance, if I go downstairs to get the mail and come back up, and have my friend who is a nurse immediately take it, it'll be around 140/90, or 138/88. Of course, this is just after I walked up two flights of stairs and my heart is beating faster, but... they claim this shouldn't raise it that high.

Well, sometimes it can and does. Getting up two flights of stairs requires some energy output. Your heart beats faster.

3) I have an ECG (and have had an ECG) which shows higher voltage and borderline LVH. For those "technical people", the highest V1 and the highest V5 QRS total around 30-35mm, and they say "> 35mm is indicative of LVH". I work out a lot, though, and they say that athletes can have higher voltages, and also, I had a test dont last December (9 months ago, echocardiogram) which showed no thickening of the heart walls at all - but I wonder what could change in 9 months?

If you have LVH and if it is borderline, with good lifestyle, diet and plenty of exercise it will most likely completely reverse itself. In the presence of documented remodeling of your left ventricle, increase in thickness of the walls or enlarged chambers, or decreased ejection fraction, you'd have more of a reason to worry. You say the echo didn't show anything like that. Good! You should probably have another test a few months from now. Don't get too worked up about your ECGs. They are good tools, but should not be considered diagnostic in any way. (That's what I was told by a cardiologist).
Blood pressure spikes can be dangerous and can cause as much damage as chronic hypertension.

flowergirl

[manlyman]

flowergirl:


Thanks for the reply. Well, when I was on my HIGHEST medicine dosage (Avapro 300mg, PLUS a calcium channel blocker, PLUS a diuretic), I would have spikes into the 180's/90's when I had anxiety attacks - a simple anxiety attack could make it that high. Are you saying during those 5-10 minute spikes I did as much damage as someone does in 40 years?

Also, I've always been convinced that there was something the docs were missing - if I run up a stairwell for instance, say 3 flights, I will have to put my hands over my ears and hum, because I will hear my heart beating so loud inside my head, that it will drown out ANY other noise I hear. Its been like that since I was young, and it drives me nuts. Or after I go for a run, I have to stop and hum, otherwise, my pounding pulse will wake the neighbors!

Anyway, my doctor took me off all medicines over the past week minus the Avapro. So right now I'm on Avapro 300 mg, and thats it. Just took my BP, and its 115/75 with both machines (I have two blood pressure machines). I took it manually and it was higher - 130/80. For some reason, if I take my blood pressure manually, its ALWAYS higher than the machines, no matter how many machines I use. Surely they can't all be inaccurate? I bet I'm just starting the second I hear even the tinyest bit of a heart beat, even though I guess you're supposed to wait until you really hear the systol? An issue for another thread I guess.

Thanks for the recommendations. I'm on avapro only, we'll see how this goes. So far, today, my blood pressure was relatively fine.

-Matt

[flowergirl2day]

Matt,

I would have spikes into the 180's/90's when I had anxiety attacks - a simple anxiety attack could make it that high. Are you saying during those 5-10 minute spikes I did as much damage as someone does in 40 years?

I am not saying that at all. Frequent blood pressure spikes over a long period of time have the potential of causing the same type of damage as long standing hypertension. In other words, one does not have to have constantly high blood pressure to suffer damage.

The doctors can easily miss symptoms,or not associate them with any particular condition. You know you can always rely on your body - you know it so well. It lets you know when something's wrong. Trust your instincts.

For some reason, if I take my blood pressure manually, its ALWAYS higher than the machines, no matter how many machines I use. Surely they can't all be inaccurate?

Matt, no offence, but do you know how to use these types of monitors? They can be a bit tricky to use. I rely on the electronic ones. I watched a video which demonstrated their use. It seemed pretty complicated to me.
Good luck and please let us know how it goes.

flowergirl