Blood pressure question

[Guest]

My right arm is almost always higher than my left. L 137/102; R 178/106. Sometimes the L will be normalish 138/89 but the right is still higher at 14-/103-6. I'm on blood pressure meds but it is still high. Ever so often both arms will be equal but still high. I'm using a battery powered wrist cuff automatic thing so I don't know if its because its junk or if I need to be concerned. Going to the Dr after insurance kicks in in mid January...if live that long. A buddy just dropped dead two days ago from an aneurism, he was 55.

I'm a 45 y.o male, 6ft, 190ish#'s non smoker/drinker.

 

[Boink]

OK... some comments from someone that used to teach this stuff to medical students. Me. [but, as a disclaimer, I'm not a physician]

I think the wrist-cuff method is inferior to the standard sphygmomanometer. The wrist method typically uses a algorithm to calculate BP (and actually utilizes a more indirect method involving plethysmography). Even an electronic sphyg (that compresses your upper arm and gives a digital read-out) is better than a wrist unit. Compressing the brachial artery and listening for Korotkoff sounds is the industry standard... and is easy to learn with a stethoscope.

Anyway, differences between arms is not unusual (especially if less than 15mmHg), but there are conditions that can cause a serious difference (such as a "carotid steal syndrome"). I'd make sure your doctor isn't concerned about it.

As for meds, it is not unusual at all to require several anti-hypertensive agents to get it into line (sometimes peripheral vaso-dilators, sometimes cardiac inhibitors, sometimes blood volume lowering drugs, or, very often, 2 or more of those). Don't be surprised if you're told to take Attenolol, Vasotec, Avapro and/or Enalipril, etc. and don't fool with the dosages.

Your diastolic is high... way too high (if you ask me - especially if you're already on meds for it), and more concerning. So:
1) measure your BP using a different method (and I'd junk the wrist unit) - go to Target or a drug-store that offers it
2) see your doctor ASAP.

Hypertension really is a silent killer and should be taken seriously. You won't feel bad while end-organ damage is happening.

[EDIT: I hope I'm not too alarming. Your BP values from a wrist unit might be falsely high. Get a reliable reading when you are at rest, and see your doc in January or earlier if you can.]

 

[rick_ingram]

I concur with Mark. I'm a retired pharmacist. I ALWAYS steered folks away from the wrist monitors due to their lack of accuracy.

In my opinion, the best it the hand pump cuff with a stethoscope...after that is the automated unit for the upper arm.

The units found at many pharmacies are OK....but they are not calibrated as frequently as you would think.

If you are currently on meds and you pressures are indeed what you state....you really need to see your physician because you are NOT be controlled adequately.

Exercise and weight loss can assist in lowering your pressure as well......and watch your intake of salt (both hidden in foods and as table salt).

Don't feel bad if it take two, three, or even four different drugs to get your pressure under check.

I am personally on three agents...amlodipine, hydrochlorothiazide, and valsartan...all taken only once daily, so compliance is not an issue for me. My pressure fluctates (which is normal) but is controlled....usually 125/75 or so.

 

[Trevor Triumph]

My blood pressure is often high at the doctor's office but quite low when doing the preliminary things while donating blood. My dad, a physician, noted that insurance companies wanted almost no blood pressure- lowest possible- not allowing for individual differences.
T.T.

 

[LarryK]

There is the white coat syndrome whereas your blood pressure is normal until you are in the DR.s office. My wife has this.

 

[NutmegCT]

To keep you a bit less worried until you see a doctor, go to a local drugstore (pharmacy). Just ask to speak with a pharmacist (not tech assistant). Tell him/her what you posted in your first post above. I'm also thinking you're a bit "heavy" for a six foot tall male, depending on body type.

Tom

 

[rick_ingram]

To keep you a bit less worried until you see a doctor, go to a local drugstore (pharmacy). Just ask to speak with a pharmacist (not tech assistant). Tell him/her what you posted in your first post above. I'm also thinking you're a bit "heavy" for a six foot tall male, depending on body type.

Tom

He just "spoke" to a pharmacist and an educator here on this thread....but second opinions are a good idea.

Yes, "white coat syndrome" is real. Which is why it's good to monitor ones blood pressure at home (or at the mall/pharmacy at one of the machines) on a regular basis and preferably at similar times. This gives you and your health care provider a good idea of your "real" blood pressure and any trends that may be starting to appear.

I won't get into my opinions of insurance companies...other than to say that I believe that suggested "norms" for blood pressure, cholestrol levels, A1C levels, etc are beginning to trend downward into levels that are not necessarily achievable for "John Q Public" in otherwise good health.

 

[Boink]

And now I'm going to concur with Rick.
As for white coat hypertension, the assessment in question (that started the thread) was done on a questionable home-monitoring device (known for its inaccuracy).

The fickle thing about HTN is that a diagnosis is never made from one or even two assessments. There are too many factors that affect BP (diet, weight, full bladder, caffeine, nicotine, position of the arm, even thinking about it - and that's not to mention the host of pathological causes that range from neurogenic causes to renal dysfunction). Therefore, the industry standard is repeat values over a period of time.

Rick summarized it well: a) get a better recording, b) see your doctor so-as to better control it.

 

[DrEntropy]

And heritage/genetics need to be taken into account as well. Mediterranean genetic influences are different than an Eastern European's are, Asian heritage has a different genetic setup than Irish or Scottish do. Blood pressure alone is a tricky thing to depend on to judge the status of one's "health" by. Many more factors are involved.

I'm a BIG fan of J. Craig Venter, BTW.

 

[Boink]

Genes are genes (with little to deal with short of acceptance)... but high blood pressure, while only an indicator of a number of variables, is serious business.

Corollary: being normotensive doesn't mean one is healthy. :rolleye:

 

[DrEntropy]

but high blood pressure, while only an indicator of a number of variables, is serious business.

No argument there. It's the "variables" which toss it into question. And Bill's numbers are cause for further investigation and concern, for sure.

Corollary: being normotensive doesn't mean one is healthy.

My point, in fact. There are influences from genetics, diet, BMI and diseases like diabetes, et al play havoc as well. Good clinicians are what make the difference. But it's hard to know the players without a program. The niche practices took on a life of their own back in the '60's. "Specialization" became a watchword about then. But they haven't gone forward into the mind-set to "cross-pollinate" (share) their data, out of what I see as simple professional jealousy. I site oncology, gynecology, retinology, etc. as examples. Some are dedicated to truth while others are dedicated to personal aggrandizement and greed.

Being your own advocate, informed, is the only way to go. A W.C. Fields movie quote comes to mind: "Trust everybody... but cut the cards."

 

[Boink]

"Being your own advocate, informed, is the only way to go. A W.C. Fields movie quote comes to mind: "Trust everybody... but cut the cards."

Excellent!

 

[NutmegCT]

Until you see a doctor, talk with the pharmacist at your local drugstore!

 

[Guest]

:laugh: I had some weird groin pain during the funeral yesterday and I didn't want to dally over the holidays. Went to the DR yesterday, gotta NP instead. Sweet girl, dressed like she went to med school in Whoville...mebbe she was taught by Dr.Seuss. Anyway BP was 117/90 L, 121/90 R which I can live with. Then she found out it looks like I herniate my abdomen in the wreck. She thinks the back pain I've been feeling was also from the wreck but no idea on the groin pain. Did the usual exam but brought a buddy in which was weird cause she was kinda young and cute too. I usually joke with the staff but the situation was already awkward enough as it was. She wants to do a cat scan but that will have to wait till mid Jan. It appears I'm not dyin' yet supposedly, but I did have a weird groin pain this morning.

 

[NutmegCT]

You must be a young guy - still experiencing groin' pains

Anyway, glad you made some progress.

 

[AN5Sprite]

Yo Billy,
I've had my own blood pressure issues, (discovered in my 20's) anyway here's the best advice I can give:
Get a good arm-cuff tester at Walgreens or the like. (less than $80 iirc)
Check your pressure EVERY day for 30 days and be serious about it. Do it before any morning coffee, or food, or activity etc. Write down every measurement in a logbook.
Take that logbook to your first doctor visit.
1. You (and the Doc's) need to see the numbers over a longer term.
2. I think most good docs will make you do at least a 1 week or (hopefully) a 30 day cycle before pronouncing judgement.
3. If you go in with the numbers you might avoid going out with a script for meds you don't need.

 

[DNK]

Like Steve ,I been fighting it since I was 23. (Thanks Parents)
Monitor it and remember the ol 120 over 80 is not excepted anymore . They want it lower