High Blood Pressure?

[bolus]

Since I've been off HCTZ for years, that isn't the problem. Thanks for mentioning hyperaldosteronism. I had no idea that existed. I'll try to avoid mentioning it with my primary care doctor, since they don't like amateur ideas. I'll just press the lack of change no matter how much Potassium supplement I take, and see if he will send me up the ladder to a specialist.

If I can't get action, I'll have to press harder.

Thanks again!!!!

Some patients do come up with the most interesting ideas though with their own research.

I recently had a patient tell me I diagnosed her wrong and she made her own diagnosis and after her research she insisted I treat her with propofol and succinylcholine.

Propofol is of course what killed Michael Jackson and is a powerful sedative that can stop breathing. succinylcholine is much worse and is the muscle paralyzer they use during surgery. It paralyzes every muscle including the diaphragm.

If I did what she said it would have killed her within 20 seconds or so. Faster than what they use for lethal injection.

At least she asked for both. If she only asked for the succinylcholine, she would have been wide awake when she stopped breathing and would be well aware of her immediate suffocation.

 

[arakboss]

Some patients do come up with the most interesting ideas though with their own research.

I recently had a patient tell me I diagnosed her wrong and she made her own diagnosis and after her research she insisted I treat her with propofol and succinylcholine.

Propofol is of course what killed Michael Jackson and is a powerful sedative that can stop breathing. succinylcholine is much worse and is the muscle paralyzer they use during surgery. It paralyzes every muscle including the diaphragm.

If I did what she said it would have killed her within 20 seconds or so. Faster than what they use for lethal injection.

At least she asked for both. If she only asked for the succinylcholine, she would have been wide awake when she stopped breathing and would be well aware of her immediate suffocation.

Do doctors generally check the volume of blood moving through the bodies blood vessels?

It seems to me that humans deal with lots of issues related to poor circulation. Is it possible that lowering blood pressure could reduce the circulation that occurs in partially blocked blood vessels?

If higher blood pressure is unnecessary and harmful to the body, why does our blood pressure rise when we do work (exercise)?

I have always been told to measure blood pressure when relaxed and not standing. If I am standing and doing work for the vast majority of the day, wouldn't I want to know what my blood pressure was during that time?


Besides increasing heart rate, are there any other mechanisms that the body uses to increase blood flow throughout the body when blood vessels begin to clog up or lose elasticity?


Some Doctors are starting to believe that target blood pressure targets should be higher for older frail adults. Where do you stand on that issue?

 

[Duneblaster]

 

[arakboss]

Blood Flow Through the Body – Boundless Anatomy and Physiology

university.pressbooks.pub

 

[bolus]

Do doctors generally check the volume of blood moving through the bodies blood vessels?

It seems to me that humans deal with lots of issues related to poor circulation. Is it possible that lowering blood pressure could reduce the circulation that occurs in partially blocked blood vessels?

If higher blood pressure is unnecessary and harmful to the body, why does our blood pressure rise when we do work (exercise)?

I have always been told to measure blood pressure when relaxed and not standing. If I am standing and doing work for the vast majority of the day, wouldn't I want to know what my blood pressure was during that time?


Besides increasing heart rate, are there any other mechanisms that the body uses to increase blood flow throughout the body when blood vessels begin to clog up or lose elasticity?


Some Doctors are starting to believe that target blood pressure targets should be higher for older frail adults. Where do you stand on that issue?

The analogy I use is RPM's on a car engine. When you are out driving sometimes you need to pass someone and hit the gas, the engine rev's up and you pass and then go back to cruising speed with lower RPMs. The car engine doesnt blow up. Its something it is designed to do.

Now imagine driving at 60mph on the highway in 2 nd gear at 6500 RPM for 1000 miles. Does the engine immediately blow up? no. But what does happen? the engine wears parts out faster, the oil life is decreased, it may overheat. Your car has a higher chance of breaking down if you run it at the rev limit all the time.

Yes blood pressure goes up when you exercise but you also dont exercise at full capacity 24 hours a day. If your blood pressure is high all the time, even at rest, it starts to wear out parts like your blood vessels, your kidneys, your heart.

The body raises blood pressure a number of different ways. Increased heart rate, increased heart muscle contractility. arteries constrict, kidneys release hormones that raise blood pressure, adrenals have several hormones that raise blood pressure, etc.

There are several reasons to have different goal blood pressures for elderly patients that are too numerous to list here. But one is autonomic insufficiency that causes blood pressure to drop too far when they stand up. If we are too aggressive with meds they may pass out when they stand up and breaking a hip is not a reason to have perfect blood pressure.

 

[arakboss]

The analogy I use is RPM's on a car engine. When you are out driving sometimes you need to pass someone and hit the gas, the engine rev's up and you pass and then go back to cruising speed with lower RPMs. The car engine doesnt blow up. Its something it is designed to do.

Now imagine driving at 60mph on the highway in 2 nd gear at 6500 RPM for 1000 miles. Does the engine immediately blow up? no. But what does happen? the engine wears parts out faster, the oil life is decreased, it may overheat. Your car has a higher chance of breaking down if you run it at the rev limit all the time.

Yes blood pressure goes up when you exercise but you also dont exercise at full capacity 24 hours a day. If your blood pressure is high all the time, even at rest, it starts to wear out parts like your blood vessels, your kidneys, your heart.

The body raises blood pressure a number of different ways. Increased heart rate, increased heart muscle contractility. arteries constrict, kidneys release hormones that raise blood pressure, adrenals have several hormones that raise blood pressure, etc.

There are several reasons to have different goal blood pressures for elderly patients that are too numerous to list here. But one is autonomic insufficiency that causes blood pressure to drop too far when they stand up. If we are too aggressive with meds they may pass out when they stand up and breaking a hip is not a reason to have perfect blood pressure.

The rpms in a car analogy is easy to understand. We could just lay around all day and eliminate anxiety in our lives, which would lower our average BP numbers throughout the day. That might be comparable to leaving the car in the garage.

My mom is taking some type of BP med and had to start taking a half dose because she was so tired while out walking, that she could barely get up the hill.

My concern is we place too much focus on BP numbers while ignoring blood flow. I always here people talk about their BP numbers but rarely here people talk about their blood flow. It did come up recently when a coworker had to have two of his toes amputated. He had very poor blood flow to his toes and they ended up having to replace sections of blood vessels in that leg.

I would like to think that the body has the ability to increase and maintain blood flow when our blood vessels begin to clog but maybe that is wishful thinking.


Edit: This article seeks to indicate that the body does indeed compensate to maintain blood flow.

Heart Failure: Compensation by the Heart and Body – Health Information Library | PeaceHealth

Heart failure means that your heart muscle doesn't pump as much blood as your body needs. Because your heart can't pump well, your heart and your body try to make up for it. This is called compensation. Your body has a remarkable ability to compensate for heart failure. The body may do such a...

www.peacehealth.org

The body's hormone and nervous systems try to make up for this. They increase blood pressure, hold on to salt (sodium) and water in the body, and increase the heart rate. These responses are the body's attempt to compensate for the poor blood circulation and the backup of blood.


Ideally a BP med would lower pressure while maintaining satisfactory flow. Maybe some meds do that, maybe they don't. If the body is compensating for poor blood flow by raising blood pressure and we lower the BP with meds, that could be problematic, if we don't provide some other method for increasing the flow.

 

[Mikej]

Propofol is of course what killed Michael Jackson and is a powerful sedative that can stop breathing.

I'd heard from someone that this ^^ is the drug they give you when you have a colonoscopy? If so, I could sure understand why Michael Jackson was doing it! Neve woke up feeling so good!

 

[Provincial]

My provider system has a policy that if they take your blood pressure and don't like the result, they make you sit for five (or more) minutes and take it again. This even if you have been sitting in the waiting room for a long time.

For some reason, the pressure is always lower with the second reading. I'm tempted to do jumping jacks ahead of the second reading just to mess with their heads. If I do, and the second reading is less, what would that tell us?

 

[DirectDrive]

My provider system has a policy that if they take your blood pressure and don't like the result, they make you sit for five (or more) minutes and take it again. This even if you have been sitting in the waiting room for a long time.

For some reason, the pressure is always lower with the second reading. I'm tempted to do jumping jacks ahead of the second reading just to mess with their heads. If I do, and the second reading is less, what would that tell us?

Just walking from the waiting room to the exam room will bump up your BP.
That's why they might take it a second time.
If you're going to an upper level in the building, they will often tell you to take the elevator.

Pro Tip :
You ALWAYS want to have your arm with the BP cuff elevated to the same level as your heart.
If your tech doesn't provide an appropriate arm rest and have you use it, they don't know what they're doing.

Book it.

 

[Provincial]

Well, it drops from 134 to 128, so that's great. It seems like they have a number that they have to reach, and do whatever to reach it, then call it good.

The reality is that blood pressure is a range, and a moving target. Picking a best case condition may establish a baseline for reference.

These tests were done in a one-story office, the waiting area 25 feet from the exam room, and with a 10 minute wait time, then several minutes in the exam room before the first test.

Interestingly, when adjusting the medication levels, 180/100 didn't seem to inspire them to follow up with any haste.

Edit to add: they always keep my arm supported at the right level.

 

[arakboss]

Well, it drops from 134 to 128, so that's great. It seems like they have a number that they have to reach, and do whatever to reach it, then call it good.

The reality is that blood pressure is a range, and a moving target. Picking a best case condition may establish a baseline for reference.

These tests were done in a one-story office, the waiting area 25 feet from the exam room, and with a 10 minute wait time, then several minutes in the exam room before the first test.

Interestingly, when adjusting the medication levels, 180/100 didn't seem to inspire them to follow up with any haste.

Edit to add: they always keep my arm supported at the right level.

Using the car engine rpms example in post #45: If you go into your mechanic for a check up and your car is idling at 800rpms, he might say your engine is in good shape, keep it at 800rpms and it will last a long time. Reality is our BP is running higher than at rest, nearly 16hrs a day.

I would think it would be more important to know your average BP throughout a normal day, week or month?

A happy go lucky sedentary person will probably have a lower average BP rate, compared to an always angry person working construction, then going to the gym after work, before going home to fight with the wife over his hoodlum kids behaviors.

I have white coat anxiety especially when needles are going to be involved during the visit. My BP at Docs office probably resembles what it is the rest of the day.

I avoid doctor's offices as much as possible.

 

[Bobbygun]

I have white coat anxiety especially when needles are going to be involved during the visit. My BP at Docs office probably resembles what it is the rest of the day.

I avoid doctor's offices as much as possible.

You and me both buddy. My medical file is actually documented for "white coat syndrome". The worst is when I go to the dentist. My BP was so high one time, they wouldn't even clean my teeth. This despite the fact my BP was just fine at home 2 hours prior. My medical doctor had me bring my monitor into his office so he could see my typical readings at home. My BP was fairly high at his office (around 150/90), so he used my monitor to see what kind of reading it gave me. It was slightly worse with my machine, so he was convinced I had the white coat syndrome.

 

[bolus]

My concern is we place too much focus on BP numbers while ignoring blood flow. I always here people talk about their BP numbers but rarely here people talk about their blood flow. It did come up recently when a coworker had to have two of his toes amputated. He had very poor blood flow to his toes and they ended up having to replace sections of blood vessels in that leg.

We do look at flow but probably not in the way you think. The coworker you lost his toes due to poor flow might have had peripheral vascular disease. the build up of cholesterol in the vessels limiting flow leading to ischemia (low oxygen) and then death of tissue. If you reduce flow at the narrowing you are getting even lower pressure downstream leading to more ischemia. If you increase pressure you have to do it much higher than the rest of your body is going to tolerate to maintain adequate pressure after the narrowing. Instead we bypass the blockage. We have ultrasounds that can look at flow in vessels.

It gets even more complex than just Bernoulli's or Darcy-Weisbach equations on pressure vs flow vs pipe diameter because the vessels are dynamic, can autoregulate flow at different pressures, and are made up of complex trees of blood vessels splitting into smaller and smaller vessels. We cant dynamically adjust flow through this type of system artificially .

I cant imagine maintaining oil pressure in your car engine if every hose and tube and filter changed size constantly.
Then if you made the engine oil like blood which is part cellular and part soup of proteins that dynamically changes with eating and fluid intake. Think of a control system in your car that handled not only every hose and tube and filter dynamically changing size but the oil also changed viscosity grades dynamically. There is no way we could do that with a car so doing it with a human is much much harder. .

So we manage one variable that is easy to change. Pressure. Add a few hundred years and millions of studies of trial and error to get where we are now.

 

[arakboss]

View: https://youtu.be/rI-ktNcbi7M?feature=shared

 

[awags_86]

Eat right.
Drink water.
Cardio.
Pick up heavy things repeatedly.

Fix it before you "need" meds.

 

[Bobbygun]

View attachment 1860021

There's a lot of truth in this. When my doctor was getting more insistent on me taking BP meds, I asked if that wouldn't just be "enabling" me, when I should be eating better and losing weight (I get PLENTY of exercise, but it makes me hungry. ). He got HOT over that comment. Started talking about maybe I needed a different doctor. Took me a bit to calm him down, saying I was making fun of myself - not him. After he moved to the east coast, I got a new doctor. He outsmarted me by telling me that losing weight would be a wonderful way to lower my blood pressure. Then added, he was putting me on medication and looked forward to the day I lost all that weight so he could take me off of them. Checkmate! Well played sir.

 

[Mikej]

I have white coat anxiety especially when needles are going to be involved during the visit.

You get over that needle fear thing if you have arthritic wrists, shoulder, knee. As far as the shots? Shoulder is easy. Wrist hurts pretty good for a few seconds and knee W/fluid drain is tough not to squirm while their doing it. But being able to sleep, on either side, with no wrist pain, and walk fairly normal. Worth it!

 

[The Heretic]