New Blood Pressure Adventure

This is my latest challenge. I found out I have pretty significant hypertension (elevated blood pressure), . This occurred at my new doctors office (general practitioner). I have had “white coat disease” in the past, where BP reading is elevated in the doctors office, but when I go home it’s fine. So when I got a reading around 170/90 on my Dr. visit, I told my new Doctor (more on her below) that and she took my word for it, and told me to go home and do a BP log for a week to show her on the next visit. Imagine my surprise when I got home and got in the range 170/90 multiple times!

Now some background. I was first diagnosed with hypertension more then 10 years ago, but is was not too bad, about 140/80, so my doc put me on low dose atenelol (beta blocker, 20 mg) I later switched to a different primary Doc near my work (at the time) whose a sports medicine specialist, who prescribed low dose lisinopril. Beta blockers are not the best idea for athletes, even amateurs like me, because they alter your heart rate response. ACE inhibitors like lisinopril work by blood vessel dilation so don’t have this problem. Then when I had incidents of AFIB due to aortic stenosis, my cardiologist put me on Metaprolol 50 mg to also control possible arrhythmias. Metaprolol is also a beta-blocker so acts to lower BP. I was on that till recently.

Around last October, I figured, you know what, it’s been more than 3 years since my surgery and I had no incidents of AFIB or other arrhythmia, so why do I still need Metaprolol?

So I phased myself off by the end of October, and continued on merrily to the present. Two mistakes: I did not consult with my doctor first, and I didn’t bother to check my BP. I forgot Metaprolol doubles as a BP med. Note to self: no self medicating, always check with your Doc!

I’ve also learned that there is a phenomenon called rebound hypertension which occurs when you go off some BP meds, especially beta-blockers. I’m not sure that’s relevant because I got off it a few months ago,

Fortunately I have a follow up with my new Doc. Presumably if I don’t have it down enough by then, she’ll put me on something for the short term, and in the long term work more on lifestyle interventions.

My New Doctor- Preventive Medicine!

My previous general practitioner retired a few months ago. I decided to look for a preventive medicine specialist as my new physician. I found Dr. Sepideh Moayed up in Campbell. I was very impressed by her website, she has great ratings, and gave me a free phone consultation. which clinched it for me when she explained her philosophy: spend more time with patients, do more in-depth investigation (preventive screening) than is normally done in physicals. And lifestyle interventions first (exercise, diet, stress relief, etc.), backed up by supplements or drugs as needed. But she is a fully-qualified practitioner of allopathic (“modern”) medicine when needed, Right up my alley! My first homework assignment is to do a detailed food log (she is also well-trained in nutrition), as well as the BP log, and she’s sending me off for the most detailed bloodwork I’ve ever had. The adventure begins!

Until next Friday, I’ll deal with the BP issue with all the lifestyle interventions I know. First, and foremost, I’m someone who errs on the side of too much exercise, not too little. So I’m cutting back on both intensity and volume for a few days: Elevated BP can be a side effect of overtraining. I did read up on exercise and hypertension and found an excellent paper on exercise prescriptions [1]. The major new wrinkle is recent findings about the intensity of exercise for BP lowering:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589552/

Recommendations in the past said low to moderate intensity, but now it seems the higher the better (although that should be discussed with your doctor, as it says in this article, you “may consider progressing to more vigorous intensities, however, the risk-to-benefit ratio has not yet been established”). So I’m going to stay with low and moderate till I follow-up with my new Doc.

I’ve also quickly implemented “low hanging fruit” measures I found on the web. I was already pretty much complying with the DASH diet, except for lowering sodium, so I’ve cut back on that. Relaxation is important so I’ve paid more attention to higher quality yoga and meditation sessions. It’s working so far, I’m down to 144/76 today.

I also found a great book Thirty Days to Natural Blood Pressure Control, by David DeRose MD MPH, Greg Steinke MD MPH, and Trudie Li MSN FNP. These authors have experience with Loma Linda University (of Seventh Day Adventist Study fame) and the highly successful Community Health Improvement program, and they have had dramatic results on BP lowering in practice. So I’ll go after what I glean from this book in addition to my Doctor’s recommendations.

I’m not at all bummed out about this, it’s just a new challenge. I’m just glad I got away with no permanent harm with my foolishness in going off a med without checking with my doc first. In fact, as Dr. DeRose points out, high BP can actually be the gift of a wake up call. Back in early 2017, I was doing very well on clean eating. At that time my wake up call was my ongoing aortic stenosis issue leading up to my surgery, as well as a bad triglyceride result from a blood test. But over time I got a bit more lackadaisical about it. It’s time to get more serious with the BP wake up call.

I will keep you posted on this continuing new saga.

References

  1. Pescatello, R, et al, Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research, Curr Hypertens Rep., 2015.

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