Blood pressure issues - any medics in the house?
Discussion
Hi all, I am looking for a bit of advice regarding blood pressure issues.
At the ripe old age of 64 I was offered an age-related general health check at my local GP and despite feeling ok I took them up on it. It was with a nurse who basically checked my height, weight and BP. The advice was to lose a bit of weight and monitor my BP which was 145/107 – some of which was white coat syndrome.
I bought a BP tester and took readings twice a day for a week and then went back with my chart and an average BP of 140/100. The nurse went off to ask a GP and they prescribed me 5mg Amlodipine.
Ten days later they upped that to 5mg Amlodipine + 1.25mg Ramipril.
A week alter that was upped to 5mg Amlodipine + 2.50mg Ramipril.
Today my BP is around 130/90 (not the 120/80 they aim for).
The weeks that followed were a series of half-cocked texts from GPs playing around with the medication amounts because the side effects were getting worse with each change. I am now back to the 5mg Amlodipine + 2.50mg Ramipril and I will not change from that until I get a F to F with a GP, which apparently I am very lucky to be doing on Thursday.
I need to be better informed before I see the GP because based on my experience so far they seem to have little interest in considering anything other than different boxes of pills, so finally my questions for anyone who might know:
Despite the nurse suggesting I need to lose weight I am not obese, if I went from 100kg to 95kg it is the lightest I will ever have been since being a teenager, so not really much wiggle room there.
I find it hard to believe that one day you are ok and the next you have long term blood pressure problems. On paper the numbers suggest I have higher than ideal BP reading, I accept that.
What I am having a problem with is that nobody is considering that there may be something else behind it, it seems they only have one answer to this more pills.
Are there any other health issues (it isn’t stress) that could be behind this? Should I try to get a referral to see a cardiologist eg.?
Any advice much appreciated, there was a time I could have asked a doctor, it seems those days are long gone!
At the ripe old age of 64 I was offered an age-related general health check at my local GP and despite feeling ok I took them up on it. It was with a nurse who basically checked my height, weight and BP. The advice was to lose a bit of weight and monitor my BP which was 145/107 – some of which was white coat syndrome.
I bought a BP tester and took readings twice a day for a week and then went back with my chart and an average BP of 140/100. The nurse went off to ask a GP and they prescribed me 5mg Amlodipine.
Ten days later they upped that to 5mg Amlodipine + 1.25mg Ramipril.
A week alter that was upped to 5mg Amlodipine + 2.50mg Ramipril.
Today my BP is around 130/90 (not the 120/80 they aim for).
The weeks that followed were a series of half-cocked texts from GPs playing around with the medication amounts because the side effects were getting worse with each change. I am now back to the 5mg Amlodipine + 2.50mg Ramipril and I will not change from that until I get a F to F with a GP, which apparently I am very lucky to be doing on Thursday.
I need to be better informed before I see the GP because based on my experience so far they seem to have little interest in considering anything other than different boxes of pills, so finally my questions for anyone who might know:
Despite the nurse suggesting I need to lose weight I am not obese, if I went from 100kg to 95kg it is the lightest I will ever have been since being a teenager, so not really much wiggle room there.
I find it hard to believe that one day you are ok and the next you have long term blood pressure problems. On paper the numbers suggest I have higher than ideal BP reading, I accept that.
What I am having a problem with is that nobody is considering that there may be something else behind it, it seems they only have one answer to this more pills.
Are there any other health issues (it isn’t stress) that could be behind this? Should I try to get a referral to see a cardiologist eg.?
Any advice much appreciated, there was a time I could have asked a doctor, it seems those days are long gone!
Back in late 2010 when I had a TIA my BP was around 155/105.
After many changes of medication it now fluctuates wildly. In the past month the upper reading has varied from 125 down to 85 & the lower reading from 82 down to 56.
According to a scan in July my heart function has improved from 33% in 2010 to its current 52%.
A letter from the consultant in October said he was considering changing or reducing or stopping some of my meds, but no contact yet.
After many changes of medication it now fluctuates wildly. In the past month the upper reading has varied from 125 down to 85 & the lower reading from 82 down to 56.
According to a scan in July my heart function has improved from 33% in 2010 to its current 52%.
A letter from the consultant in October said he was considering changing or reducing or stopping some of my meds, but no contact yet.
Long term BP issues, peaking at 270/160 in 30s and a medic. Would suggest 24 hour BP monitoring as a start to get a true baseline and some investigations. Additionally some people do not respond to the drugs initially prescribed. You are on an ACE inhibitor (ramipril) and a calcium channel blocker which dilates the artery by relaxing the walls of the blood vessels. it's a common combo but there are also others, many others.
Personally I tried the ACEs, little effect; Ca channel blockers, swollen ankles only; vaso-dliators, head ache but no significant reduction. it was only Beta blockers that worked. The cause was attributed to an increased adrenergic drive. Beta blockers are now unfashionable and I regularly get pressured to change as it is not in the guidelines.
Bottom line is BP issues can start early, they should not affect what you do but it does require some investigation and alteration to get a suitable combination of drugs. Even then once you find a category that works it can require tweaking with different subtypes of the drug family - in my own case atenolol produces fatigue and lethargy but bisoprolol has been side effect free.
It doesn't help that NICE guidelines railroad the treatment paths and favour certain drug families without taking into account individual responses. Discuss it with someone who knows what they are doing.
Personally I tried the ACEs, little effect; Ca channel blockers, swollen ankles only; vaso-dliators, head ache but no significant reduction. it was only Beta blockers that worked. The cause was attributed to an increased adrenergic drive. Beta blockers are now unfashionable and I regularly get pressured to change as it is not in the guidelines.
Bottom line is BP issues can start early, they should not affect what you do but it does require some investigation and alteration to get a suitable combination of drugs. Even then once you find a category that works it can require tweaking with different subtypes of the drug family - in my own case atenolol produces fatigue and lethargy but bisoprolol has been side effect free.
It doesn't help that NICE guidelines railroad the treatment paths and favour certain drug families without taking into account individual responses. Discuss it with someone who knows what they are doing.
I would recommend the Dummies Guide to High Blood Pressure for back ground reading and to be better informed overall.
I've had a number of investigations done on the cause of my BP, all the way up to an angiogram, and the general consensus seems to be the service manager saying "They all do that sir". The most laughable was a private specialist telling me he didn't know what was causing it and I should try hugging a tree occasionally...
I've not had a face to face with my GP on my medication since Dec 2019, although they have had a week's worth of readings to review the prescriptions occasionally so if you have got a face to face appointment you're doing better than I am.
I've had a number of investigations done on the cause of my BP, all the way up to an angiogram, and the general consensus seems to be the service manager saying "They all do that sir". The most laughable was a private specialist telling me he didn't know what was causing it and I should try hugging a tree occasionally...
I've not had a face to face with my GP on my medication since Dec 2019, although they have had a week's worth of readings to review the prescriptions occasionally so if you have got a face to face appointment you're doing better than I am.
Not a medical doctor, not medical advice, etc.
You can and should try to get extra checks and tests.
That said, your blood pressure is more likely to have risen slowly over the decades. Our western lifestyle isn't great for us, our diets are high in carbohydates/sugars that push us slowly but inexorably toward insulin resistance - more generally "metabolic disease". This is why "lifestyle" changes can help. You may have success with just losing weight, or going keto. Either would require some effort on your part and some understanding and monitoring from the doctor. They are both preferable to the side effects of the blood pressure meds.
You can and should try to get extra checks and tests.
That said, your blood pressure is more likely to have risen slowly over the decades. Our western lifestyle isn't great for us, our diets are high in carbohydates/sugars that push us slowly but inexorably toward insulin resistance - more generally "metabolic disease". This is why "lifestyle" changes can help. You may have success with just losing weight, or going keto. Either would require some effort on your part and some understanding and monitoring from the doctor. They are both preferable to the side effects of the blood pressure meds.
120/80 is nonsense if you ask me it’s like saying 5 fruit and veg a day, why not 7,8,10,25?
Did they give you the 24 hour test which tests your BP throughout the day and night? If not why not? Just bunging you straight on pills isn’t the answer how does your BP fluctuate throughout the day and night? That’s what needs to happen before pills. It might be that 130/90 is fine for you it’s not far off 120/80. Would 127/185 be ok?
Thing is when you go into pills you will never come off them.
Did they give you the 24 hour test which tests your BP throughout the day and night? If not why not? Just bunging you straight on pills isn’t the answer how does your BP fluctuate throughout the day and night? That’s what needs to happen before pills. It might be that 130/90 is fine for you it’s not far off 120/80. Would 127/185 be ok?
Thing is when you go into pills you will never come off them.
smn159 said:
How tall are you? 100kg is borderline obese for an average height man.
Unless you're a former NBA basketball player you really need to shift some significant weight to get your BP down. Best advice is to exercise more and eat less - f you don't fancy that, then stay on the meds.
You would easily get a job as a GP at my local practice.Unless you're a former NBA basketball player you really need to shift some significant weight to get your BP down. Best advice is to exercise more and eat less - f you don't fancy that, then stay on the meds.
They also never ask all the right questions before diagnosing either.
130/90 is “high normal” so you aren’t about to drop dead. I’ve been on 25mg Losartan (same as Ramipril but without the cough) for a number of years and I’m 14 years younger than you, blood pressure runs in the family though and I’ve struggled to control it since my late 20s. There’s no shame in it and the main thing is not to let it get out of control. I found lifestyle changes do help so get more exercise, eat well, avoid too much alcohol etc.
Also when you take your blood pressure matters. Do it in the morning when you’ve just got up, but haven’t eaten. Then do it again before you go to bed. It changes throughout the day so always do it at the same time.
Also when you take your blood pressure matters. Do it in the morning when you’ve just got up, but haven’t eaten. Then do it again before you go to bed. It changes throughout the day so always do it at the same time.
Bone Rat said:
Discuss it with someone who knows what they are doing.
And where do you find one of those today .........I have zero confidence in the care I get and have recently looked into changing my GP Practice, but having read reviews on all the local ones they are all as bad as each other.
I recently visited a GP (you never see the same one twice) and as they are always in such a hurry I started talking to him about a problem with my hip whilst I was getting my coat off. In the time it took me to take my coat off and sit down he had already told me that "you probably need a hip replacement" - job done, diagnosed.
I asked to be referred for an X-ray, he agreed, but forgot to do it.
I then start again a month later, this time they actually managed to complete a referral.
I had an x-ray.
A week later I got a text from a GP:
"The x-ray showed severe arthritis worse on the right. If you are happy I will request a review by orthopedic surgeon with a view to a hip replacement"
It seems to me they just tick whatever box is easiest, hip replacement, blood pressure pills, funeral ..........
Daz1855 said:
smn159 said:
How tall are you? 100kg is borderline obese for an average height man.
Unless you're a former NBA basketball player you really need to shift some significant weight to get your BP down. Best advice is to exercise more and eat less - f you don't fancy that, then stay on the meds.
You would easily get a job as a GP at my local practice.Unless you're a former NBA basketball player you really need to shift some significant weight to get your BP down. Best advice is to exercise more and eat less - f you don't fancy that, then stay on the meds.
They also never ask all the right questions before diagnosing either.
I would have thought that's the best starting point
smn159 said:
OP is significantly overweight, is concerned with his blood pressure and has been advised to lose weight
I would have thought that's the best starting point
I have been heavier than I look my whole life, you would NOT guess my weight or even close by looking at me. The least I have weighed since being at school is 95kg and at that weight several people that knew me asked if I was ok. So whilst the chart may well work for 95% of people it doesn't work for everyone.I would have thought that's the best starting point
According to the chart I need to lose 22kg, if I lost that weight I would be in a hospital bed and someone would be calling a priest.
I have a BP problem, got it, would I like to find out if something is causing it other than old age, yes.
Would I lie to myself about my weight to take medication I don't need to just so I can keep eating burgers and chips every day, no.
Daz1855 said:
smn159 said:
OP is significantly overweight, is concerned with his blood pressure and has been advised to lose weight
I would have thought that's the best starting point
I have been heavier than I look my whole life, you would NOT guess my weight or even close by looking at me. The least I have weighed since being at school is 95kg and at that weight several people that knew me asked if I was ok. So whilst the chart may well work for 95% of people it doesn't work for everyone.I would have thought that's the best starting point
According to the chart I need to lose 22kg, if I lost that weight I would be in a hospital bed and someone would be calling a priest.
I have a BP problem, got it, would I like to find out if something is causing it other than old age, yes.
Would I lie to myself about my weight to take medication I don't need to just so I can keep eating burgers and chips every day, no.
Respectfully, your health will not deteriorate if you were to lose it.
Daz1855 said:
have been heavier than I look my whole life, you would NOT guess my weight or even close by looking at me. The least I have weighed since being at school is 95kg and at that weight several people that knew me asked if I was ok. So whilst the chart may well work for 95% of people it doesn't work for everyone.
I know what you mean, I’m 6’ 1” and powerfully built. Last time I was the recommended 13st was when I was about 18 years old, before I “filled out”. You must be the same or built like Odd Job from the film Goldfinger! wormus said:
I know what you mean, I’m 6’ 1” and powerfully built. Last time I was the recommended 13st was when I was about 18 years old, before I “filled out”. You must be the same or built like Odd Job from the film Goldfinger!
Rest assured I am not a barrel like Odd Job, neither do I have a gut to rest things on either 
Bone Rat said:
Long term BP issues, peaking at 270/160 in 30s......
LOL - my worst unmedicated was similar 240/160 and detected in my early 40s - seems I'm not as unique as I thought 
I'm on a cocktail of medication which evolves about once every 10 years - now on 8 pills a day, only 5 of which are actually doing anything about the BP the rest are for the side effects. I was told it was being caused by an imbalance in the hormones secreted by the kidneys to manage BP.
In the early investigations I couldn't sustain Amlodipine, although if the white coats want to drop my BP for any reason then they add it to the list short term.
OP - I'm a few years younger but similar weight to you - 1.9m tall and certainly not the body type to be considered obese. I'm constantly told that losing weight would have a positive affect. Yes, I know - it's been proved over and over again - I've tried, and did bring it down, however the lack of energy and constant tiredness hindered my day to day activities. I now stick to a balanced diet and keep taking the pills.
Push your doc for a 24 BP monitor - even adding a 24hr urine check, as well as the other scans and tests. It took 4 years before they got me onto meds that both worked and didn't cause any major side effects.
Dr Jekyll said:
I've been on ramipril and amlidopine for years and my BP hovered around 125-130/75-80.
Then lost weight from just about obese to not quite overweight and it's now around 105-110/60. So I'm wondering if I can cut back on the pills.
Out of interest how much of each (R & A) do you take?Then lost weight from just about obese to not quite overweight and it's now around 105-110/60. So I'm wondering if I can cut back on the pills.
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