My Blood Pressure Dilema

[trkarl]

I'll make this as short as possible. Since about 2009 1/2 I wasn't feeling very good.
By November of 2010 I felt real bad. My wife is an ARNP for an oncologist. She took my BP.
It was high. She says 170/100 but she blows things out of proportion. Anyways she freaked out
which did nothing for me except send it soaring higher. She decided to start monitoring it
and keep a log but because she freaks out I get upset and this sent the numbers high. Every time she would pick up the cuff my heart would start pounding hard. Typical white coat syndrome.

After a while the numbers were consistently in the mid to upper 130s over mid to upper 80s

Here are some figures:

November 2010
44 y/o male
72 inches 190 lbs.

I decided to lose some weight and try to do a few things to get the bp lower.

Fast forward to March 2011. I went to the doctor for the first time in about forever.
He took my BP and sure enough around 145/90 or so. He set me up to do lots of blood work
urine test, chest x-ray and wanted me to do an ANSAR test and set a date for that.

I went home and decided to get serious about the BP and weight and diet. I started running
again but after a couple of weeks my knees hurt real bad so I told my wife we were getting
real mountain bikes and were going to start riding to get in shape.

4/18/2011 I get my blood work done. 4/22/2011 I take the ANSAR test at the docs office.
BP still high according to them. Weight down to 177.

4/29/2011 docs office to go over results. BP still high. He puts me on 2.5 mg Lisinopril
schedules another ANSAR test for July and another Lipid panel.

I asked about a home BP monitor and he suggested something from OMRON. I bought an OMRON BP785.
I started using the monitor and it gave me readings consistently around 115/75 or so. Interesting.
I thought maybe it is wrong. As I got used to it the readings steadily declined a little.

I go home and go over all my results slowly as I got copies to keep.

My lipid panel is as follows:

Total cholesterol 181
HDL 56
LDL 117
VLDL 8
Triglycerides 41

One thing I noticed though my baseline BP during the ANSAR test was 126/83 ... interesting.

I changed my diet and really tried hard to exercise. My goal was to be below 170lbs at my next visit.

July arrives and I had blood drawn for the Lipid panel on the 18th. The ANSAR test on the 20th. Appt. for results on the 29th.

Weight the day of the test was 158lbs. I wore the same clothes as before to eliminate as many variables as possible. I had lost right around 20lbs.

July 29th appt and my wife gets off early from work to be there. The nurse takes my BP. 123/80. Doc comes in with results. We go over the results.

Lipid panel:

Total cholesterol 148
HDL 56
LDL 88
VLDL 4
triglycerides 20

Baseline ANSAR test BP 123/65

Now the real interesting part. I get out my BP monitor to show the doc. He slaps it on my arm. Turns it on. And gets a reading. He says "what do you think it says?" I say the highest I ever got was 123/83. I look at the screen. 144/92.

Now I am panicking a little. He tries it again. 155/95. He takes it off and uses his. 145/92. I said this is crazy. The nurse measured 123/80.

Then I had him pull up my first ANSAR test and look at the baseline BP. 126/83. The last test 123/65. I said that 10k plus dollar machine says one thing and you get something else. According to the first test I didn't need BP meds. Your readings say I need to increase the dose.
He says he'll leave the room for a couple minutes and have the nurse retake my BP. She gets 125/80.
He comes back in bewildered. Says it must be white coat hypertension. He took me off the BP med and said to keep a log at home until next visit in October.

I had been researching on the internet how to take a proper BP measurement. I told my wife according to this no one does it right. She agreed.
Almost none of the doctors or nurses take it correctly. Amazing.

Here is how each took my BP. The first nurse I had along with the first ANSAR test pushed my t-shirt sleeve up and put the cuff on my bare arm snug but not tight.

The second ANSAR test the nurse put the cuff over my t-shirt sleeve snug but not tight. The nurse at my last visit put the cuff over my sleeve snug but not tight.

The doc puts the cuff on the bare arm but he puts it on so tight it almost feels like a tourniquet before he even starts to inflate it. For the BP monitor it says you should be able to place one finger between the cuff and the skin. Everything I read you should be able to place 2 or 3 fingers between the cuff and the skin for the regular BP measurement. I told my wife this and she doesn't want to discuss it.

The OMRON monitor is made so you can test your BP by yourself. There is no way possible for me to put that cuff on myself anywhere near as tight as the doc did. My wife says there is no way even putting it on tight that there would be a 20 pt difference but I said you just saw it
right in front of your own eyes. So lets see...

Some take a BP cuff over shirt
Some take a BP cuff on bare arm
Some take it super tight
Some take it just snug enough not to fall off. Which is it? This really bugs me.

Now my readings at home are around 110 or so over 68 - 72 or so. And as far as how I feel I feel fantastic. I think losing the weight, exercise and diet really helped things out. The blood work proved to me that cutting out the junk and following a good diet works wonders.

But the BP readings really bother me. Has anyone had a similar experience? My wife's monitor readings are what she normally gets at her docs. How can I know for sure?

[Matt In Oklahoma]

I have white coat synfrome. Dont like going in, makes me paranoid, like taking a car to the mechanic, just waitin on the bad news. I have to wait till the end of the visit before they can get mine

[Patriotic Sheepdog]

The way I've taken a B/P since 1975...
Place cuff on arm, preferably left arm, just snug enough so cuff won't slide off.
Pump cuff up to approx 180-200mmHg depending on person.
Listen for first sound of heart beat take reading
Listen for change in sound of heart beat take reading

Now, you will get different readings if you continue to do readings in the same arm over and over again without some time between readings. You will also get different readings betweeen left and right arms. You will also get somewhat different readings between people as I have found that it seems everyone has learned a slightly "different way" and has slightly different hearing. Your position will also give different readings...standing, sitting, lying. Did you just eat, walk, run, go from a standing to sitting position or vice versa. Also, when was the last time the doctors B/P cuff was calibrated. Even different cuffs in the different exam rooms will give different readings. In other words many things to cause different readings.

Keep a good diary and check it a couple times a day at about the same times each day. Also, can you take your OMRON to his office so he can test your B/P with it?

[trkarl]

Keep a good diary and check it a couple times a day at about the same times each day. Also, can you take your OMRON to his office so he can test your B/P with it?

That is what I did. He got real high readings with it.

Now the real interesting part. I get out my BP monitor to show the doc. He slaps it on my arm. Turns it on. And gets a reading. He says "what do you think it says?" I say the highest I ever got was 123/83. I look at the screen. 144/92.

Now I am panicking a little. He tries it again. 155/95. He takes it off and uses his. 145/92. I said this is crazy. The nurse measured 123/80.

Everything I read says:
You should be sitting in a chair with back supported against the back of the chair.
You should not eat at least 30 minutes before the reading.
You should empty your bladder if possible before the reading.
You should be rested in the chair between 5 and 15 minutes.
Your feet should be flat on the floor.
No talking and no moving around.
Cuff should be on the bare arm snug but able to have 2 fingers inserted between cuff and skin.

Like I said, the doctor put the cuff on REALLY REALLY tight. It already feels like it is cutting off the blood flow even BEFORE he begins to inflate the cuff.
There is no possible way to even get a piece of paper let alone a pinky finger between the cuff and skin when he puts it on.
According to all my research a cuff on TOO TIGHT will give a false high reading.

As soon as entering the exam room they sit me on the table. No back support, no rest between walking in and sitting. Immediately put the cuff on and talk asking questions I must answer while taking the BP reading. This seems to violate EVERYTHING I read about taking an accurate reading.

And now because of the high readings when in the room I get anxiety as soon as they pull out that cuff. I can feel it. My heart starts pounding and I FEEL my pressure rise.

I am sure my monitor is accurate because he got basically the same readings with his stethoscope that he got with my monitor. But there are 3 separate scenarios here:

1) If they went by my first ANSAR baseline BP reading before I was on the med then I would have never been put on it in the first place.

2) If they went by my second ANSAR baseline and the nurse readings after I was put on the med then they would say the med is working and I should continue the same dose.

3) If they went by his readings after I was on the med they would say the dose must be increased because it's not keeping the BP down.

This is my whole dilemma. They don't take the readings in a consistent way and to my observations this gives radically differing results which drives me nuts because this is my health and not some lab rat meant to be experimented on which doesn't matter.

Maybe I'm just making too big of a deal about it. I've read several sites which talk about the improper way docs take readings and the results are large amounts of people are being medicated unnecessarily. If this is true which in my case the evidence points that way then it makes me lose a lot of faith in the medical community.

[Patriotic Sheepdog]

That is what I did. He got real high readings with it.


Everything I read says:
You should be sitting in a chair with back supported against the back of the chair.
You should not eat at least 30 minutes before the reading. No caffeine for at least an hour as well.
You should empty your bladder if possible before the reading.
You should be rested in the chair between 5 and 15 minutes.
Your feet should be flat on the floor.
No talking and no moving around.
Cuff should be on the bare arm snug but able to have 2 fingers inserted between cuff and skin.
...
Maybe I'm just making too big of a deal about it. I've read several sites which talk about the improper way docs take readings and the results are large amounts of people are being medicated unnecessarily. If this is true which in my case the evidence points that way then it makes me lose a lot of faith in the medical community.

Before you lose faith in the whole med community, have you thought of a second opinion? Take your diary with you and show them what you get at home before you get your B/P taken. That will give you a chance to rest a bit also. When the new doc comes in tell him your story, show him the readings you get at home and tell him your wife, who is an ARNP can verify them. You may have true white coat syndrome, some people do.

[qrprat77]

trkarl:
first of all, thank you for sharing your adventure with healthy living! I personally was encouraged by what you had to say about the whole process of at least attempting to lower your blood pressure. From where I sit, it even sounds like you are winning to a degree even. If you want, I can put on my Mr T outfit, and come down there, and tell the Dr: "I pity the fool who don't read blood pressure right!"
Keep up the good work!

[Javin]

The way that blood pressure monitors work, there's little difference between how tight the cuff is prior to starting the test. One finger, two fingers, even slightly tight. (Still, if the doctor's making it RESTRICTIVELY tight prior to inflating, that's an exception to the rule.) The purpose of the cuff is to tighten itself past your systolic (upper number) and slowly lower until it detects the veins pushing blood through. Systolic is the upper limit of pressure your veins can still push blood through. That's your first reading. Then it continues to lower until your diastolic (lower number) is detected. This is the point at which the blood flows freely without pushing back against the pressure of the cuff. I've seen fluctuations of as much as +- 15 on completely normal, healthy people (and animals!), even within the same few minutes. I wouldn't be overly concerned, especially if you guys were testing the same arm within a matter of minutes. There are all KINDS of factors that are at play, but something as simple as how excited/calm you are at *that very moment* plays a huge role.

One of the biggest factors for blood pressure is your sugar intake. And I don't just mean table sugar and soda. Keep an eye on your daily glycemic load to get your blood pressure under control. Congrats on the weight loss! I wish I had the will power...

[EX121]

Another point is what size of BP cuff, if you have huge biceps a reg/adult cuff probably won't take an accurate reading. Good job on loosing the weight.

[Grantmeliberty]

One other very important IMHO fact to consider is that the medical profession is caught up in the fat lie. Cholesterol is a symptom not a cause of heart problems. The vein from your leg which they use for a heart bypass is perfectly clear, and has been exposed to the same cholesterol. The heart blood vessels flex with each heartbeat, and because of a vitamin C deficiency they can start to crack and must be repaired to prevent you from bleeding to death internally. The leg blood vessels flex slowly and infrequently and are therefore not under such stress.
Linus Pauling and a German MD had a couple of patents on reversing heart disease with 5 grams daily of Vit C and a gram or so each of llysine and proline, two amino acids which are part of the coollagen which makes up your blood vessels.
www.mercola.com is a very good website for accurate and appropriate medical and health information. I have read his site and gotten his email newsletters for more than 10 years, and he is always cutting edge.
Statin drugs are poison and destroy your liver and kidneys, and low cholesterol is linked to increased risk of stroke.
Dr Mercola has some excellent information on exercise, as does Dr Al Sears http://www.alsearsmd.com/

[Grinnan Barrett]

Reality is blood pressure/hypertension tends to be more hereditary than anything else. I lost down to my high school weight and I still had high blood pressure. The good thing about the medicine he put you on Lisinopril is that it comes in a generic form and can be bought for 90 days at $10 a pop. You can at least load up on it. One thing forums like these tend to do is have a lot of paranoia about any form or authority. I know my doctor personally. He is in our group. He also graduated in the top 5 percent of his medical school class. Don't let yourself get caught up in the fear of doctors routine. Get to know your doctor and if you don't like them move on to another one. Just remember it is not the bedside manner you are looking for. It is the smartest doctor you can find (HIM OR HER).

[cpaspr]

Hopping on a bit late, but I just noticed this thread.

Another thing to remember is that though he is a doctor, he is also a businessman. Either independently, or as a member of a group. They don't make any money if they can't keep patients coming back to them. Gone are the days when doctors really are in practice simply to help people. Most are in it for the money and the prestige, but mostly for the money.

So, it may be possible that his putting the cuff on really tight may be a way for him to attempt to force your BP to a false high reading, thereby requiring you to continue using his services. I've seen similar actions several times.