Blood Pressure: Testing and reasonable levels

Saw a story today about blood pressure testing and inaccuracy.

Some of the people commenting on this on another site were rather insistent that hypertension is ONLY a really high blood pressure and that most people should not be taking high blood pressure meds.

However, the facts are that almost half of Americans are on high blood pressure meds.

For my history, when I took the physical back in 2005 for my security job, my blood pressure was something like 160/96 the first time they tested me and they went completely berzerk, diagnosing me with hypertension and refusing to clear me for the job until I got it below 140/90. Well, I went home, spent a week making precisely zero changes in my diet, concentrating on de-stressing and then tested at 132/84.

Ever since then, that seems to be about where I test, with a few outliers.

And yet every doctor I’ve had tells me that I have high blood pressure and tries to get me to take the meds. I’m on a very low dose right now, but I’m thinking of dropping it with my new doctor, because I test the same while on it, so it is clearly not making any difference and I’d rather not be taking drugs just to be taking drugs. This sort of overt pushing of more and more prescriptions over the smallest thing is exactly why I fired my previous two doctors.

So here’s my question(s): Are doctors vastly over-prescribing high blood pressures for ratings that are essentially ‘normal’? Is it really necessary with someone in my blood pressure range to be taking high blood pressure meds? And if you’re a doctor, what do you think about the accuracy of testing and the entire process?

Anxiety and physical activity can cause blood pressure to spike quite a bit. Some people see their systolic spike 100 points and diastolic spike by 50 points due to these things. Systolic goes to about 240 when running on a treadmill even in healthy people.

I think during intense weight lifting, blood pressure can go up to 400/200.

I really can’t advise you on whether to take meds or not. But you should look into NNTs (number needed to treat, basically how many people do you have to give medical intervention X to over Y years to prevent 1 negative complication) to evaluate the benefits.

Generally speaking, the more risk factors you have for hypertension complications (old age, being male, having a previous CVD event, severity of hypertension, etc) the lower the NNT and the higher the probability you will benefit from the medication.

So if you are a woman in her 20s with mild hypertension who eats healthy and exercises, then they’d have to treat (as a guess) many thousands of people like you to prevent 1 heart attack or stroke over a 5 year period. If you are a 72 year old male who has already had 2 heart attacks and has severe hypertension, the NNT may be 6 (meaning if they treat 6 people like you, they prevent 1 stroke or heart attack).

I used to test at 170/ or 180/ on those drug store machines. I didn’t get medicine until I went for a pilot medical and tested too high. (the doctor said you had to test less than /90 to be safe). One of my co-workers said she had to take a few days off because she was consistently in the 140’s, whereas that is my resting value nowadays with two medications.

the general consensus is that high blood pressure can lead to strokes and heart attacks - i.e. you’re more likely to get them later in life. OTOH, I see where the medical community is lowering the bar, so to speak - recently dropped the official hypertension diagnosis level by 10 points. The cynic in me says that’s because the big pharma companies are not selling enough meds. (Apparently the same with Type II Diabetes - they’ve lowered the diagnosis number, which means a huge number of extra people will be urged to take a lot of relatively ineffective medications a lot more often.)

  1. For a lot of people with moderate HBP this means little. It won’t effect them in the long run. OTOH, for some people HBP will contribute to any number of things, with stroke being a particularly scary thing to me.

Blood pressure meds have a lot of negative side effects. Ergo, way too many people are worse off being treated for HBP.

At the present there are no tests to see who would benefit from taking meds and who would be only harmed taking meds. And given the economics of this universe, no such tests are likely to be developed. Who wants to kill the goose that lays the golden egg?

  1. Mrs FtG had HBP. Was on meds for a little while. Stopped them. Did some dietary changes. No more HBP.

Many, many people can safely get rid of their HBP by exercise, diet and other lifestyle changes. All cheaper and better for you than taking the meds.

If you have HBP cleaning up you life is almost certainly going to have positive effects and might allow you to stop/avoid the meds.

Learn to ignore the double chili bacon cheeseburger ads, folks.

Nada, not relevant to GQ.

I test my BP several times a week. I’ve gotten to where I test it twice every sitting and average the two readings. Most of the time, the 2nd reading is at least 5 points lower, often 10. I always sit down and take 10-15 deep breaths first.

Most antihypertensives are off patent and pretty cheap now. In fact I think the only class of antihypertensives that are still on patent are ARBs, and even that class has several generics now.

So I don’t think it is pharma’s economic incentive, as most of these drugs are $5/month or less.

However the issue is that the fewer risk factors you have for CVD, the higher the NNT to see a benefit from treating hypertension (or any other risk factor). I personally do not know where the cutoff is where the NNT is high enough that the drug causes more damage than it prevents. If you have to treat 2000 people to prevent 1 stroke, but of the people you treat about 10% will have mild side effects and 1% will have severe side effects, the drug could be more dangerous than the stroke risk. 20 people developing severe side effects from a drug could be more damaging than 1 stroke.

Studies go both ways on hypertension. Some studies say that current guidelines aren’t strict enough, other studies say they are too strict and more people are hurt by treatment than helped. I don’t know the answer. But the definition of hypertension that requires treatment keeps getting stricter.

Medical advice is best suited to IMHO.

General Questions Moderator

Thanks for this discussion.
I get more freaked out by the cuff on my arm than anything else. I feel like gangrene will set in shortly, and whatever is on my arm needs to come off…NOW!! (my dentist tested my BP and said it was high) I read from the linked article there is a term called “white coat hypertension” .:eek: Combine that factor with my coffee habits, I feel a bit better about my reading.

That is a very good overview.

To highlight from it:

Yes, many of us now have “elevated blood pressure.” The majority (click for pdf download) of adults over 50 (more males than females) fit the definition, and that fraction increases more with age. Treatment for that though is common sense diet and exercise and even for stage 1 hypertension is only meds if there are other risk factors.

Not overreacting to a single measurement and proper technique/equipment is vital.

If your current medicine isn’t helping it might be a sign that you don’t need it - or it might be a sign that you would benefit from a higher dose or a different formula. I couldn’t say which. But you’ve had three doctors now all telling you that your blood pressure is too high. I suspect that if you get a fourth doctor, he’ll probably say the same.

If your 140-ish rating was “normal”, and doctors were conspiring to make your blood pressure lower than normal, you’d be suffering a whole different range of symptoms, including fainting, dizziness, weakness, blurred vision & clammy skin. They’d also be opening themselves up to massive lawsuits.

Are you experiencing any of that?

Everyone’s different. Personally, when my BP spikes above 140, I get a weird fluttering in my chest, I run out of breath easily, and I get migraines. It hit 180 last spring and I could tell I was in real trouble. I was able to get it back to 130-ish, but it was in the 160’s this week. I take 2 blood pressure meds and a beta blocker. The doc increased the dosage on one of my pills and I’m taking it easy (I have COPD and a bad bronchitis at the mo, so I’m coughing a lot, which doesn’t help).

So yeah, for me, the 130’s are about the limit that I can handle. Maybe you’re built to handle a higher 140’s - or maybe the longer you go with the higher stress on your heart, the closer you get to a stroke. That’s the limit of anecdotes.

Blood pressure and blood pressure medicines are a thoroughly researched field. I suggest you take your doctor’s advice.

If you’re a doctor - what do recommend for home blood pressure monitors. I have one but I’m not sure I trust it.

Get a BP monitor, they’re not expensive. If I test on one of those grocery store machines I can easily get 130/90 (“high BP”), but when I test at home where I’m relaxed I have 110/64 (“perfect BP”). For a BP measurement to mean something you need to be relaxed.

Edit: Should add that the 110/64 has been confirmed by medical professional, so the home machine is accurate (Omron brand).

Every time I’ve tested myself on one of those machines in a pharmacy, it comes back with absurd numbers like 190/110 or once, 210/140-something. Sure, that’s accurate. :rolleyes: I have not once seen a realistic number.

Home machines? I’ve owned two. The first was reasonably accurate and I’m sure I still have it somewhere, but probably at the bottom of a box at the bottom of my storage locker. The second one I bought was utter rubbish, regularly showing me over 180/100. I returned it as defective.
Honestly, facts like this make me think this is all a bunch of hogwash at these levels;

*How many adults have high blood pressure?

About 75 million American adults (29%) have high blood pressure—that’s 1 in every 3 American adults. *

Maybe not. If you’re so sensitive to stress that having your blood pressure taken causes your blood pressure to spike there are probably dozens of events during your normal day that will do the same thing, and that big old aneurysm waiting to pop doesn’t care why your blood pressure spiked.

Do facts like 36.5% of American adults are obese make you think “hogwash” as well? Maybe they are really all ideal body weight?
Again, the net of who should be getting medicated for high blood pressure is smaller than those who should be labelled and possibly strongly advised to make lifestyle adjustments. None of us know your complete medical profile. Those several docs you’ve seen do.

Your approach to your BP monitors reminds me of some people’s thoughts about scales - it says I’ve gained weight? Rubbish!

I was originally diagnosed with hbp right after I got my rabies shots. Top number was well over 200 and no offers about the bottom number. Well, hell, you just used many needles on me very quickly!

But they wouldn’t let me leave the hospital until I too something and tested at a much lower number. And they notified my GP, and thus began my medical history of high blood pressure.

Both my BP and even my blood sugar were very high when I went to the ER because I was afraid I was having a heart attack because my heart was racing and pounding like a jack hammer. It remained that way for four days until someone finally came in to inform me that I had tachycardia and an (non-dangerous) irregular heartbeat due to a wandering atrial pacemaker. Everything got better immediately as soon as someone finally came to inform me that I wasn’t in danger of dropping dead any second.zxyzh

(That last word was from the cat.)

…lets hope not!!! I just “freak” out because the cuff makes me feel like my arm is stuck in a trap. :eek: Otherwise I’m pretty laid back, surfer/gardener/ etc. I have a pretty stress free lifestyle ( I will use a home unit and see what the real deal is.)

High blood pressure is an important risk factor for strokes, heart disease, kidney disease and eye problems.

I would say that doctors are often too quick to prescribe medicines and do not try hard enough to get people off medicines who may no longer need it. But many folks who should be taking high blood pressure medications don’t because they are undiagnosed or don’t fill the prescription or take the medicine (due to cost, preference or fact high blood pressure may not have annoying symptoms). All in all, I would say these medicines are only slightly over prescribed.

There are several different classes of medicine. The cheaper ones like thiazides, metoprolol and ramipril should often be prescribed first. Drug companies push more expensive and less effective medicines pretty hard.

Diabetics should probably keep the top number below 120 (or 130). Most people should have systolic blood pressures below 140. I would treat above 160 for sure if it is a consistent measurement over time. It’s not always easy to measure due to white coat syndrome or anxiety elevating numbers, but there are strategies to help mitigate this.

Your doctor is best placed to advise you. If your blood pressure is consistently good a trial of stopping the medication may be worthwhile in the absence of diabetes or heart disease.

I don’t recommend testing your blood pressure more than a few times a week. Home measurements can be better than the office ones. Some fluctuation is okay but if it is persistently elevated changes need to be made. Some people need to reduce delicious salt. Many need medication.

Getting an artificially elevated BP reading in the doctor’s office is a common enough occurrence that it has it’s own name, “white coat syndrome”. So I wouldn’t jump to any conclusions about the general state of their blood pressure based on this symptom alone.