Re: Hypertension, prehypertension and normal BP

August 3, 2005

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high.

To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3.

IMO, the biggest problem is knowing what the BP is, and how to measure it.

The second problem is being able to gage what the BP should be for the individual, that is, you cannot medicate to 120/70 if the person cannot stand up.

There is an optimum BP for that person's condition mine is 135/85 up-and-around. If I try to get lower than that with meds, I'll get dizzy.

Now if I lose weight, and exercise I can use a lower level, like 125/80. So something is altered in the my physiology - maybe arteries are expanded - maybe they become more flexible,but the result is the pressure is lowered after the exercise and some component of that lowering is retained.

And it doesn't take that much effort. The lowering is achieved by 30 mins of walking at 3 mph.

Regards.

[ ] Hypertension, prehypertension and normal BP

In the last digest of posts, there was discussion about what really constitutes hypertension, and related topics.The most recent National Practice Guidelines for BP for physicians in the U.S. came out in May 2003. These are the Practice Guidelines of the Joint National Committee 7. Note that a new category, prehypertension, was created and defined. Also note the marked effect that increasing levels of BP have on the risk of CVD: starting at 115/75 mm Hg, for each increment of 20/10 mm Hg, the risk of CVD doubles. Someone with a BP of 135/85 has double the risk of CVD than someone with 115/75 (all other things being equal). Someone with 155/95 has four times the risk of CVD than someone with 115/75.The oft-quoted 120/80 is not a normal BP; it is now considered prehypertension, and requires action ("health-promoting lifestyle modifications") to prevent CVD JAMA. 2003 May 21;289(19):2560-72. Epub 2003 May 14. Related Articles, Links The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, DW, Materson BJ, Oparil S, JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee.Department of Medicine, Boston University School of Medicine, Boston, Mass, USA."The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.Publication Types: Guideline Practice Guideline PMID: 12748199 [PubMed - indexed for MEDLINE] Bob Bessen

August 3, 2005

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high.

To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3.

IMO, the biggest problem is knowing what the BP is, and how to measure it.

The second problem is being able to gage what the BP should be for the individual, that is, you cannot medicate to 120/70 if the person cannot stand up.

There is an optimum BP for that person's condition mine is 135/85 up-and-around. If I try to get lower than that with meds, I'll get dizzy.

Now if I lose weight, and exercise I can use a lower level, like 125/80. So something is altered in the my physiology - maybe arteries are expanded - maybe they become more flexible,but the result is the pressure is lowered after the exercise and some component of that lowering is retained.

And it doesn't take that much effort. The lowering is achieved by 30 mins of walking at 3 mph.

Regards.

[ ] Hypertension, prehypertension and normal BP

In the last digest of posts, there was discussion about what really constitutes hypertension, and related topics.The most recent National Practice Guidelines for BP for physicians in the U.S. came out in May 2003. These are the Practice Guidelines of the Joint National Committee 7. Note that a new category, prehypertension, was created and defined. Also note the marked effect that increasing levels of BP have on the risk of CVD: starting at 115/75 mm Hg, for each increment of 20/10 mm Hg, the risk of CVD doubles. Someone with a BP of 135/85 has double the risk of CVD than someone with 115/75 (all other things being equal). Someone with 155/95 has four times the risk of CVD than someone with 115/75.The oft-quoted 120/80 is not a normal BP; it is now considered prehypertension, and requires action ("health-promoting lifestyle modifications") to prevent CVD JAMA. 2003 May 21;289(19):2560-72. Epub 2003 May 14. Related Articles, Links The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, DW, Materson BJ, Oparil S, JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee.Department of Medicine, Boston University School of Medicine, Boston, Mass, USA."The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.Publication Types: Guideline Practice Guideline PMID: 12748199 [PubMed - indexed for MEDLINE] Bob Bessen

August 3, 2005

JW: you bring up a good point. What is one's REAL BP? Mine varies enormously. It's on the higher side in the a.m., much lower at night. It varies during the day. So how the heck does one know? Which numbers are the most meaningful?

on 8/3/2005 9:15 AM, jwwright at jwwright@... wrote:

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high.

To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3.

IMO, the biggest problem is knowing what the BP is, and how to measure it.

August 3, 2005

JW: you bring up a good point. What is one's REAL BP? Mine varies enormously. It's on the higher side in the a.m., much lower at night. It varies during the day. So how the heck does one know? Which numbers are the most meaningful?

on 8/3/2005 9:15 AM, jwwright at jwwright@... wrote:

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high.

To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3.

IMO, the biggest problem is knowing what the BP is, and how to measure it.

August 3, 2005

I suspect the importance is how much of the day does one's BP spend at elevated levels....

JR

-----Original Message-----From: [mailto: ]On Behalf Of Francesca SkeltonSent: Wednesday, August 03, 2005 8:23 AM Subject: Re: [ ] Hypertension, prehypertension and normal BPJW: you bring up a good point. What is one's REAL BP? Mine varies enormously. It's on the higher side in the a.m., much lower at night. It varies during the day. So how the heck does one know? Which numbers are the most meaningful?on 8/3/2005 9:15 AM, jwwright at jwwright@... wrote:

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high. To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3. IMO, the biggest problem is knowing what the BP is, and how to measure it.

August 3, 2005

I suspect the importance is how much of the day does one's BP spend at elevated levels....

JR

-----Original Message-----From: [mailto: ]On Behalf Of Francesca SkeltonSent: Wednesday, August 03, 2005 8:23 AM Subject: Re: [ ] Hypertension, prehypertension and normal BPJW: you bring up a good point. What is one's REAL BP? Mine varies enormously. It's on the higher side in the a.m., much lower at night. It varies during the day. So how the heck does one know? Which numbers are the most meaningful?on 8/3/2005 9:15 AM, jwwright at jwwright@... wrote:

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high. To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3. IMO, the biggest problem is knowing what the BP is, and how to measure it.

August 3, 2005

Measure it every day several times in several modes. Get an idea of how it varies. And keep a log of what you eat, exercise and the BP.

The common comparison is the measurement after sitting 5 mins. I make a point of having my arm and the measurement device at the same level as my heart. But comparing yours with others measured routinely outside a controlled lab, is suspect, IMO.

I'm one whose BP goes up more with exercise, so I use a regulated pace, and I stop at 10 min intervals, sit down and measure my BP. Usually I do 60 mins, taking measurements each 10 mins(0.5 mile), also at 5 min and 10 mins rested.

Doing that daily I can see a trend in BP. The exercise benefit levels off quickly after exercising like 3 days. If I've had a high fat meal, or no exercise for 2 or 3 days, I'll see a higher pressure.

If you're one of the third of people like me your BP will rise more during exercise. I want to know how high it's rising. I use a monitor for convenience and to minimize errors of eye/ear coordination reading the gage.

I calibrate it using a mercury sphygmo connected to the monitor so it sees the same pressure I'm reading.

I guess the "real" BP is the average of all during the day. If you plot the numbers for each day, you'll see trends perhaps. I expect to see is a seasonal shift upward for winter, eg.

The number will fall with weight loss, but in my case it leveled off at about 175# (-60#).

Mine is lowest at waking, goes up as I eat and add water during the day, and drops overnight.

Regards.

Re: [ ] Hypertension, prehypertension and normal BP

JW: you bring up a good point. What is one's REAL BP? Mine varies enormously. It's on the higher side in the a.m., much lower at night. It varies during the day. So how the heck does one know? Which numbers are the most meaningful?on 8/3/2005 9:15 AM, jwwright at jwwright@... wrote:

Probably the easiest way to know you have HTN is measure your wife's when you measure yours. mine may be 125/75 to 145/85, but hers will be 117/65 or less. Even when she weighed 185# her BP was never high. To demonstrate the funniness of measurements in the doc's office, my recent visit yielded 104/65 - she measured both arms with a sphygmo. I doubt I could stand up with a 104/65. My morning measurements have been running 125 +/- 3 / 75 +/- 3. IMO, the biggest problem is knowing what the BP is, and how to measure it.

August 3, 2005