My BP has gone crazy

[CM4Me]

For the last 5 years, or so, my BP has been relatively stable, but recently it has gone crazy, with fluctuating readings. 

 

When I recently became aware of these fluctuations I commenced taking a reading 4 times a day. These readings now can range from 119/73 to 150/70, with a similar difference, each time, between L & R.

 

I do take Ramipril 2.5mg/day (which I have been doing for the last 5 years or so, where my BP has normally been in the normal range).

 

I do NOT have any adverse symptoms, like headaches, blurred vision, dizziness etc, and today I went and had blood tests for Lipid Profile, 

Glucose and Sodium, all within normal range (except down a bit for Triglycerides). 

 

I do have an appointment to see a Cardiologist this coming Monday, but would appreciate any reports from members that have had similar 

problems (so I can better understand what the Dr is asking/telling me).

 

TIA

 

 

[chiang mai]

Blood pressure does vary based on whether you're fully resting or not, have just eaten, have just woken up, the range you mention doesn't appear suspicious to me but I'm not a doctor, Sheryl is.

[CM4Me]

Tks for your post chiang mai.

 

I follow the UK NHS recommendation re testing for BP

 

They say when you wake up, go for a pee the sit and relax for 5 minutes before testing.

The other 3 daily tests I do are before eating, but again I sit and relax for 5 minutes.

 

[chiang mai]

1 hour ago, CM4Me said:

Tks for your post chiang mai.

 

I follow the UK NHS recommendation re testing for BP

 

They say when you wake up, go for a pee the sit and relax for 5 minutes before testing.

The other 3 daily tests I do are before eating, but again I sit and relax for 5 minutes.

 

You can influence your BP test results to quite a degree by breathing properly, often, sub conscious stress causes BP to be higher than it would normally be, eg white coat phobia where BP readings in a medical setting are much higher in many people.

 

Sit in a chair, upright, feet together hands in lap. Close eyes and relax. take a deep breath and fil your lungs, with your eyes still closed, breathe out very very very slowly from your mouth only. Repeat half a dozen times. That stimulates the vagus nerve which controls blood pressure and heart rate. Try it and see what happens. 

[shdmn]

7 minutes ago, chiang mai said:

You can influence your BP test results to quite a degree by breathing properly, often, sub conscious stress causes BP to be higher than it would normally be, eg white coat phobia where BP readings in a medical setting are much higher in many people.

 

Sit in a chair, upright, feet together hands in lap. Close eyes and relax. take a deep breath and fil your lungs, with your eyes still closed, breathe out very very very slowly from your mouth only. Repeat half a dozen times. That stimulates the vagus nerve which controls blood pressure and heart rate. Try it and see what happens. 

 

This is very true.  When I go into the doctors office my BP is fairly high even though I do not feel any anxiety or stress whatsoever.  When I get it done at those public BP testers its completely normal.  I thought maybe they weren't giving an accurate reading but I have tried many different ones and have been told by doctors that they are usually pretty accurate.

[Sheryl]

It would be worth noting how the readings relate to timing of your Ramipril dose.

 

The higher readings you mention still have a normal diastolic (bottom number). Typically when only the systolic is elevated (top number) it is a temporary elevation due to pain, stress, excitement etc.   It is completely normal for BP to fluctuate in repsonse to such things.

 

When you get such readings, take some deep slow breaths, wait a while and repeat to see if it is then lower.

[Kinok Farang]

Hope this makes you feel better.

Check the time stamps.

This happened at hospital a few years ago because of anxiety and white coat syndrome.

perfectly normal (ish) at home.

[loong]

My BP used to be similar to yours with quite large differences.

It settled down after quitting smoking.

[chiang mai]

12 minutes ago, loong said:

My BP used to be similar to yours with quite large differences.

It settled down after quitting smoking.

I went even more radical, I had my thyroid removed. Before, my BP was always always high, it wa s a real battle at times to lower it. I had my thyroid removed for a completely unrelated reason and now my BP is constant all the time, I don't have to do breathing exercises at the hospital before tests, at times I wonder if I'm still functioning normally but doctors tell me it's not uncommon.

[thesetat2013]

Haha... Blood pressure for me is chaotic to say the least. For years, I would have high blood pressure until about an hour after i had breakfast. Those times I learned the pressure because dentists would refuse treatment, then i would go to eat and they would check it again and it would be normal. 

 

Normally my BP runs about 165/92. I was given the medicine ENALAPRIL which seemed to lower it a little. Yesterday I did not take the medicine as it was all gone. I was at the hospital getting an injury checked and my BP was 196/108. The doctor freaked and told me to take a pill and go lay down to be monitored. Asking if i had a headache or felt dizzy. I felt normal and explained i had not eaten yet and needed some food and the pressure would lower again. The doctor was reluctant to allow me to leave and said I would do it against the doctors advice. Needless to say, the pressure lowered after I ate and took my medicine while at home. 

 

Your pressure changes constantly, hunger, pain, stress, activities will make it higher. You need to check your pressure when you are relaxed and fed. Then decide if it is high or not. The pills i was given lowers my pressure only a little. The doctors say i have hypertension only. Also, to note. the pills they gave me previously took a couple weeks to begin showing any sign of my pressure lowering. I have a blood pressure machine at home now to check daily that i bought in Lazada. But usually I only check when I feel something is off. 

[newbee2022]

15 hours ago, CM4Me said:

For the last 5 years, or so, my BP has been relatively stable, but recently it has gone crazy, with fluctuating readings. 

 

When I recently became aware of these fluctuations I commenced taking a reading 4 times a day. These readings now can range from 119/73 to 150/70, with a similar difference, each time, between L & R.

 

I do take Ramipril 2.5mg/day (which I have been doing for the last 5 years or so, where my BP has normally been in the normal range).

 

I do NOT have any adverse symptoms, like headaches, blurred vision, dizziness etc, and today I went and had blood tests for Lipid Profile, 

Glucose and Sodium, all within normal range (except down a bit for Triglycerides). 

 

I do have an appointment to see a Cardiologist this coming Monday, but would appreciate any reports from members that have had similar 

problems (so I can better understand what the Dr is asking/telling me).

 

TIA

 

 

Ask Sheryl for her expertise. Or meet a doctor who will do Anamnesis ,Diagnosis, Treatment.

[Lacessit]

Take a look at your heart rate as well. When you think your BP is out of sync, is your pulse varying too?

 

Be aware quite a few drugs ( e.g. Viagra, opioids, BPH medications, alcohol ) can cause your BP to fluctuate.

[Banana7]

I was diagnosed with hypertension when I went into Bang Lamung hospital with chest pains, BP 220/160. Since the hospital visit, I had been taking Anapril 20mg for about 3 years, which reduced bp into the 130/85 range. I changed my diet in April 2024 to a keto diet, cut out all sugars, starches, products with white flour, and seed oils.  BP in June was averaging 105/68 with the Anapril. In June this year, doctor authorized to stop Anapril all together. Now I eat mostly very low net carb foods, meats, and whole foods. Now BP is: lowest 107/67, worst 134/83, most days 125/83, with no Anapril. Since April I have lost 22 lbs., BMI now is 21.5. Also cut out statins for high cholesterol. Diet can make a huge difference.  With the initial keto diet, also reduce eating window to 5-6 hours per day. Now I eat only once a day, 4 course meal, and feel better than I have felt in decades. I also walk at least one hour per day.

[NanLaew]

7 hours ago, CM4Me said:

Tks for your post chiang mai.

 

I follow the UK NHS recommendation re testing for BP

 

They say when you wake up, go for a pee the sit and relax for 5 minutes before testing.

The other 3 daily tests I do are before eating, but again I sit and relax for 5 minutes.

 

 

Notable, none of your BP measurements are after exercise.

[NanLaew]

2 minutes ago, Banana7 said:

Diet can make a huge difference. 

 

This.

 

+ exercise.

[john donson]

did you measure after eating ?  some food spike your glucose and also BP

[Guitar God]

See a cardiologist and have them prescribe a different anti-hypertensive. 
Some ACE inhibitors and ARBs can become less effective after you reach a certain age. For people over 60, doctors usually switch their patients to the latest generation beta-blockers (Carvdilol)  and either a latest generation ARB like Edarbi or a new Calcium channel blocker such as Zanidip. 

[jojothai]

Sheryl has made a good point to consider.

However you have not said why you are taking ramapril in the first place.

What incident resulted in that?

If you had hypertension problems or had a cardiac problem then it is important to consider that.

If so, then look at what banana 7 says.

I had a serious incident 24 years ago. Fortunately spared from a heart attack.

I followed all medical advice at the time and about 3 years later was still getting bad hypertension problems.

Then i cut the carbs, my life was changed, and no repetitive hypertension.

I took regular readings every day when itwas a problem. I know if my blood pressure gets elevated without doing any readings. It does happen some times, mainly due to stress.

To add to some of the other comments, when i go to the hospital, its easiest to get a motorcyle taxi the last part of the journey. I always have to tell the nurses to ignore any BP reading they require immediately because it will be too high, and i ask that it is taken at least 15 minutes later.

 

[CM4Me]

Thanks to one and all for the replies to my post.

To answer some of the questions:

* I take my Ramipril the last thing at night before I retire

* Haven't smoked for around 25 years

* I'm only a very modest drinker & then only on the occasion when enjoying a dinner

with friends

* I exercise most days - 60 laps non-stop in my lap pool

* All readings are taken before eating

* Perhaps one other important factor might be is that I celebrated my 80th this year 🙂.

 

[degrub]

Sensitivity to sodium from table salt, MSG, etc can raise your blood pressure. Mine will go up 20-30 points (top number) for a day or two if i eat something salty like soup or many asian foods until the body flushes it out.

[Boycie]

Does anyone else use cayenne pepper in their diet?

 

I've been a big fan for the past year. I sprinkle it on nearly all my food dishes.

 

Blood pressure reading in March 2023 was 161/108. A few weeks ago 114/74. Haven't really changed anything else. I do very little exercise but have been trying to eat a healthy diet for the past 5 years.

[TedG]

On 8/30/2024 at 9:01 PM, Banana7 said:

I was diagnosed with hypertension when I went into Bang Lamung hospital with chest pains, BP 220/160. Since the hospital visit, I had been taking Anapril 20mg for about 3 years, which reduced bp into the 130/85 range. I changed my diet in April 2024 to a keto diet, cut out all sugars, starches, products with white flour, and seed oils.  BP in June was averaging 105/68 with the Anapril. In June this year, doctor authorized to stop Anapril all together. Now I eat mostly very low net carb foods, meats, and whole foods. Now BP is: lowest 107/67, worst 134/83, most days 125/83, with no Anapril. Since April I have lost 22 lbs., BMI now is 21.5. Also cut out statins for high cholesterol. Diet can make a huge difference.  With the initial keto diet, also reduce eating window to 5-6 hours per day. Now I eat only once a day, 4 course meal, and feel better than I have felt in decades. I also walk at least one hour per day.

 

Life style matters.  

[save the frogs]

17 minutes ago, Boycie said:

Does anyone else use cayenne pepper in their diet?

yeah, cayenne pepper may be helpful for heart health.

 

also, Kyolic Aged Garlic capsules helps reduce blood pressure. 

 

 

[SlappyMc]

On 8/29/2024 at 11:03 PM, CM4Me said:

For the last 5 years, or so, my BP has been relatively stable, but recently it has gone crazy, with fluctuating readings. 

 

As someone mentioned, how much salt is in your diet? Since your body will try balance the salt with more water, so higher/larger blood volume, which means higher BP.

 

I am 62. Had a left ACA stroke in June 2020. Put on lisinopril and atorvastatin. When finally home after rehab did more online research and two changes in meds. First, if one reviews the statin literature most humans experiencing mental issues are on something like atorvastatin, which is fat (lipid) loving statin and so has an easier time making it into one's brain. So asked for and switched to rosuvastatin (a water loving statin)(not an easy call, since the three doctors who offered their opinion said that the clot originated inside my brain and so if rosuvastatin has a harder time making it there...)(that risk versus possible mental issues from a fat (lipid) loving statin).

 

The first change was my BP med. Some have mentioned everything but indapamide. Since you are not in the US, should be able to obtain the time-release version (no time-release in the US). For a big reason for my insistence:

 

https://www.eshonline.org/esh-content/uploads/2019/07/4.-Redefining-diuretics-use-in-hypertension-why-select-a-thiazide-like-diuretic.pdf

 

Solves the salt leading to high BP problem by removing the salt, which you pee out, so a diuretic.  Taken first thing in the morning.

 

In the US, they want a systolic of 130 or lower. These fellows here say that they are modeling the data wrong:

 

https://www.math.ucla.edu/~scp/publications/mortality.PDF

 

So, according to them not log linear but instead horizontal splines. May just be me but I'm going with the math/stat heads.

 

They wrote a subsequent paper on diastolic and 90 is the correct number, though perhaps med intervention not warranted until 94. See:

 

https://www.math.ucla.edu/~scp/publications/dbp

 

Now on to the surrogate marker that is BP, maybe it is not, repeat not the BP. As there are these things called pleiotropic effects, which for indapamide means (from the eshonline piece above):

 

Lastly, indapamide appears to reduce oxidative stress, whereas chlorthalidone and HCTZ do not [107–109]. As the endothelium mediates direct vasodilation at least in part by responding to nitric oxide, beneficial cardiovascular effects of indapamide may also be related to improvements in endothelial function, which, in turn, improves vasomotor tone, arterial stiffness and remodeling, inflammation, and target organ damage.

 

As well:

 

Not only the antihypertensive efficacy of indapamide and HCTZ has been compared. In a small study that specifically compared the metabolic and endothelial effects of indapamide retard with those of HCTZ, patients with hypertension received either indapamide retard (1.5 mg/day) or HCTZ (25 mg/day) for 12 weeks. At the end of the study, both drugs reduced BP levels to a similar extent. However, whereas indapamide retard was metabolically neutral, the patients who received HCTZ showed a significant increase in triglycerides  (+15.3%, P<0.05) and glucose levels (+12.2%, P<0.05). Moreover, there was a tendency for endothelium-dependent vasodilation to improve with indapamide and become worse with HCTZ.

 

See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142573/

 

Now back to the other important part of the eshonline piece:

 

 

Both treatments had significant effects on stroke and on the composite endpoint (stroke and coronary heart disease). Similar results were obtained by the United Kingdom National Clinical Guideline meta-analysis for stroke (significant versus placebo for both treatments) and all-cause mortality (only significant versus placebo for indapamide)[2]. Coronary heart disease, however, was significantly reduced with indapamide, but not chlorthalidone [2].

 

First, read the paper, since a split when it comes to heart disease (I omitted part). Now note the all cause mortality, since one can die from anything. From another paper:

 

In relatively diverse patient populations, long-term indapamide treatment provided a 15% risk reduction in all-cause mortality, a 21% reduction in cardiovascular death and a 37% reduction in fatal stroke.

 

See: 

 

https://journals.lww.com/jhypertension/Abstract/2019/07001/BENEFIT_OF_INDAPAMIDE_BASED_TREATMENT_ON.143.aspx

 

Will remain forever convinced that has zero to do with BP and everything to do with helping endothelial cells, etc., aka those pleiotropic effects.

 

For the same reason I am not taking a statin merely to lower my LDL. Instead, plaque usually comes with a lipid core, which means it's prone to rupture. Statins calcify the lipid core and so less likely to rupture. Again, pleiotropic effect and all that.

 

But did not give up lisinopril, instead halved the dose, which I take about two hours before bed. As for why:

 

Shortly after the study [PROGRESS] was published, an editorial (in line with a small number of earlier critical letters and commentaries^2-4) in the American Journal of Hypertension stated explicitly the two major problems with PROGRESS. Firstly, it is illogical and misleading to combine two treatment arms that have significantly heterogeneous results—if the findings from two trial arms differ substantially “then the findings need to be presented separately and interpreted separately”; secondly, “the major limitation of the PROGRESS trial was the failure to include a group randomized to indapamide alone.”⁵ These editorialists speculated that indapamide alone may have reduced stroke by as much as 38% (43% for the combined therapy minus 5% for perindopril alone), which would be consistent with the 34% risk reduction seen with low dose diuretics in the primary prevention setting⁶ and the 29% risk reduction seen with indapamide alone in the post-stroke antihypertensive treatment study (PATS).⁷ However, from the design of PROGRESS, one cannot know whether the benefit seen with combination therapy is due to indapamide alone or to an additive or synergistic effect of indapamide with perindopril. What is clear is that the benefit is not attributable to perindopril alone [that 5% was not clinically significant aka no better than placebo].

 

The same editorial also argues that the blood pressure differences between the two arms (5/3 mm Hg for perindopril alone v 12/5 mm Hg for the combined therapy) are unlikely to explain the large difference in stroke reduction.⁵ For example, the blood pressure reduction with indapamide alone in the PATS trial was only 5/2 mm Hg, less than the reduction seen with perindopril alone in PROGRESS. Yet indapamide alone in PATS was associated with significant stroke reduction, while perindopril alone in PROGRESS was not.

 

That last is the part where surrogate marker comes in, since perindopril alone reduces BP more than indapamide alone yet perindopril alone does near nothing to prevent recurrent stroke (that was the PROGRESS trial)(PATS was the Chinese version for recurrent stroke). 

 

For how f'd the whole thing, why was there no indapamide alone arm in PROGRESS? Because the makers of perindopril knew that indapamide does the heavy lifting? So take the combo pill, now that the patent for perindopril has expired. Why the article references the false/misleading claims. So half the dose of lisinopril since maybe there is that synergistic effect. Thank Deity it's cheap. Oh, and not that this helps you, but here in the US, the not time-release indapamide can be bought, a 90 day supply, for 10 dollars at Walmart.

 

Lastly, some say, but I don't/didn't feel excited. Which may mean nothing. Since one can still be excited. Even with rest (white coat effect).

Sorry, for one more, know near zero about heart attack, since never had one, but once you've had a stroke, if you have any symptom that can mean stroke, cue both CT and MRI. Which I had in mid-October 2022. No further stroke damage. Indapamide, the miracle pill.  And to put that in context, from October 2022, note the left ACA stroke damage, and all the other stroke damage from before that:

 

No evidence of acute infarct or acute intracranial hemorrhage. Multiple
old infarcts involving bilateral cerebellum with some old petechial
hemorrhages. Old cortical infarcts involving the bilateral posterior
frontal, parietal [left frontal and parietal are left ACA] and right occipital lobes with encephalomalacia and old petechial hemorrhage. Old infarct with encephalomalacia of the anterior corpus callosum. Patchy white matter lesions are seen in bilateral cerebral hemispheres likely representing moderate to severe chronic small vessel ischemic changes [cue greater risk of dementia]. No significant mass effect or midline shift. The ventricles and extra axial spaces are within normal. Fluid in the left maxillary sinus. The mastoid air cells are clear. Visualized orbits are within normal. Visualized vessels demonstrate normal flow-voids.
 

By the time I'd my left ACA I'd had all of that other stroke damage. Seems that the right frontal/parietal was damage to a non-functional area since my left leg is the same as it ever was. Re my right occipital lobe, had an M.D. eye test in connection with DL renewal and my vision is 20/20 and I can at least discern green, red and yellow. Re that fluid, the provisional diagnosis of peripheral vertigo became the discharge diagnosis once both the CT and MRI came back negative for stroke.

 

Anyway, watch the salt and see the monks re meditation.