Blood pressure changes?*

[TromboneAl]

A note on white-coat hypertension: I read something that said trying to relax and get a lower blood pressure reading can actually result in a higher reading.

Here's an Amazon review of the Zona that shows how it may raise your blood pressure:

 

[harley]

Thanks, Al!

I actually do believe that stress is a large factor in high BP, and there's nothing that causes stress more than dealing with anybody's customer service department. Buy the product and hope nothing goes wrong, that's my theory.

 

[haha]

This dispersion in results makes me very wary about the recent health reform fad of "don't fund what doesn't work?" Doesn't work for whom? Obviously, for some of the reviewers it did nothing, for some others and me and helped a lot. This sounds like individual differences.

As far as the complaints about stickiness (notchiness?) or grip problems (other than the arthritis which is self expanatory) it really appears to be a solid little machine to me.

About customer service complaints I can only say that I have called several times, to ask little questions about what score to try for etc, and they have always been helpful.

Ha

 

[Rich_by_the_Bay]

This dispersion in results makes me very wary about the recent health reform fad of "don't fund what doesn't work?" Doesn't work for whom? Obviously, for some of the reviewers it did nothing, for some others and me and helped a lot. This sounds like individual differences.

Yes, they do sound like individual differences, because they are. But in the end, you either believe in quality evidence (it's not all high quality to be sure) or you don't.

Consider a disease with two treatments. The first treatment cures 80% of those who take the pill and fails to cure 20%. The indistinguishable placebo group noted a cure rate of 70%, with the other 30% not cured.

If you are in the cured, real treatment group you are happy. If you are in the cured placebo group you are happy.

If you are in the cured placebo group, you might conclude the drug worked for you and that this is an individual difference. But in fact, the evidence shows otherwise.

Similarly, the real pill cured group had a higher cure rate, but only 10% better than the placebo group. So the drug works, but not dramatically. Throw in an 8% incidence of side-effects of comparable severity and it's not a clear cut decision to treat.

Like investing, clinical research is all about the margins. Drug companies exploit the evidence by pointing to relative risk reduction rather than absolute reduction and in many other ways (particularly misleading in prevention where the disease isn't that likely to begin with).

 

[haha]

Yes, they do sound like individual differences, because they are. But in the end, you either believe in quality evidence (it's not all high quality to be sure) or you don't.

Consider a disease with two treatments. The first treatment cures 80% of those who take the pill and fails to cure 20%. The indistinguishable placebo group noted a cure rate of 70%, with the other 30% not cured.

If you are in the cured, real treatment group you are happy. If you are in the cured placebo group you are happy.

If you are in the cured placebo group, you might conclude the drug worked for you and that this is an individual difference. But in fact, the evidence shows otherwise.

Similarly, the real pill cured group had a higher cure rate, but only 10% better than the placebo group. So the drug works, but not dramatically. Throw in an 8% incidence of side-effects of comparable severity and it's not a clear cut decision to treat.

Like investing, clinical research is all about the margins. Drug companies exploit the evidence by pointing to relative risk reduction rather than absolute reduction and in many other ways (particularly misleading in prevention where the disease isn't that likely to begin with).

I hesitate to answer this because you are a doctor. But in this case we are talking more about logic than clinical medicine, so I'll go ahead. I agree with what you are saying about putting lipstick on the pig by using relative risk reduction to describe postitive results. Many consumers wouldn't have a clue about the distinction you are drawing, but clearly it is very important.

I think your example of the placebo and the supposed effective treatment is only a partial description of the problem presented for example by the Zona Plus, or by two active pills of possibly unknown effectiveness. If it is known that one treatment is a placebo-eg. it is a sugar pill, then your example is right. However, it is quite possible that the treatment is real, but it just doesn't work for many of the subjects, while working very well for others.

A well known biochemist from U Texas Austin, Roger Williams, spent much of a very long career investigating these individual differences. It doesn't fit well with today's medicine for the mass man, and that is why I said what I did in my post about individual differences.

Take another example, the controversey about high fat vs high carb reducing diets. If a high fat diet were a pill, the FDA would never have approved it. But for many people at least, it turns out to be both more effective and safer than the high carb diet. It may be worse or less safe or both of these for another group of individuals.

Ha

 

[chemist]

A few years ago my BP which had always been low started creeping up, first into borderline hypertension then into Stage I hypertension.

My doc put me on generic lisinopril (really inexpensive) and I developed a terrible hacking cough (but it lowered my BP). Finally I couldn't stand it any more, was going through a bag of Halls a day and told the doc no more.

Turns out ACE inhibitors do this to some people, cause a build up of some oligopeptide in the lungs.

He put me on an ARB, Hyzaar (many $$$) and my BP is perfect and no side effects.

And fortunately for me Hyzaar is the first ARB to go off patent just in time for my ER.

I am hoping when I am retired and lose some weight, increase my cardio health etc. that maybe I can go off the Hyzaar but if not it is OK as it is a wonderful drug after that awful experience with the ACE inhibitor.

PS I found out that the ACE inhibitors are basically snake venom. I am not making this up. The drug companies made variants of a snake venom from a species of snake that basically killed or stunned its prey by causing it to go into hypotensive shock.

 

[Rich_by_the_Bay]

A few years ago my BP which had always been low started creeping up, first into borderline hypertension then into Stage I hypertension.

My doc put me on generic lisinopril (really inexpensive) and I developed a terrible hacking cough (but it lowered my BP). Finally I couldn't stand it any more, was going through a bag of Halls a day and told the doc no more.

You might want to be aware that Hyzaar contains not only the angiotensin receptor blocker losartan (an "ARB") but also a small dose of the diuretic hydrochlorothiazide. Cozaar (losartan alone) does not contain the diuretic. ARBs do not cause the cough that ACEs cause and are comparably effective.

So essentially you went from one drug to two drugs. This is not a bad thing at all, but just something to note. Diuretics have their own set of advantages and disadvantages. Sounds like your doctor is on top of things. Now if only we had a generic ARB...

 

[unclemick]

I know this - even three touchdowns ahead - my BP was 150/100 range till at least an hour after the game. And I took one extra BP pill(enalapril) the morning of the game.

Expect similarly high readings during the game tomorrow - win or lose.

And that's with controled breathing and trying to relax.

heh heh heh - so that Zona Plus might be worth it. Geaux Saints.

 

[haha]

Damn Mick, maybe you should get a little drunk by kickoff time?

Ha

 

[oldtrig]

After reading here about blood pressure I am getting more confused. Maybe someone can help me with this or maybe make a suggestion.

About 12 years ago a local doctor said I needed to be on b/s medicine. I started on a pill right away. That was in 1998. I continued to make the yearly visit and each time his ether changes my meds or raised the one I was on.

Then the day came in 2005 that I quit going to that doctor. I started a diet and exercise plan and lost 40 pounds in 6 months. I then went to a new doctor and my blood pressure was 110/70. They checked it many times over the next few weeks and it was always perfect.

Later that same year we had our annual city physical where all these people check B/P, b/s and cholesterol and that day my blood pressure was 195/100. The told me to rest and it came down to 170/90. They told me to see a doctor. I called the doctor’s office and I was told to just come in and they would test it. I drove to the doctor’s office that same day and it was 120/80. I was told just to come in every few days and a nurse would test it for me. I did and it was always perfect.

I had another physical a month ago and again it was perfect, 110/70. The nurse even asked me how I was keeping my blood pressure so good. I said nothing that I knew of just eating and walking.

This past Wednesday I went to the dentist to have a wisdom tooth pulled. They tested my blood pressure and it was 195/115. They said I would have to get my blood pressure under control before they could pull that tooth. I was sent immediately to the doctor and they tested it. It was 120/78.

I remember 30 years ago I had to go to the emergency room because I cut myself . They checked my B/P that day it was 200/120. I was put in a dark room after they sewed me up and told to test. The finally let me go and I was told to see a doctor about the B/S problem. I never did until many years later and here I am now.

I know this is a long post and I apologize but would like to have an opinion on what others think I should do. I know many here have had B/P problem and maybe someone here has had something similar. Thanks. Oldtrig

 

[Ed_The_Gypsy]

Just to step back a minute to the original post, I work in Calgary at about 3400 ftASL but I live in Bellingham close to sea level. My blood pressure is consistently higher in Calgary than in Bellingham, mostly the diastolic, year-round.

It could be
a) the altitude difference,
b) the low humidity vs the higher humidity,
c) the stress associated with working vs living at home,
d) what I eat in the two places.

Dunno.

I might point out that I have learned to not accept stress in my life. Years ago I had a staff job with high stress. I learned anger management and that helped me enormously. Then I got laid off and my blood pressure dropped way down. Now a contractor, I do not let stuff bother me. If everything goes to hell, I know I can retire in Mexico.

 

[W2R]

That's really odd, oldtrig. It sounds like your BP has been high everywhere except when measured at your present doctor's office.

Who measures BP at your doctor's office? Maybe you need to ask your doctor to measure it himself instead of leaving it to his staff.

 

[TromboneAl]

I know this is a long post and I apologize but would like to have an opinion on what others think I should do.

You should stop measuring your blood pressure. Ha ha just kidding.

What did the doctor say was going on? I've also seen a range of readings in the past.

 

[oldtrig]

TromboneAl, that was I have done. I quit checking it. I feel good and will not worry about it but just wondering if anyone else might have had this problem and what they did about it. I turn 63 this year and I am still here
W2R. I agree it is odd. The doctor has checked it himself and it was good. Really strange. Maybe I need to be on meds for it. Oldtrig

 

[zinger1457]

Went through a recent physical exam for work and found out that the size of the cuff they wrap around your arm can also make a difference. I've never had an issue with HBP but when the nurse took the first reading it was much higher than normal and I told her so. She explained that the cuff size can make a difference and changed out the cuff with a narrower one, took my blood pressure again and it was normal. First time I ran into this, didn't even realize they had different sizes for patients.

 

[Rich_by_the_Bay]

Went through a recent physical exam for work and found out that the size of the cuff they wrap around your arm can also make a difference. I've never had an issue with HBP but when the nurse took the first reading it was much higher than normal and I told her so. She explained that the cuff size can make a difference and changed out the cuff with a narrower one, took my blood pressure again and it was normal. First time I ran into this, didn't even realize they had different sizes for patients.

Generally the problem is using too small a cuff, with switching to a larger cuff resulting in a lower reading. The cuffs have markings to determine if they are the right size.