High blood pressure / Hypertension

[NXR7]

Can you provide more specifics on the bolded part? Where on the ankle do you press? How long is "snap right back" (2 -3 seconds?)?

Sure. First off, I should have checked to assure the grading system is still the same nowadays and it's not. If you google pitting edema you'll see the new one. Nevertheless, simply telling your doc how long your skin stays dented in seconds is fine. They'll do their own test. We would report any denting, even one second.

Where on the ankle doesn't really matter because the fluid will fairly evenly disperse. I do it about 3" or 4" above the bone that sticks out on the inside, the medial malleolus, because there's more tissue there than down lower.

When I wrote "snap right back" that's what I meant. The instant your finger is off the skin it should be back to normal. Any type of dent that's still there is a potential concern.

The "blanche test" may take a bit longer, maybe a second or two to return to normal color. That tests the capillary refill ability and is affected by temperature. Try it on your cold fingernail.

When someone had a leg or foot injury we would always press down on the top of the foot near the toes to see how fast the area returned to normal color. If the area remained white and it was not outside temperature-related, it could mean the injury had impaired circulation past the area of injury. We also would feel for a pulse in that area.

When I worked on the National Ski Patrol, the blanche test was not real valuable after we removed someone's ski boot because their feet usually were cold anyway.

I'll also do some measurement of right vs left over the next few weeks to see.

Pitting edema is something that does not occur and then go away without treatment. If it's there one week it's there the next. It's an accumulation of fluid in the lower extremities, usually do to a circulatory problem, and those do not come and go.

Or were you referring to left and right arm blood pressures?

As someone who spent (invested?) much of their career with measurement systems, it bugs the heck out of me that decisions are made on a single reading once/twice a year in a doctor's office. You really need more data points when the measurement is variable.

Yeah, no kidding, same here in a few of my careers. I get that a proper sample size can be extrapolated to a much larger population but still...

I think the problem is that a set of simple guidelines is needed that could be used to "ring the alarm bell" and cause further investigation, guidelines that can be reasonably applied to almost anyone. The guideline chosen was the maximum and minimum pressure under a defined set of circumstances.

But really, does anyone believe if I do not sit in a chair with both of my feet flat on the ground that it's going to make a material difference in my blood pressure? Or I am not sitting with my back against the chair? What about people with scoliosis? Can they not ever get an accurate blood pressure?

I also have the same question posed earlier - is the 'at rest' measurement the best indicator?

I'll give you a personal example. This morning I lay awake in bed for about 20 minutes checking the news. I then got up, walked to a chair in the room, sat down, and checked my BP with an Omron machine. Right arm, first time: 116/81 pulse 78.

It's never been that low.

Another time I had to stay overnight in a hospital because of cardiac symptoms. (A later echo showed all was well.)

When I awoke the next morning the nurse told me I caused them some concern overnight because my pulse rate dropped to 41 and set off the alarms. They watched me for a while and my color was OK and my breathing rate was OK so they let me sleep and the next morning my pulse rate was back to normal. I don't know if they took my BP, though. Probably but I do not recall.

That's about as "resting" as one could get.

Ray

 

[skyking1]

I did that after the cath lab event. I went in the lab about 11 PM, and around 5 a nurse came looking for a BP. I stuck my arm up and he got a 105/55 or so and the HR was 40s.
"do you usually get up early and have coffee?" "I'll get you some coffee"

 

[Rianne]

I take BP a few times/day due to kidney disease. BP changes in minutes. Take BP, wait a few minutes and take deep breaths, it will come down pretty dramatically, at least it does for me.

 

[Dash man]

Just took my blood pressure in both arms:

Left: 106/62 HR 62
Right: 100/60 HR 60

That’s after three cups of coffee! [emoji23]

 

[ERD50]

....

Or were you referring to left and right arm blood pressures? ...

Ray

Thanks for all that, yes left/right was about BP.

So the skin on my ankle does spring right back, no noticeable delay.

My ankles are pretty pale, and it's cool in the house today, but the backs of my hands have more color. I'd say ~ 3 seconds for them to be mostly normal color, maybe a couple seconds more before I'd say 100% completely the same as surrounding color. I'll do so more searching on line to get a better idea on this.

Thanks - ERD50

 

[NXR7]

Thanks for all that, yes left/right was about BP.

So the skin on my ankle does spring right back, no noticeable delay.

My ankles are pretty pale, and it's cool in the house today, but the backs of my hands have more color. I'd say ~ 3 seconds for them to be mostly normal color, maybe a couple seconds more before I'd say 100% completely the same as surrounding color. I'll do so more searching on line to get a better idea on this.

Yes, those are fine. Remember, with many of these diagnostic tests it's rarely the "snapshot" reading that's the problem. It's the trend that the readings are moving in.

Ray

 

[eytonxav]

My BP generally runs about 115/76, although I have been on lisinopril for many years. I have always craved salt and that certainly can cause BP increases if you are getting too much. I'd also say be careful how you take your BP. Keep both feet flat on the floor and make sure your arm is supported and at heart level which should provide a more accurate reading.

 

[NW-Bound]

My BP generally runs about 115/76, although I have been on lisinopril for many years. I have always craved salt and that certainly can cause BP increases if you are getting too much. I'd also say be careful how you take your BP. Keep both feet flat on the floor and make sure your arm is supported and at heart level which should provide a more accurate reading.

If your BP is that low, does it make sense to cut out the drug, or at least reduce the dosage to see what happens?

My mother-in-law was on BP medication for decades. Her doctor was afraid to take her off the drug. When she was in the hospital for her COPD 3 years ago, the hospital doctors said she did not need to take it, and she has been fine since.

 

[aja8888]

If your BP is that low, does it make sense to cut out the drug, or at least reduce the dosage to see what happens?

My mother-in-law was on BP medication for decades. Her doctor was afraid to take her off the drug. When she was in the hospital for her COPD 3 years ago, the hospital doctors said she did not need to take it, and she has been fine since.

After years of taking a BP drug, my cardiologist took me off of it when the other drug I take, Tamsulosin, was also lowering my BP. I dropped the BP drug with no noticeable effects. Of course, I may be different than someone else.

 

[GenXguy]

I was put on BP medication a couple years ago. But during the warmer months when I'm biking, my blood pressure is lower, so I stop taking it and monitor my blood pressure.

Diet and losing quite a bit of weight appears not to work to any significant degree with me. I'm down over 40 pounds from when I was first placed on it, but if I go without exercising, it will be up to 140/90 or such. So for me, exercise is the key (for now) to keeping it lower. OP is already doing that, though.

If I had my choice, I think I would rather not be on lisinopril (ACE inhibitor). It can cause a cough and permanent tinnitus. There's a thread on it here:

https://www.early-retirement.org/forums/f38/lisinopril-side-effects-108004.html

 

[NW-Bound]

If I had my choice, I think I would rather not be on lisinopril (ACE inhibitor). It can cause a cough and permanent tinnitus. There's a thread on it here:

https://www.early-retirement.org/forums/f38/lisinopril-side-effects-108004.html

My mother-in-law was on lisinopril for years. Then, she started to have food allergy symptoms, when her lips and cheeks got swollen up. It came and went.

Her doctor told her to keep track of what she ate. Could not figure it out. Finally, my nephew who's a pharmacist told us it was the damn lisinopril.

Drugs may have very weird side effects, which vary with the patients, and also vary with time. It's up to the patients to watch out for it. Doctors don't know all these things.

PS. The dry cough effect of lisinopril is quite common. I got it, and it came and went. I am not taking it anymore, and am now on Losartan.

 

[GenXguy]

PS. The dry cough effect of lisinopril is quite common. I got it, and it came and went. I am not taking it anymore, and am now on Losartan.

My dentist mentioned he had the cough with lisinopril and switched. Interestingly, I have had problems with chronic coughing for years, mostly during the colder months, but not since early in the pandemic, so I wouldn't know whether to blame lisinopril if it happened now vs. the same old chronic problem. I've had tinnitus to some degree for so long, I definitely didn't want anything to make it worse. Although it did get worse not long ago, but I hadn't been taking lisinopril at the time. So, not sure if I should change at this point to something else that might actually give me side effects.

 

[Ronstar]

As to salt - I had popcorn loaded with salt last night and my systolic was 10 points higher than my last 7 days average. Maybe a coincidence. Maybe not.

 

[street]

As to salt - I had popcorn loaded with salt last night and my systolic was 10 points higher than my last 7 days average. Maybe a coincidence. Maybe not.

It might coincidence but salt for me makes my BP go up. I like canned soup once in a while I do not have any canned soup anymore.

 

[GenXguy]

It might coincidence but salt for me makes my BP go up. I like canned soup once in a while I do not have any canned soup anymore.

I cut back on canned soup when the price went up from about $1.50 to $2 some months back. I got the low sodium since I try to keep my salt intake down.

 

[street]

I cut back on canned soup when the price went up from about $1.50 to $2 some months back. I got the low sodium since I try to keep my salt intake down.

Yes that is an option for sure.

 

[eytonxav]

If your BP is that low, does it make sense to cut out the drug, or at least reduce the dosage to see what happens?

My mother-in-law was on BP medication for decades. Her doctor was afraid to take her off the drug. When she was in the hospital for her COPD 3 years ago, the hospital doctors said she did not need to take it, and she has been fine since.

I have been on the lowest dose, but my Dr has not suggested going off it as I have a family history of HBP.

 

[JoeWras]

Salt is an interesting issue. It has been hot here and I've worked outside. My shirt had a "salt ring" on it. I feel this gives me some permission to bring out the shaker.

Speaking of salt shakers, they say "Put it away." I disagree with this. I think the real problem is processed foods and restaurant food. That's where you get ridiculous amounts.

We cook with little to no salt. We make our own bread and know how much is in it. And so on. So I season to taste.

DW never uses the shaker, I do. It holds 70g. It lasts about 8 months. That's about 300mg per day from the shaker. I can control it. As long as we don't overdo the restaurants or fall back to processed food, I see no harm in the shaker if used judiciously.

And I can't stand eggs without just a touch of salt. Sorry, man, I gotta enjoy life.

 

[braumeister]

Salt is an interesting issue.

It certainly is. One often overlooked aspect is that those on a very low carb (ketogenic) diet typically need to consume more salt than those on a more typical diet because your body excretes more sodium.

 

[Ronstar]

My 7 day average is 142/81. This morning’s reading was 141/83 about average. Then I lifted weights and ran 3 miles for the first time in a week. Took bp again 121/79. Verifies what I believe was posted here that bp goes down immediately after exercise.

I just saw an article where first time marathon runners bp’s were studied. On an average their bp (diastolic and systolic) went down 3-4 mm hg during several months of training. Thought it would go down more than that.

 

[audreyh1]

Salt: Quite a few studies over the past 20 years have come out that show salt consumption and health/mortality are a U or J shaped curve, rather than a single slope rising with higher sodium intake. This article reviews a few. Note that they are able to measure subject sodium intake via urine samples. https://www.cardiosmart.org/news/20...salt-is-associated-with-increased-heart-risks

The current guidelines for lower salt also have increased risks for cardiovascular problems. There is an optimal point at the bottom of the U-shaped curve which corresponds close to typical American usage. Increasing or decreasing from that area increases health risks.

But health guidelines tend to get set in stone and very difficult to change - it takes forever.

It certainly is. One often overlooked aspect is that those on a very low carb (ketogenic) diet typically need to consume more salt than those on a more typical diet because your body excretes more sodium.

Definitely. On a low carb diet which dramatically reduces blood insulin, the kidneys readily release sodium, so you sometimes need to increase salt intake to avoid some side effects that are associated with “keto flu”. Notably, low carb diets also drop blood pressure. Kidneys don’t retain excess sodium, nor retain extra water associated with it.

As I mentioned earlier in this thread, hypertension is a well established early symptom of insulin resistance, and for many people you can lower it by addressing insulin resistance directly through diet. No junk or fast food, reduce the starchy carbs, drastically reduce the sweets, and don’t drink your calories.

 

[JoeWras]

Salt: Quite a few studies over the past 20 years have come out that show salt consumption and health/mortality are a U or J shaped curve, rather than a single slope rising with higher sodium intake. This article reviews a few. Note that they are able to measure subject sodium intake via urine samples. https://www.cardiosmart.org/news/20...salt-is-associated-with-increased-heart-risks

Thanks for the pointer. Keeping sodium at 2300mg is very hard. 4000mg is not too difficult. The article mentions a big issue at 7000mg. And it has me wondering about junk food. I'm starting to think sodium is the big nasty with junk food.

When I want breakfast carbs, I've grown fond of the old fashioned "Big Biscuit Shredded Wheat" that great grandma used to eat. This is one of the cereals that has nothing in it, just wheat. Cereals are devils when it comes to sodium. You can't taste it, but they use it for leavening and flavor enhancers.

BTW: we bought the big biscuits during a shortage time in the pandemic out of slight desperation. I remember hating them as a kid. Now, I just break them up and it turns out I like them. Some people actually fry them (there goes the health impacts).

 

[audreyh1]

Thanks for the pointer. Keeping sodium at 2300mg is very hard. 4000mg is not too difficult. The article mentions a big issue at 7000mg. And it has me wondering about junk food. I'm starting to think sodium is the big nasty with junk food.

When I want breakfast carbs, I've grown fond of the old fashioned "Big Biscuit Shredded Wheat" that great grandma used to eat. This is one of the cereals that has nothing in it, just wheat. Cereals are devils when it comes to sodium. You can't taste it, but they use it for leavening and flavor enhancers.

BTW: we bought the big biscuits during a shortage time in the pandemic out of slight desperation. I remember hating them as a kid. Now, I just break them up and it turns out I like them. Some people actually fry them (there goes the health impacts).

Yes, sodium is one of several big nasties with junk and fast food. But there is also high refined carb (typical of ultra processed food), high fat mixed with high refined carb, sugar loaded, seed oils predominantly used for fat, and no fiber.

Cereal for breakfast can also a serious dietary issue, even the old fashioned no junk added kind. It’s still a highly refined high carb food. If you have no symptoms of insulin resistance such as expanding waistline, high triglycerides, hypertension, blood sugar creeping up, low HDL, cardiovascular disease, etc., then it may not be an issue for you. But starting the day with a high carb breakfast such as cereal, juice, pancakes, toast, flavored yogurt, etc., is a problem for most Americans, because 88% of adult American do not have optimal metabolic health*. Better to start the day with a high protein minimally processed breakfast.

*https://pubmed.ncbi.nlm.nih.gov/30484738/

Using the most recent guidelines, metabolic health was defined as having optimal levels of waist circumference (WC <102/88 cm for men/women), glucose (fasting glucose <100 mg/dL and hemoglobin A1c <5.7%), blood pressure (systolic <120 and diastolic <80 mmHg), triglycerides (<150 mg/dL), and high-density lipoprotein cholesterol (≥40/50 mg/dL for men/women), and not taking any related medication.

Also https://www.sciencedaily.com/releases/2018/11/181128115045.htm
https://www.unc.edu/posts/2018/11/2...e-metabolically-healthy-carolina-study-finds/

 

[GenXguy]

because 88% of adult American do not have optimal metabolic health*. Better to start the day with a high protein minimally processed breakfast.

I'm surprised it's not higher than 88%. It seems like everyone is always eating unhealthy food, going out to restaurants/fast food to eat, getting tator tots with gravy or biscuits and gravy for breakfast. Even if they get eggs, they usually get a a couple pieces of toast to go with it.

 

[JoeWras]

I'm all for low carb, but sometimes I need the convenience and variety of something else at breakfast. That's why I mention the least processed foods for a break away from the usual. I'm not advocating a complete diet of cold cereal every day.