Blood pressure issue class one medical

[patryan]

Hi im nineteen years old, i travelled from Ireland to Gatwick last week to complete my class one medical. During my exam i had to complete an ECG i was very nervous during it due the build up of anxiety of the entire medical. During the rest of my time with the nurse i asked her was everything going smoothly and she stated that there was a small issue with the ECG but nothing to worrie about. When it came to the end of the medical i was greeted by what i guessed was the head doctor who tells people have the passed or not. While in her office i did a short physical exam and she asked me various questions about my health through the years and any illnesses such as heart disease in my family thankfully there wasnt. The doctor also gave a short summery of my medical exam and said that everything was fine except my high blood pressure reading when completing the ecg, i explained to her that it was just nerves and i was very built up about the medical. The doctor then explained that there is certain steps that i need to do now to prove that it was just nerves and i dont have high blood pressure. The doctor then took another bp reading in her office and it was still quiet high. The cardiologist then came into the room and explained that they want me to take another ecg and evaluate it after. I began to get very anxious and stressed over the entire situation with my bp. I did the ecg again and although it wasnt as high as the first one, the head doctor sadly still wasn't happy with it. I was then left in a very sticky situation of wondering what is the next step to resolve this situation, the nurse then explained that i can do an extra bp test where it involved me fast walking on a thread mill and pushing my bp to 250 and then seeing how long it takes for my bp to drop, i agreed to do this extra exam although it was quiet costly. When i completed this extra exam i met the cardiologist and said that she evaluated the results and said that it was fine and that i passed my medical she reassured that i was fine and i passed the medical. I was over the moon becouse, i had spent the past two hours doing various exams to prove to them that i really had low bp. Although when i met the head doctor once again she was still not happy with my blood pressure and advised that i should wear a 24 hour blood pressure monitor and send the readings back to them. I was very disappointed and quiet shocked that the cardiologist told me i passed and the head doctor told me she wasn't happy with the results. So sadly i had to leave Gatwick without my medical and put my training on hold. Im basically asking ye people out there what can i basically do to gain my class one, although i didnt fail its just pending until i prove that i have low bp. Do you think i should fight my case with them about the cardiologist saying my bp was fine or should i just leave it.

[patryan]

Also id just like to say im a big fan of the website PPRUNE and i rarely post on threads, so please dont give me stick about my grammar etc! I just need some guidance on the situation im in with my medical. Thanks!

[Dash8driver1312]

I hate to be the one to say it, but, these doctors are aware that you have a simulated higher BP due to anxiety during these tests…

The best thing to do for the class one, and also your life in this case, is to follow their advice and to listen to what they have to say.

Hopefully the 24-hour check will show that there are no grounds for concern, but take it anyway just to make sure. These doctors have been working for a considerable number of years in this area, and to be honest it is better to catch blood pressure problems earlier rather than later.

[patryan]

Thanks for the reply , the reason I'm frustrated is that I never thought blood pressure would be an issue I even joked about, I was more worried about eye sight or been colour blind. It was just a shock, I suppose I'm annoyed that the cardiologist told me I passed. I took my 24 hour blood pressure reading yesterday and it was a regular 135, and sometimes 112-135 . During the night it was 115-120. My doctor does not think it's high bp he wrote a cover letter stating that he checked my bp once again and it was a regular 130 and that the high readings on my 24 hour bp reading was due to white coat syndrome . Do you think having my doctor write a cover letter would be helpful in gaining my medical .

[Radgirl]

I am sorry but I am confused. I appreciate you are concerned and probably rather annoyed but

Your blood pressure on single readings was high

I assume the ECG was normal. I also assume the exercise ECG was normal.

Have you now had a 24 hour monitor for blood pressure or are you just taking occasional readings yourself? The lower reading or diastolic is what we are really interested in not the higher or systolic reading.

I am afraid if your 24 hour readings are high you really need to have this investigated separately from your flying medical. However his would be very rare at your age which is why I want to know exactly how the readings were taken

[patryan]

Yes I got the results of my 24 hour bp, most of the results were in and around 135. And sometimes it would be around 110-120. During the night it was below 120.my doctor does not think it's high bp he wrote a letter stating that some of the high readings on my 24 hour bp script was due to white coat syndrome . My doctor told me to send the letter over with my 24 hour bp reading .

[Dash8driver1312]

http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Bloodpressurechart

This might give you a more visual guide. Only a guide, mind, and as a young person, you should be on the lower end of the bracket anyway...

[Ulster]

The lower reading or diastolic is what we are really interested in not the higher or systolic reading

I'm sorry to see that here. When pilots ask me which of the BP figures is the more important, I always tell them "neither ; they are both important".

Nor does the CAA's hypertension algorithm differentiate at all between systolic and diastolic . . . . . . .
http://www.caa.co.uk/docs/2499/Hypertension%20FC.pdf

" BP exceeds 160 systolic and / or 95 diastolic" ( my boldening):=

[AdamFrisch]

Here's a little tip for the future: fast or eat very little for 2 days before you go in for next BP reading/medical. You'll easily drop 10-15 points in 2 days.

Another trick is to exercise right before you go in. Post exercise you'll see similar drops when the heart rests down and relaxes.

[Radgirl]

Guys lets try to help this chap and not get into side arguments about systolic vs diastolic

Pantryan

Thank you for the further information. A systolic of 135 on a 24 hour tape doesn't sound high. This isn't really white coat syndrome as the doctor presumably didn't spend the day with you!!!!! If for example you did a work out at the gym your systolic could have been well over 200 with no concern which is why I hope you also completed a diary for the day

As I said in the previous post it is very very rare for someone your age to have high blood pressure and I would simply let the CAA look at the result. I strongly suspect they will be satisfied and the problem will be history.

Do let us know the outcome

Best wishes

[Ulster]

Arguments are not required at all - side, or otherwise !

The lower reading or diastolic is what we are really interested in

But since then we have seen not one single diastolic figure - well, except for the one I quoted from the CAA's algorithm ! :O

[tom775257]

I've been through the situation with the CAA with regards to white coat hypertension. I have ended up in a position where I struggle to provide a 'passing' blood pressure at a class one medical due to stress and expectation of failure. My AME assures me I am not the only one he sees with the issue.

My situation (after jumping through many hoops which I suspect you will have to do) is I provide my own readings for a month before the medical with a mean, max and min on both systolic and diastolic.

Keep jumping through the hoops, if you do not have hypertension I'm sure it will come out in the end. My cardiologist told me he could tell that I didn't from my ECG, not sure if that was just to put my mind at ease though! If you do have hypertension, better to sort it out sooner rather than later.

Good luck.

[patryan]

Thanks for all the replies its appreciated, ok i have the readings from what i got from the doctor here.

My minimum systolic when i was awake was (106)

My mean systolic when i was awake was (138)

And my max systolic when i was awake was (190)

Ok and someone asked for some info on my DIASTOLIC

My min diastolic was (49)

My mean diastolic was (76)

My max diastolic was (107)



This is a summery of the results when i was asleep.

My min systolic during the night was (106)

My mean systolic during the night was (124)

My max systolic during the night was (143)



And also the day i went in to recieve my results my doctor took my bp reading once again and it was (130)

And do you think the cover letter, stating that my doctor thinks that i do not have high blood pressure, and that the high readings are due to white coat syndrome will provide me with a good chance of getting my class one?

[Radgirl]

This is clearly a dreadful issue for a number of people so perhaps a few comments may help

Hypertension is a disorder of age. Very very few people under say 40 have what we call essential hypertension which is high blood pressure for no other reason. There are some illnesses seen in young adults that result in high blood pressure such as phaechromocytoma and kidney failure but they are rare and these people usually have other symptoms

The ECG and exercise ECG wil therefore be normal as either it is white coat syndrome or a disease of another organ.

The best advice is to get a simple blood pressure machine and take your own readings at different times of the day and keep a record of the reading, the time, and what you are doing. That at least proves to you that you don't have hypertension. If the regulator won't accept this they can ask for a 24 hour monitor which should be cheap and quick and give them the proof.

Most white coat syndrome will result in similar responses as severe exercise or stress with the higher reading going far further than the lower reading. NASA published some of the launch readings of astronauts and the systolic readings were incredible. However if you don't have hypertension BOTH readings will come back to normal

[Radgirl]

Sorry Patryan just seen your last post

This suggests you have a normal blood pressure. I suspect you were exercising or doing something at the time of the highest readings but the point is your blood pressure at other times was normal indeed below average. However low blood pressure is not a disease (unless you have just been run over by a bus and are bleeding!!!!) so don't worry and hopefully you will get the all clear soon

The letter from your GP should not be needed. The evidence is in the results

[cavortingcheetah]

A mean blood pressure of 138/76 in a 19 year old male is, one would, in a manner of speaking, respectfully postulate, neither average nor particularly normal. Indeed, isn't it open to conjecture as to whether there is any such thing as a categorically normal or average blood pressure for any one group or bracket of people? What there are though are blood pressure readings that raise teeny flags and perhaps it's unwise to ignore or dismiss these little harbingers of potential trouble to come, however remote one might imagine that prospect to be.
But the issue at the moment is a UK CAA Class I medical. If the applicant is issued with that certificate then he is doubly fortunate.
Fortunate in that he will be the possessor of an initial Class I and lucky to have had a heads up on potential problems down the arterial line which, of course, may never arise, and even were they to raise their little hostile heads in the years to come, medical science will surely have invented a cure for almost everything except freedom of thought and intellectual resilience.

[patryan]

Thanks rad girl you some what reassured me , but I suppose at the end of the day it's up the doctor with the white coat to give me the go ahead . I suppose that's all I can do for now just send over the bp results ?

[Radgirl]

Patryan

Correct you have to wait for the thumbs up from the doctor but on the information you have provided I do not think it will be a problem

Cavortingcheetah

Sorry but the readings provided are completely benign. We do indeed know what is normal and it is totally unjustified to suggest that this person might have problems in the future. On the basis of the information he has given he is normal and his risk of hypertension in the future is no greater than for the rest of the normal population. I see no flags. Mean readings will be dependant on what the individual does during the day. An hour in the gym will produce much higher means than sitting watching TV in the same individual which is why a little interpretation is involved.

[cavortingcheetah]

One should most assuredly be delighted with your diagnosis.

[patryan]

Once again thanks for the replies, i feel some bit more optimistic now! The reason im so eager to get my medical is that im ready to start my training, its not that im rushing into this, ive taken certain steps in the past year to make sure that this is the career i want to go down. Ive taken flying lessons first of all to see do i actually enjoy it, and ive also visited many flying schools before i made a decision on one. So basically this medical is the one thing that is holding me back at the moment its the one obstacle in my way.

[cavortingcheetah]

Well then, you must get the initial medical out of the way first. It's the big hurdle for the renewals are usually much more straightforward. Once you've done that you should be aware that, as a professional pilot, your livelihood depends upon your six monthly or annual medical. Unless you have prodigious loss of licence insurance or run a business on the side, your income walks finger in glove with your medical certificate.
That being the case then it's logical to be a little more careful about your health than the ordinary punter might be about his. Hypochondria is an undesirable manifestation but vigilance in matters medical is not.
In working with the UK CAA medical department you're dealing with one of the more pragmatic bodies in aviation medicine, dedicated more to keeping the aviator flying than to grounding him. In South Africa, as a contrary example, the Institute of Aviation Medicine employs some doctors whose digits you'd not want near your corpse, let alone your quivering recumbent form.
Good luck to you and a happy new year challenges conquered.

[gingernut]

Radgirl has hit the nail on the head.

Doctors often disagree, which is why it's called medical "opinion."

Your ambulatory bp suggests there is nothing more sinister here, than nerves.

The maximums and minimums are irrelevant here, the average daytime systolic and diastolic readings are key. If someone wanted to argue the toss, which I doubt they would, your average daytime systolic is 3 points over. The AME's have a duty to protect your passengers, and all that are underneath them, but they don't seem to be deliberately in the business of failing pilots.

Enjoy your flying career.

Haven't lookrd at the caa algorithm, here's what I use... http://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf

[Ulster]

Haven't looked at the CAA algorithm, here's what I use

Agreement and harmony breaking out all over the place, Gingernut ! Must be the influence of the festive season ! :ok:

NICE defines hypertension as BP consistently over 140/90, which is exactly the level specified in the CAA's algorithm ! (ie the level below which all is considered to be well ). In the CAA scheme of things there is then a "needs further consideration" interval, up to 160/95. If either figure is above those, then grounding ensues (albeit maybe only temporarily). :=

[gingernut]

Yes it's quite interesting Ulster, we start with a patient in need, and we all have a little scuffle over the evidence.

Personally, I reckon that's a healthy sign. I reckon we've sorted out patryan's queries between us.

So what about the evidence ?

The diastolic vs systolic question is quite interesting. It's based on "expert opinion," and, to be fair, it seems sensible, that a raised diastolic (which accounts for 2/3's of the cardiac cycle), is more damaging than a raised systolic (which accounts for 1/3 of the cardiac cycle.) Outcome based studies refute this.

Doctors used to base much of their practice on this sort of thing, nurses even more so.:(

It's a fair enough assumption, but when you start looking at more robust studies, (studying interventions and outcomes), it would appear that the picture is more complex.

The latest hypertension guidance is a little bit of a mish mash, combining the opinion of the great and good, (poor evidence) a few cohort studies, (mid range evidence) and the odd incidental finding from an RCT (better).

Merry Xmas, Nurse (with an attitude), Ginge.

[Ulster]

The diastolic vs systolic question is quite interesting. It's based on "expert opinion," and, to be fair, it seems sensible that a raised diastolic (which accounts for 2/3's of the cardiac cycle), is more damaging than a raised systolic (which accounts for 1/3 of the cardiac cycle). Outcome based studies refute this

As you say, a very interesting topic ! Scientifically speaking, about as easily determined as the toss of a coin ! :=

The distinction is further blurred in that we simply do not have any treatments at all which specifically target either of the BP parameters individually.

Seasonal greetings to you too ! :) :)

[gingernut]

I authored a systematic review in the 90's, around the treatment and outcomes in Isolated Systolic Hypertension. I'm afraid to say, I haven't picked it up since I wrote it !

I think the general consensus now it to lower both the readings, (the agent used is probably not that important.)

Of course, patient choice, side effects etc, offer greater challenges.

[Hydromet]

Ever since I started having my BP checked regularly, it was around 125-130/90, despite the fact that I was cycling about 200-300km/week and was never more than 5kg over my racing weight. Whenever he checked it, the doc would tell me I was borderline for my age, and should continue to watch it, particularly with a family history of heart disease.
When I retired, It dropped to 125/85. Great says the doc, but they've changed the guidelines and you're still borderline. A couple of years later, I was on a low dose medication, and it's more to his liking now.

[airjet]

2 things 1) always quote your BP with this format 129/76.
2) be aware that even if u are diagnosed with high BP, it does not mean you won`t be issued a med, these days there are tons of BP lowering drugs,..

[patryan]

Ive just sent my results in the post over to gatwick today, so i hope to get a response in the next few days, il keep ye updated!

[Ulster]

I've just sent my results in the post over to Gatwick today, so I hope to get a response in the next few days

Might not be QUITE as quick a response as you were hoping for ; the Belgrano is all but shut down this week ; and it's obvious that after the weekend they will have a massive backlog to attend to ! Just so you know ! :=

[patryan]

am one thing that has been on my mind since i travelled to gatwick, when i was leaving the doctor said she would send me a letter in the post, i suppose just giving me a information of how the medical went etc, its the 2nd of January now and i travelled on the 16th? Should i be worried...

[Ulster]

Should I be worried...?

Probably not ; the Belgrano is not noted for doing anything quickly, and least of all routine correspondence ! You would have heard much quicker (even a phone call sometimes) if something had gone wrong, of if there had been a change of decision.

As the old saying goes : "Bad news travels much faster than good" ! :ok:

[patryan]

Just received the letter today just stating that ive two options aether send over three blood pressure readings, or wear a 24 hour bp monitor and send over the results which i have already done! Thankfully there was no other complications just a straight forward request to send over the results. Il keep in formed when i get the verdict from gatwick!