As this seems to be a recurring worry for pilots, I thought it may be useful to summarise the current medical thinking about hypertension. (Raised blood pressure).
It's not definitive, but I'll try and be scientific by grading recommendations as follows.
(A) Strong Evidence (Clinical trials of a high standard)
(B) Fairly strong evidence (Clinical studies of less higher standard)
(C) "Expert" opinion.
I'd welcome any contribution/corrections, but to try and make the advice more "robust," I wonder if you would mind also grading your evidence ?
What is "blood pressure?"
It's simply the force exerted on the artery walls by circulating blood.
What do the figures mean?
Usually blood pressure is recorded as two figures, eg 120/70 mmHg. The top figure is the force exerted when the heart is contracted (Systolic blood pressure), the bottom figure when the heart is relaxed (diastolic).
What is hypertension?
Hypertension is diagnosed when the reading are persistently raised.
Is it Common?
Yes, about 30% of adults in the UK have hypertension.
(B)
What does persistently raised mean?
Patients should usually have their bp measured again, if initially raised. They should then be asked to return on two occassions, 1 month apart.
(C)
Can I help with my diagnosis by monitoring my blood pressure at home?
A popular concept, particularly amongst pilots, some of whom tend to err towards the logical (nurdy) side
(me included).
Unfortunately, no matter how attractive the concept, the use home and ambulatory measurements are not recommended at present. Although further research is currently being performed in this area. Callibration of home machines is also an issue. (As it can be in the health service!).
(C)
But doesn't this help identify the "white coat" effect.
The million dollar question. "My blood pressure is ok throughout my day to day routine, it's only ever raised when I see the quack."
There is a school of thought that suggests that even these intermittent rises can lead to long term disease- a controversial area
(C)
Is hypertension a disease in itself?
Usually not, (about 95% of cases), it is a risk factor for Cardiovascular Disease- Heart attacks and strokes.
(C)
How does my quack make a diagnosis of hypertension?
Usually when one or both of the readings are pesistently raised on different occasions-although if very high he may decide to commence treatment immediately.
What are these readings?
Depends on who you ask. Most authorities agree that a reading equal or over 160/100mmHg warrants treatment. If over 140/90 (some say 80), your quack should be taking into account other risk factors, (eg chloesterol, family history), prior to reaching a decision on your management.
Thresholds are lower for certain patients, eg diabetics.
(C)
Who decides the targets?
Experts
(C)
Is it worth doing anything about?
Yes, generally a small reduction in BP dramatically reduces the risk of illness and death from heart disease and stroke. A 2mm reduction reduces risk by about 10%)
(A)
Can I do anything myself?
There are two strands to this argument, firstly can I actually reduce the blood pressure reading itself? Secondly, can I reduce my cardiovascular risk?
This is quite an important concept, often overlooked if you get too fixated on the numbers.(Pilots
) I'd suggest number 2 is equally, if not more important than number 1.
Diet and exercise can reduce bp&risk
(B)
Relaxation can reduce bp
(B)
Alcohol consumption-reduce if raised-bp&risk
(B)
Reduce excessive caffeine intake bp
(C)
Reduce salt reduce bp
(B)
Stop smoking -reduces risk (but not bp)
(A)
Remember-small changes can make big differences.
Ok, I've made the changes, and my bp is still up, what next?
This will depend on two things, the actual reading itself, and your cardivascular risk. If persistently over 160/100 you will need drug treatment. If in the "grey area" eg treatment will probably depend on overall risk factors.
(B)
For example, if your bp is 140/90, you smoke 20/day, you dad died of a heart attack aged 40, and your cholesterol was high, you are probably aiming for drug treatment.
If you a chap who doesn't smoke, thinks a kebab should consist of fish, tomatoes and peppers, doesn't know the pleasures of a "pie dinner", and thinks that "happy hour" is spent in the pool, then a strategy of close monitoring may be the best strategy.
(Remember pilots, don't get fixated on the numbers)
My quack has decided I need medication, why should I take a tablet when I feel perfectly well?
Good question- once the decision is made for drug treatment, it's likely that you will need it for life, and it could potentially make you feel unwell. Drug treatment is unlikely to make you "feel" better.
However the benefits of treatment, in terms of reducing death and illness, are clear and well established
(A)
Is treatment guaranteed to cut down my risk?
(Okay, for the pilots,
some figures)
Definately not! If I had a roomful of 100 people who had a 20% risk of having a heart attack in the next 10 years, then 20 will have a heart attack in 10 years, and 80 will not.
If I successfully treated these people, then in 10 years, 80 will still be healthy (whether they had treatment or not), 15 will still have a heart attack, 5 will be saved.
(Ok it's a bit simple, but you never know, a surgeon could be reading this.)
I'm taking 4 tablets a day, is this a bad sign?
No, in the "old days," you would be started on one tablet, if the response was poor, the dose would be doubled, (again and again) unil control was maintained. Modern thinking suggests that patients should be given "lower" doses of drugs which act in different ways, as this reduces side effects.
(B)
Is anyone drug better than another?
The differences are probably negligible, the important thing is to get the blood pressure down. Older drugs (Alpha and Beta blockers) are used less and less. Thiazide diuretics, calcium channel blockers and ACE inhibitors appear to work well, with minimal side effects.
(A)
Will treatment and a diagnosis of hypertension affect my life/career?
Probably not- it's important to let your quack know if you are suffering any adverse effects- the range of treatments available is vast. Of course, your AME needs to be informed.
Who is the best person to consult about my hypertension?
Your treatment should easilly be managed by a team, but your day to day care may involve a doctor, health care assistant, nurse, or a pharmacist.
The key to successful managment is to be systematic.
Safe flying, remember if you wish to add to this thread, try and grade your evidence, don't know what you lot think, but would it be possible to keep this thread for updating current guidance, perhaps specific enquiries could be tagged on to existing threads?
cheers, ginge