Blood Pressure / Hypertension thread.

[cessna l plate]

]Hi All
I have a class 2 renewal due later this year and I have to admit to having some concerns over my blood pressure. It was all OK last time, but in the last 2 years I have suffered the loss of both my Grandparents, a change of job that has resulted in a rapid increase in responsibility (and the stress that goes with it). As I now drive a desk most of the day I have put on some weight (and I wasn't light to begin with) coupled with a noticeable decrease in my fitness levels, and cannot find the time for exercise at the moment either. In other words, I am doing everything that contributes to high BP including smoking as well. (I plan to give up after the medical)
With this in mind I am considering buying one of those machines from Boots for £25. Although I apprecaite that they aren't going to be as acurate as what a doctor uses, my question is, are they good enough?
Secondly what sort of readings are acceptable for passing the medical?
Thanks

[Bealzebub]

This topic has been covered quite a bit in this forum. If you do a search for "Blood pressure" and "Hypertension" you will come up with some good threads such as This one (http://www.pprune.org/forums/showthread.php?t=223714&highlight=Hypertension).

You can get your BP checked easily at your GP's or at home using a bought monitor. A lot of the monitors are good enough to be useful, and makes such as Omron have a good reputation. It is important to get the right cuff size, and it is usually better to stick to cuff style monitors.

BP readings in isolation are only a spot indicator of something that varies throughout the day ordinarily. If the reading is indicitive of hypertension (high blood pressure), it will be retaken after an addition rest period. If it is persistently high then you may be referred for further monitoring.

As you say your lifestyle has a number of high risk factors and it would be sensible to address them sooner rather than later. If you intend to stop smoking, now rather than after the medical might be a good idea. The impetus is less likely to be there after the medical ?

[Newforest]

If you intend to stop smoking, now rather than after the medical might be a good idea. The impetus is less likely to be there after the medical ?

No, the impetus to stop is now, considering his age, he is much more likely to fail the medical without taking some preventive steps. I use a Sanitas checker which compares favourably with my pharmacists machine.

[Bealzebub]

Thanks Newforest, but I think that is what I said. ;)

[Newforest]

So you did, now where is the optician?:eek:

[keithl]

Cessna, I got a Boots one and had it checked for accuracy by my local practice nurse. It was accurate.

[cessna l plate]

Thanks for the replies folks. It is a sad indictment of my lifestyle, although not totally to blame, that I suspect that my BP might be a problem. To be honest I am not a fan of the quackerage at the best of times and I do tend to suffer from "white coat syndrome" so I am only guessing that it might be high anyway. I accept that there are lifestyle changes that I need to make, and quickly, and exercise is probably the main one, followed by the ciggies. These combined should help and I know that. Finding the willpower to give up the smoking, and the time to exercise are different issues, but I have taken a step in the right direction by accepting that this is what needs to happen, all I need to do now is put that into practice. Perhaps the thought of the medical has focused my mind a little more, although to be fair in the last 18 months there has been more than enough to occupy it!!! All I want is to make sure that I pass the medical, in common with most people here, the thought of not getting behind the controls fills me with more dread than any of the other things in life.

So thanks for the replies, and finally, what are the defeinitive figures that would get you grounded? And for interest what is the definition of the XX/XX reading anyway?

[oldbeefer]

Mine was consistently high - not grounded, just put on ACE inhibitors.

[sharmine]

So thanks for the replies, and finally, what are the defeinitive figures that would get you grounded? And for interest what is the definition of the XX/XX reading anyway?


Cessna,

I had a similar problem with the lower end reading of the two i.e. lets say your reading is 130/90. The lower, 90, is the limit for that figure, you won't pass at 90 or above. Mine was hovering around this and some life style changes brought it back down. Most doctors (GPs) will do something from about 85 anyway, let alone the CAA. I bought a measuring unit from Boots and used it several time a day to help me understand the effects of my life style changes and it did help. Cost about 20 quid. If you can't reduce it yourself then prescribed tablets are allowed. I just wanted to avoid taking medicines but if you can't change the life style then acceptance of the pills will do the job. Don't know what the upper end limit is but your AMO should be able to give you a quick answer seeing as you don't seem to be getting a response here. Loosing a stone, a few less pints a week and more exercise seemed to do it for me

Good luck:ok:

BJ

[Salusa]

Hello all,

I have used the search function to find out information but nothing has appeared...

When you or your GP/AME take your BP they want it to be taken when your rested. My question is how long is "normal" to rest before you take a measurement. Few mins OK?

Thanks,

L Met

About ten minutes is the norm. If you measure it yourself at home, try and do it at the same time every day, and as mentioned above get your 'home machine calibrated' when you next go to your doctor. Take a few readings, and providing that none of them differ by 10% or more, use the lowest.

Also bear in mind that when BP is taken by your doctor, many people will suffer from "white coat syndrome" and will show a higher than normal reading. Hence the reason for checking it yourself at home.

I keep a daily record on a spreadsheet and show this to the doc.

[Fly3]

I had a hiccup a couple of years ago and purchased an Omron T8 which is very good if a little pricey. My doc says that ones which measure round your upper arm are better than ones that go around the wrist and he also advised about taking your BP at the same time each day and that you should take more than one reading.

[Mike6567]

I have a query about my self BP measuring equipment.
A few weeks ago my BP was measured at 155/95. At the age of 64 I have never had any real problems before so the doc suggested I have it checked again by the nurse in a week or so.
I bought an Omron MX2 and checked my blood pressure myself over the next week. Readings were in the region of between 130 and 140 over 75 to 90. My wife's taken by me was about 120/80 so I felt I was doing the checking correctly.
I went to see the nurse and she came up with a reading of 150/96. So I got my machine out and my measurement was a pressure of 195/ 120 ish. We thought there must be something wrong with the machine so I went home and checked again at home coming up with 132/85.
A couple of weeks later (today) I went back to the nurse who came up with 152/100. I did my own reading which was 195/ 120 ish causing great confusion again. I went home and the reading was 139/82.
Is this "white coat effect" possible to cause such a high reading or is my machine suspect?
I will be seeing the doc next to try and clarify things.

[maycli]

I have an Omron MX2 also. When I had a twice weekly visit from my rehab nurse we checked mine against her readings. Like you also had higher readings. Suggested I take it to " chemist" for calibration which I evenyually did. Didn't cost a lot but can't remember how much. Alas by the time I had done this the nurses visits had finished so I'm no wiser.

[F3]

Hi Cessna l plate.
I know exactly what your going through. Over the last few years I have gone through a similar pattern of events culminating in the onset of hypertension.
The definition of hypertension (high BP) according to the CAA is a reading consistently 160/95 or above. There is an algorythm available on the CAA website which shows what can be done to resolve the problem. In my case I've ended up on ACE Inhibitors and a Calcium Channel Blocker to bring the BP reading back to within limits. I'm a couple of years older than you and I'm resigned to the fact that the ciggies and weight will have to go if I'm to have any chance of retaining Class One Medical privileges, and it is a hell of a lot harder to reduce weight now than ten years ago. :(
Don't let it worry you too much - the AME you go to and the CAA are very helpful. But do reverse the causes as it's a good way of purging your mind of the bad things that have happened as well as being able to carry on enjoying flying which is what life is all about!
Good luck with it. :)

[Shunter]

Blood pressure is a wierd thing. I had mine checked for the first time in a very long time a couple of years ago. I was quite shocked when it came back as 170/120!! I'm not overweight, cook all my own food sans salt, don't drink excessively, exercise a lot...

Did the 24-hour thing c/o the hospital which measures it every half hour for a day. Most of the time it was perfectly normal. GP even said that taking BP on the spot is practically a worthless exercise as it can go up and down at the drop of a hat, hence averaged readings over a period of time were the only meaningful way to measure.

Went for my initial medical and it was 150/100. Told the AME about the 24hr thing and she suggest I just read a magazine and chill out for 10 minutes whilst she did the paperwork. Took it again - perfectly normal.

I'm sure everyone's different, but it does seem like one of those things which can have a mind of its own!

[gingernut]

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:8(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:)

[ARENDIII]

Just took three readings over 45 minute period.
1.115/63
2.103/62
3.110/66
Age 50
Will I make it?:(

[Finals19]

The CAA will accept a 24 hour ambulatory if you need one. In fact, a mate of mine went for his class 1 at LGW, he had high BP and they suggested he did the 24hr. It came back normal, and class 1 passed.

White Coat is definitely a real thing. My BP averages 130/75 when I take it at home. Go to the doctors and it can be much much higher.

[Finals19]

Unfortunately, no matter how attractive the concept, the use home and ambulatory measurements are not recommended at present.

Not so. The CAA at LGW accepted my 24 hour report at my initial Class 1, which reflected my BP at 133/81 over a 12 hour period average. In the docs office, it was a lot higher.

[gingernut]

Yeh, perhaps I should have made things a little clearer, as I'm coming from the perspective of controlling blood pressure in an attempt to prevent long term damage to your health, not from the perspective of passing an aviation medical.


The two things may be at odds.



Again, a controversial area, perhaps posing more questions than answers. Perhaps others know of studies (grading please!) to support it's use?

[spoilers yellow]

A cabin crew friend of mine has recently been diagnosed with high blood pressure.

Our company doctor wouldnt tell him what the upper limit was, but added that it was over the pilot limit.

Anyone know what the upper limit is for a male around 35yrs old and around 85kgs.

[airman13]

if the blood pressure is more than 140/80 , you cannt conduct a flight....

[gingernut]

I've not heard that before airman.

Previous posts on this forum, seem to suggest that th CAA work to limits of 160/95.

More info at http://www.pprune.org/forums/showthread.php?t=303414&highlight=blood+pressure

[Loose rivets]

I was quite shocked when it came back as 170/120!!

Did the 24-hour thing c/o the hospital

Went for my initial medical and it was 150/100. Told the AME about the 24hr thing and she suggest I just read a magazine and chill out for 10 minutes whilst she did the paperwork. Took it again - perfectly normal.


Shunter How did your pulse rate vary with the range of readings?

[Shunter]

gingernut is correct. JAR maximum is 160/95.

Mine is above average, but it's nowhere near that. If you're that high you really ought to pay a visit to your GP I'd say.

[Shunter]

Loose Rivets, I don't recall, I'm afraid.

[Jimmy The Big Greek]

I have white coat hypertension. Every time I go to the doctor I am scared I am going to loose my job. My pulse is around 120 and my BP 150/100.
I have very low cholesterol levels (aound 100)

When I go to the doctor I ask him if he can take my BP when lying down.
My pulse and BP decreases rapidly withing 30 seconds. Pulse 75 and BP 100/65.


Are there any known natural remedies that really lowers blood pressure?
Is it true that if you take blood pressure controlling medicine that you will have problems with erection?

[gingernut]

Big Jimmy, your first reading of 150/100 is slightly up, but should be discounted.

The lower reading (in your case the 2nd reading) should be the one recorded. (see my post of 6/12/07).

I know of no known natural remedies to lower bp, other than exercise, lose weight, low salt etc, and cut down other risk factors (diet/smoking etc).

Treatment of hypertension can cause erection problems in a minority of patients, but this can usually be cirumnavigated by a change in medication.

Of course you've got to let the quack know about the problem in the first place!

[tom775257]

White coat hypertension - I know the feeling. Every medical I fail blood pressure until I try to relax somewhat. I have recorded as high as 180 over x. The docs say I'm too nervous... I enjoyed the comment of one AME - "I'm not wearing a white coat so deal with it.'

[bluenose81huskys]

The Medical will be checked with a manual BP checker and not an electronic one, start eating foods in moderation with plenty of potassium in them i.e Bananas, Potatoes veg and fruit and try and exercise as much as you can. This all helps!

The electronic ones will help and do work but take it to your docs first for him/her to calibrate it for you!

Hope this helps!:ok:

[Whirlybird]

Are there any known natural remedies that really lowers blood pressure?


There is an Indian ayurvedic remedy called Ivy's Muktavati. It's supposed to deal with stress etc primarily, but I've read a lot of first hand accounts recently of people lowering bp after using it, sometimes by quite a lot. You could do a web search and try it. According to those in the know, it has to be Ivy's, not anyone else's. Should be harmless, if nothing else. But I claim no responsibility for damage to your bank account!

[cats_five]

<snip>
I accept that there are lifestyle changes that I need to make, and quickly, and exercise is probably the main one, followed by the ciggies.
<snip>

A low salt, low fat diet matters as well, along with plenty of fruit & veg and not drinking much alcohol. If you eat a lot of take-away food or eat out a lot your diet is probably far too high in both fat and salt and almost certainly doesn't have enough fruit & veg.

It's a subject that Google will get you lots of information about:

http://www.patient.co.uk/showdoc/23068761/
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleid=203

[finals40]

Being a doctor and a pilot I understand all of your health concerns. whilst the following advice may not help with immediate BP trends but in the long run. If you are carrying a bit more weight than you ought to, if you reduce this down you will also find your BP may also settle down. Exercise, diet I can not stress stronglyu enough.

[gingernut]

Oh well, all change.....

CG127 Hypertension: quick reference guide (http://guidance.nice.org.uk/CG127/QuickRefGuide/pdf/English)

[Pass your message]

I am told taking one aspirin a day helps reduce/ control blood pressure Any of the the subscribing medics confirm or have a view on this please?

[homonculus]

No

Nor does much else except reducing salt intake. Although a healthy diet masy reduce the onset of hypertension, once you have developed it the treatment is drug based. A healthy lifestyle may then reduce the ongoing increased risk of heart attacks and strokes but the blood pressure is I am farid a wake up call

Oh, and electronic machines are MORE accurate and I have never come across one that can be calibratedoutside a manufacturing facility.

[gingernut]

I am told taking one aspirin a day helps reduce/ control blood pressure Any of the the subscribing medics confirm or have a view on this please?



Aspirin has it's uses in treating arteriopaths.(But not by reducing blood pressure). For it to work, it has to be taken daily.

In all these decisions, one has to weigh up the benefits against the risks. Even with low dose use, if given to enough people, then it will burn a few holes in a few tummies, whilst at the same time, stopping a few clots.

In terms of "simple hypertension" then generally the balance tips towards not using. With established disease, such as after a heart attack,the balance is tipped t'other way.

There are many exceptions to the rule, so it's always best having a chat with your GP, they are usually up to speed with the latest evidence.

Aspirin and cancer prevention is another debate....:)

ps not a medic

[Pass your message]

Thank you to the last two posters.

Gigernut, most interested in the other debate on aspirin and cancer prevention. If you do not mind, can you please enlighten me on this aspect? I am sure most of us would find this useful. Thanks in advance.

[gingernut]

I'll have a look around, I think the paper was published in The Lancet about 6-9 months ago.

[Rory Dixon]

I guess, that's the one you mentioned: Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials : The Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962110-1/fulltext)
Nevertheless, this study calculates the effects of aspirin on cancer death, but does not provide a risk benefit assessment. So unfortunately still quite some work to do.

[Pace]

I have bounced along the top of normal for my medicals and being opposed to medication especially with the side effects and long term damage they can do.
With a certain scepticism I gave a herbal product called ALISTROL a go.

This is available from the USA. having taken the product for six weeks before my next medical I was amazed to get readings which are the lowest I have had for years.

Worth a google?

[maryamchaudhary]

thanks for your such nice sharing here

[Bushfiva]

Cripes, that's an eye-watering price. You might want to check out hibiscus tea (made from 100% hibiscus, not tea-plus-a-bit-of-hibiscus). If you buy hibuiscus from somewhere like a middle-eastern or Mexican food store in the US rather than a health store, expect to pay around $15/kilo. Around $4/kilo in Mexico and Egypt. A kilo is good for about 250 cuppas. Two or 3 cups a day appear to take around 7mm Hg off the top.