24 hour blood pressure readings

[Whirlybird]

To anyone else who has problems with their blood pressure when they have a medical - get a 24 hour reading! Every time I've had a medical mine has been close to the upper limit, but I've usually been just about OK. The last time, however, it was a new AME, who questioned me about it. When I told him it kept happening, he said I was to get a 24 hour reading from my GP before the next one, adding: "If you don't and it's this high again I might ground you until you do!" Needless to say, that persuaded me to go to my doctor, and get this ridiculous apparatus strapped to me which whirred and pumped up every half hour and kept me awake about half the night. Well, I just had a phone call from my GP, to tell me my BP was "extremely healthy". I'm calling in to pick up a copy for the AME tomorrow. It's now official - I only have white coat hypertension.

So if this keeps happening to you - and it's common - go get a 24 hour reading. The nurse at the surgery told me they've taken loads of people off medication since they started doing these 24 hour readings. It seems to me that doctors have a lot to answer for.

[fobotcso]

Whirly, is it possible for you to say what the "high" in the AME context readings are - without giving anything away you don't want to? When does CAA begin to sit up and take notice?

[HEATHROW DIRECTOR]

I too have suffered from White-coat hypertension all my life and at each medical I've been told "your BP is on the high side", etc. I'm now 57 and at my last medical the doc at the Heathrow Medical Centre said my BP was too high for him to renew my med cert so he immediately fitted me up with a 24 hr BP monitor. Next day he ran the readings through a computer and found them to be quite normal, despite the fact that it scared me stiff each time the thing inflated! I can't remember precise readings except those taken by the infernal machine were very much lower than the one he took during the medical.

[Daifly]

I've had exactly the same thing. Being a bit on the big boned (i.e. fat) side, it's always taken that my insistence that it is "White Coat Syndrome" is actually a cover for my being unhealthy...

But I invested £90 in a proper bells and whistles BP monitor and discovered that it was low until about, well, the time I took a seat in the waiting room!

My GP did the same as Whirlybirds and hooked me up to a 24 hour monitor. Sure enough, it's normal most of the time!

The only difficult thing is finding a doctor who will believe you to begin with; there are a great deal of sceptics out there.

Before my recent MiG flight (detailed elsewhere on here!) I had a medical where I "achieved" 180/105... Personally, I'd have thought I'd have been dead but, as the Doctor assured me "this is quite normal for this situation"...

From medterms.com:

What is white coat hypertension?

A single elevated blood pressure reading in the doctor's office can be misleading because the elevation may be only temporary. Presumably, such an elevation is caused by the patient's anxiety that is related to the stress of the examination. In fact, the suggestion has been made that about one out of four people that are thought to have mild hypertension actually may have normal blood pressure when they are outside of the physician's office. This sort of elevated blood pressure, that is, an increase noted only in the doctor's office, is called white coat hypertension. The name, of course, suggests that the white coat, which is symbolic for the physician, induces the patient's anxiety and a passing increase in blood pressure. A diagnosis of white coat hypertension might imply that it is not a clinically important or dangerous finding.
However, caution is warranted in such an innocent interpretation of white coat hypertension. An elevated blood pressure that is induced by the stress and anxiety of a visit to the doctor may not necessarily always be a harmless finding. Other stresses in the patient's life may likewise cause elevations in the blood pressure that are not ordinarily being measured. Accordingly, monitoring the blood pressure at home or at a pharmacy can help estimate the frequency and consistency of higher blood pressure readings. Additionally, conducting appropriate tests to search for any complications of hypertension can help evaluate the significance of variable blood pressure readings.

[Whirlybird]

fobotcso,

I think the CAA's limit is 160/100, but I'm not 100% certain.

Daifly,

Interesting comments. Blood pressure is expected to go up as a result of stress; it's normal for it to do so. You're just not supposed to be that stressed in the doctor's surgery. Actually I bought one of those wrist gadgets to read mine some time back, and it's almost always in the normal range, but the AME said he couldn't accept my readings even though I'd recorded them. The only time I've had a sky high reading myself was...guess..just after I'd talked on the phone to the surgery to arrange the 24 hour thingy. My GP said since I'm female, not overweight, and don't smoke, even if I had high BP it's not really a risk, and he wouldn't want to give me medication anyway. I said I didn't care about any of that, so long as I could fly, and if the CAA insisted I'd take anything if it kept them happy. Although the CAA's medical charts at Gatwick prove exactly the same thing; I studied them while hanging about during my initial Class 1. But the CAA in their great wisdom have a limit, and that's it.

Anyway, do I have to go through this whole thing before every medical now, or will the AME be able to assume a raised BP is doctor-induced? Does anyone know?

[Nightcap]

Yeah WHITECOATs VEXXXXXXX me big time :mad:

Have seen many a nice nurse checkinnng me out man, now it wasnt my blood pressure that rose and Hit the roof ;)

Have also seen pigs flying!

:D :D :cool:

[Captain Airclues]

The Jar-FCL 3 limit is 160/95.

Airclues

[fobotcso]

Whirly et al, thanks a lot. I'm on the 160/95 limit at times but now hope to make through to tomorrow! Reading some PPRuNe offerings doesn't help sometimes. :)

[helimutt]

Just a brief addition to this post. My blood pressure rises slightly when going for medicals. I was told to take a brisk walk every day for at least half an hour. After two weeks the readings definitely do decrease. A lot of the problem is that non of us seem to get as much exercise as we should. Give up smoking (I don't anyway), reduce alcohol consumption (as if that'll ever happen, we're pilots for god's sake)


Do those wrist thingys really give an accurate reading? I wouldn't have thought so.

[Whirlybird]

helimutt,

The wrist thingies are supposed to be pretty accurate. However, my 24 average (I finally picked up the results at the doctor's surgery) is 122/85, which is lower than either I or any doctor has ever got. It'll be interesting to see if they can get a lower reading now I'm not worried about it because I have the proof.

[Tom the Tenor]

Hi Whirly et al, I work on the desk at a busy surgery at the weekends and as I soon as I turn the corner into the car park and see that it is packed full of cars and know that the occupants are now sitting patiently in the waiting room before being seen my hypertension level goes absolutely through the roof before I eventually begin to calm down again about 30/40 minutes later!

[Whirlybird]

Hi Tom and others,

The interesting thing about this is that I appear completely calm to others, and often to myself, in the doctor's surgery. I've had my blood pressure taken sometimes when I'm apparently stressed, eg once very soon after a flying lesson when the instructor had spent the whole time yelling at me, and at those times it's usually fairly low! But this last time I left the surgery thinking to myself that the doctor was a nice guy - we'd spent quite a while chatting about his hang gliding addiction and his son who wanted to be an airline pilot - and I realised I was silently shaking for no apparent reason. Now, I read somewhere it's suppressed anxiety/stress which causes high BP, not yelling and getting mad or whatever; that may be healthy (just as well!). So the question is, why am I scared of doctors, when I think I'm not? Is it because they've spent so many years shaking their heads at my BP, my weight, or something else, and I feel put down and criticised for being me? Or is it because I hate not being in control and I know they can ground me? Or some other reason. Answers on a postcard please. :D