High blood pressure

[Loop... Hole]

Does anyone know at what point your medical examiner deems blood pressure to be too high to fly with a Class 1 medical?

Mine has been commented on at my renewal exam as being "on the red line" and recently by my GP as being "mildly hypertensive" at 140/80 (I'm 38, tall and otherwise in good health). However in a spot check with my GP last week it was 149/80 and the doc started talking about controlling with drugs and has advised further weekly monitoring.

I'm in the middle of the ATPL ground course (probably not great for the blood pressure!) with airline ambitions. I'm keen to try and best judge the severity of this particular 'warning light' before thinking about 'diverting'.

[Circuit Basher]

[Non-medical reply here - where's QDMcubed when you need him??!!!]

I know that the more critical number when referring to blood pressure is the diastolic (second number). On my initial exam 6 yrs ago (as CAA Class 3), when my pressure was first taken, apparently the systolic was 135 and I was advised by my AME that it was close to borderline (he said that 140 was the number at which they looked more closely at the medical history). It was re-measured later in the test and was OK and has never been a problem since.

JAR FCL-3 states at P19 Para 3.135 (Class 1) and P28 Para 3.255 (Class 2) that for Class 1 and Class 2 'When the blood pressure at examination consistently exceeds 160mm Hg systolic or 95mm Hg diastolic, with or without treatment, the applicant shall be assessed as unfit.'

JAR FCL-3 Blood Pressure (http://www.jaa.nl/section1/jars/37/12/371205/371205.pdf)

Further detail is there about drug therapies.

The FAA Web site specifies their limits as 155 / 95.

[I have included a further paragraph in a Private Message to you, Loophole]

*Edited shortly after sending 'coz I'm a rubbish typist!!*

[Loop... Hole]

Thanks Circuit Basher - from that useful info (and the JAR FCL document) it appears I can safely continue 'on course'.

I think I'll pull back on the pie and salt intake and rev up a bit on the biking just to be on the safe side.

[Captain Airclues]

Loop... Hole

www.pprune.org/forums/showthread.php?s=&threadid=65653&highlig

Airclues

[Loop... Hole]

I was surprised not to find a BP thread in this Medical area - now I know why..

LH:)

[m&v]

At 65, my Doc' has just put me on ALTACE,initially at 2.5mg capsule. I was showing 155/95,it didn't do too much so we've double the dose alt days.Now showing 137/88(varies)..
But the industry seem to be putting guys onto this stuff in Canada now at the drop of a hat. The Yardstick is to get to 135/85...
It also reduces the chances of Heart Attack 60%...
You can still fly with this medicine...
Cheers......:eek:

[crazypilot]

My blood pressure is somewhat strange... 140/60 so highish on the 1st one, and low on the second. What does this mean as it has been puzzling me for ages. More over, will I be able to get a Class 1 with it?

Cheers

Crazy

[QDMQDMQDM]

My blood pressure is somewhat strange... 140/60 so highish on the 1st one, and low on the second. What does this mean as it has been puzzling me for ages.

Nothing. It's a normal blood pressure, with the first reading around the upper limit of 'normal' (see below). I wouldn't sweat about it. Get it taken again and it'll be different anyway. BP varies a lot and it's the trend which is important, rather than a single reading. Some of these home BP monitors can therefore be useful for that reason. It's certainly a help in managing someone's hypertension to see a series of home readings.

By the by, there are two main causes of a large split (known as the pulse pressure) between the systolic (1st reading) and diastolic (2nd reading). The first is hardening of the arteries which can occur in older people. This gives a very high systolic reading and you may see a BP of the order of 210/80. The other cause is incompetence of the aortic valve. Without going into the physiology of the cardiac cycle, this means that very large volumes of blood are being ejected from the left ventricle, only to cascade rapidly back through the leaky aortic valve. This will give a similar blood pressure, although the pulse has a very particular characteristic and the findings are obvious on listening to the heart and, clearly, on echocardiography.

The debate about what is a 'normal' blood pressure is an interesting one. Basically, there isn't a normal blood pressure. There is a continuum of blood pressure from very low to very high and the higher it is the greater the cardiovascular risk which attaches to it. The thresholds for treatment are coming down all the time, as the data we have get better and better, hence the 'normal' comes down all the time. There must be a limit, however, and I'd be surprised if blood pressures of 135/85 or below will ever be treated.

QDM

[tony draper]

Err, where did Drapes post this?,waddus moved mean?, Drapes thunk he posted this in JB, is drapes going senile as well as having high blood pressure? :eek:


Whats the significance of high disystolic pressure?
Drapes systolic pressure seems ok forra old codger,conciderin the life of debaunchery and excess he once lived, around 120/ 130 ,but the distolic thingy alus seems a tad high, betwixt 80 and 95.
Drapes got one of they blood pressure machines, an been takin his blood pressure a few times a day.
Is it worth Drapes gettin his puter upgraded, or payin back folks munny he owes em?
Does it mean that Drapes old ticker blows ok, but is runnin out of suck?
One needs to know these things before planning anything long term, indeed , is it worth startin another long thread with Tricky Woo,since we solved the problem of the human mind and memory, Drapes was gonna start a thread on his unified field theory, is it worth it one asks?. :(

[LordGrumpy]

A high diastolic pressure aint good. Because it is the phase of the cardiac cycle is supposed to be 'resting'
Go see a good cardiologist. Be prepared to take on some changes.
Remember some tables can take any size laying down, and you dont move of your own will!

[tony draper]

Oh Drapes is getting treatment for high blood pressure, the sistolic has come down a lot, its this other buggah thats got me beat, they have also took Drapes off the colesterol donor list.

[AtlPax]

Cholesterol is important, but equally important are triglycerides, which (as I understand) are carbohydrates your body has converted for short term "storage," and regulated by insulin. As I understand it, some people lose their sensitivity to insulin, and the triglyceride level starts going haywire. The name for this is hyperinsulinemia, and sometimes called "Syndrome X."

Probably will need to start taking more pills but - you gotta start exercising and cut waay back on the carbohydrates.

[Circuit Basher]

Drapes - this is not a medically qualified opinion, but a systolic of 120 - 130 over a diastolic of 80 - 95 doesn't sound anything like time for the blues and twos (maybe following good self maintenance techniques as per the advice offered would do some good). I don't believe that an AME would even blink at those sort of numbers (for a Class 2, anyway).

My wife (who has owned horses most of her life, with all the exercise that involves) has just about stabilised after an 18 month stretch of high blood pressure. ISTR the worst measurement of her BP was 220 / 115, which maybe indicates the perspective I've got!!

[Tricky Woo]

Herr D, I'm afraid you're gonna die... in twenty or thirty years from now.

Time to come to terms with it. Hmm, think you recently wrote that you go for the oblivion theory of death. A bit bleak, mate. Considering a rethink?

TW

[Dangerous_Dave]

If you are genuinely worried check out the following link

Blood Pressure (http://www.nhlbi.nih.gov/hbp/)

120/80 is completely average. The first number should be below 100+age (I'm 31, so 100+31=131), and the second number should be below 100.

The difference between the Systolic (first number), and Diastolic (second number) is called pulse pressure. That shows how health your arteries and blood vessels are. (I'm not sure how)

Hope this helps

[Blacksheep]

Blacksheep's BP was 180/110 and medication was prescribed. Then came a spell in Nepal where pills were hard to come by, so the old Ram stopped taking the pills. Not long afterwards, Blacksheep became a quivering heap, clutching his chest and gasping for breath. An infusion of Heparin and a spell in the CCU brought the old fart back to life, then a double bypass put the ticker back in working order. I never forget me pills any more and the BP is 130/80, this being considered excellent going for an old sheep. The old sheep's Doctor says a systolic that remains consistently above 140, or a diastolic that remains consistently above 90 (or both at the same time), may be a cause for concern. At 130/85 you've not got much to worry about, but since you obviously are worried anyway, pop off to the doctors, have a well man (or well sheep) check up and keep taking the pills. Whey aye tony - you'll be arl reet, man.

**************************
Through difficulties to the cinema

[QDMQDMQDM]

BP is more or less a continuum and in a sense there is no 'normal' blood pressure (or at least what is 'normal' is constantly changing), merely lower blood pressures which confer correspondingly less risk of heart attacks, strokes and what-have-you. In non-diabetic hypertensive people, the treatment aim is a BP below 140/85, with 150/90 being acceptable. To achieve 140/85 can sometimes take a combination of three drugs in my experience.

Click on 'Resources' and then the Third working party guidelines at www.bhsoc.org for more info. You'll find the summary at the beginning contains most of what you want to know. Sounds like your BP isn't too drastic though.

QDM

[lord melchett]

Cut out salt and alcohol only in moderation. Usual sensible diet changes (eg low fat spread instead of butter etc etc) Plenty of cardio vascular exercise and most important of all lots of sex!

[lamplighter]

QDM

With respect, I cannot see why 140/85 is the BP to aim for.

The requirement for a class 1 medical is a BP less than 160/95.
(JAR-FCL 3.135(b))

The side effects of anti-hypertensive drugs can be extremely unpleasant.

[sunday driver]

Speaking as a victim, not a doctor -

High blood pressure might (in a minority of cases) be caused by pre-existing unpleasantness in amongst the offal :yuk: - so get good advice!

High blood pressure, if present for a long time, WILL cause unpleasantness in the heart and / or in the head and / or in the blood vessels.

You are very unlikely to realise yourself that your blood pressure is high - a VERY good reason to pay your AME's bill with a smile.

Often, high blood pressure responds very well to medication, with zero side effects (as I live and breathe).

You might, if you are very unusual, reduce your blood pressure a little bit by taking careful thought and relaxation therapy.

You are more likely to benefit from zero salt, slashed caffeine, reduce alcohol from a bottle a day to a glass a day, forget the burgers and chocolate bars, give up the fudge cake and the fresh (or any other) cream, "pass" on the cheese, take up the lettuce and fruit salad, and as an antidote to all that misery, you're encouraged to do something which makes you pant for half an hour, five days a week, provided it's not so energetic that it brings on the heart attack / stroke you were trying to avoid in the first place.

One thing I've been advised NOT to do is give up taking the tablets now I've started, since "they" say that although your BP may be down, if it goes up again the simple treatments are much less likely to work next time.

SD

[QDMQDMQDM]

With respect, I cannot see why 140/85 is the BP to aim for.

Those are the British Hypertension Society guidelines which relate to maximising long-term survival and are quite a separate issue from fitness to fly aeroplanes.

QDM

[Semaphore Sam]

I fought the cholesterol/blood pressure battle up til August; I ran 4 miles/day, cut out fat (skin off chicken, etc), and still couldn't lose weight, lower blood pressure or cholesterol. But, I finally did, with remarkable results. How?

Read this book, those of you really interested: "Dr. Atkins New Diet Revolution". Blood pressure way down (from over FAA limits), and cholesterol LDL down, and the ratio of HDL/LDL very much improved. Price $7.99; for those of you with problems with weight, triglycerides, cholesterol and/or blood pressure, it might save your life as well as your career.

[QDMQDMQDM]

I am 38 and have blood pressure which when I get up in the morning will be around 118/76 to 125/82. If I am tired it will normally be on the higher side of the above readings. Evening times, prior to bed they will sit at around 130/82 but on days off will often drop to around 125/75. I am not on medication, take it very easy on the salt and alcohol and swim and cycle a couple of times a week.
Normal blood pressure, no sweat.

I am conserned that during the day, and when working hard or under pressure these readings go up significantly somtimes as high as 150/100. The highest I recorded was 168/112 but only once. It seems their is a significant variation in readings which concerns me. Should I be concerned at these higher, under stress readings as it seems my at rest blood pressure would be considered normal.

Blood pressure and pulse rate rise in the normal person in response to mental or physical stress. In fact, a lack of blood pressure rise in response to exercise is a sign of severe heart disease.

As I said previously, an individual's blood pressure varies enormously and it is the trend which is important. From the limited information you have given here, you do not seem abnormal.

Worry less about your blood pressure and you may find your white coat hypertension disappears. Or that it doesn't. ;)

QDM

[max alt]

QDM,I have just been snagged for hypertension.
My Bp has been classed as to render me unfit.
I have been monitoring my Bp for over two years now as comments have been made about it being borderline.During recent Ame tests.
My Bp at home around 135/85.Sometimes higher,sometimes less.
I am 44 and in good health.
I have recently changed AME due to retirement and find the wholething a real ordeal.I wish I could relax more but find it very difficult.I am now undergoing tests with a consultant who is convinced I have White coat syndrome.
Fact. I have lost my class One.
Fact This has been done on Bp taken under In my case Extreme anxiety about Failing.
Fact the Ame Recommended I go onto drugs to regulate Bp.
Fact the cost of this action to my comp in the last month around 10,000 pounds and rising.
Question Would it not be prudent before reaching for the ejection handles to try and put the patient at a little ease befofe rushing in to put a cuff around your arm.Would it also not be prudent to arrange for a 24 hour BP test,before pulling a ticket, to see the whole picture as my consultant has arranged.Your views would be welcome. :confused:

[QDMQDMQDM]

BP measurement is a black art when it comes to measurement of borderline cases. It's very hard for me to comment on this situation as I don't know a) the particulars of it and b) the extent to which AMEs are able to go to assess your BP, before having to revoke your medical and refer you on for further assessment.

I can, however, well understand your frustration. Certainly, I would never take such a drastic decision on a single BP reading taken at the beginning of a consultation. It's important to get the patient at their ease and where there is doubt about the BP value and it is important, I generally get them to lie down in a quiet examination room for ten to 15 minutes and read the paper to relax, before retaking the BP.

QDM

[max alt]

Many thanks for your swift reply.

[missinglink]

" and lots of sex"

Only with the wife! We dont want you getting excited!!!

[gingernut]

No wonder they call you dangerous dave !!!

[driftdown]

Like Semaphore Sam I have used diet and exercise based lifestyle changes to moderate blood pressure and cholesterol. I used the Mens Health T-Plan, available from Amazon, interesting reading and gives specimen weekly diets and exercise routines for both gym and home based exercise. The best 10 quid I have spent for a while.

[MoFo]

RE the White coat syndrome, does any one have any tips for handling this.

Despite the best mental effort to relax its hard not to be subconciously concerned because you are being checked.

[Whirlybird]

INSIST on a 24 hour reading before taking the pills. I ALWAYS have a high BP reading - close to the CAA limit, if not over - when I go to a doctor, despite the fact I get on very well with my AME and don't knowingly feel nervous. I had a 24 hour reading after insisting that readings I took myself were normal, and the average over 24 hours was something like 122/80, and never went above the normal range, despite a "normally" stressful day...yelling at a few people, and getting annoyed with the bloody monitor strapped to me etc. I went to my AME with my 24 hour read-out in triumph, and definitely not nervous. He still couldn't get a normal reading, and "White Coat Hypertension" is now down officially on my form.

My feeling is that it's something pretty deep-rooted. I'm careful about my health, diet etc almost to the point of fanaticism, but I never go to a doctor if I can possibly avoid it, and I don't really know why. But I do know they raise my BP! But to tell you the truth I'm totally pissed off with this whole blood pressure obsession of the medical profession. When I did my Initial Class 1 at Gatwick, there were a series of charts there which I read in my spare time, relating high BP to sex, age, high cholesterol, etc, and the whole lot to risk of heart disease etc. I wish I'd asked for a copy, but my conclusion from a thorough reading of the charts was that if you were FEMALE, and had no other risk factors, your BP had to be absolutely sky high before it put you at risk of heart disease, strokes etc. Yet still doctors tut-tut at any single reading over 140/90. QDM, any comments???

[Beethoven]

I know exactly what you mean Whirly.I recently had a medical with my GP for my application to the Metropolitan Police and he was shocked that my BP was 160/92.I am male,32,over 6 ft and quite a determined drinker lol!! He did however say that he suspected it was due to tension in the surgery rather than high BP per se.Still I didn't believe him and ended up so worried I was going to be ill that I actually FELT ill.So the only solution was to get my own BP monitor and take my own readings over certain periods.The result being that I now KNOW that my normal BP is actually quite low compared to the norm (last reading yesterday was about 117/70 and am glad that I don't have one of these gp's that gives you pills on the basis of one reading (though I have never met one of these as my AME is excellent and has always asked me if I am tense after he has taken a reading....never thought much of it until now...probably the same thing as the police medical but the AME had the good sense not to get me worried about it.
One thing which I find quite strange is that BP can change so much over just a few minutes that I would dare to say that one-off BP readings must not be a reason to pull someones ticket.Rather use the 24 hour method if there is doubt.
Another interesting thing is that because I have my own machine I no longer have a fear of my own blood pressure or having it taken so I am hoping that this will go some way to alleviating the "white coat" syndrome.
Interestingly enough,I have discovered that a doc does not need to be present for this to happen as when I first got my machine,the first 3 or 4 readings were as high as during the medical but ater a few tries I had calmed down and they never ever reached those heights again...It was fear of the results that influenced my BP reading...not the presence of a medical person.
I have also cut right back on the drinking and given up cigs totally and also do weights 3 times a week.I took my BP immediately after a heavy weights workout last week and it was 10 lower (systolic) than my supposed "resting" BP in my GP's office.
Best wishes and relaxing thoughts,
Beet

[QDMQDMQDM]

my conclusion from a thorough reading of the charts was that if you were FEMALE, and had no other risk factors, your BP had to be absolutely sky high before it put you at risk of heart disease, strokes etc. Yet still doctors tut-tut at any single reading over 140/90. QDM, any comments???

Dead right, Whirly. As a profession we are obsessed with numbers and, sadly, collaborate actively with the government's desire to control the health of the population. Result: 'tick box medicine' where the boxes are ticked, but the patient is forgotten. (The new GP contract will make this a lot worse.)

I'm not saying high blood pressure shouldn't be treated, but it is certainly true that we over-medicalise and over-treat. There's a balance between being obsessive (have to get the numbers right, sod the patient) and being nihilistic (aw, it doesn't matter what the hell you do, everyone dies eventually anyway). I don't think we've struck that balance.

I'm as guilty as the rest of them.

QDM

[USE THE RUDDERS]

I myself also suffer from white coat syndrome.
Last year on my renewal my BP was taken and it was 150/100,the ame could tell I was nervous and told me to lie down.20 mins BP taken again this time 160/100.
The ame couldn't sign me off there and gave me a 24hr monitor.
The readings came back at 128/80 fairly normal.

Seems that white coat syndrome is fairly common. :D

[Whirlybird]

USE THE RUDDERS,

White Coat Syndrome does indeed seem to be very common. My GP's practice has their own 24 hour monitor, and the nurse told me that in the months after they bought it and started testing people, they took many of them off medication. So these people were risking side effects etc NEEDLESSLY, and the drug companies were getting rich. Maybe there's a good reason why I never visit a doctor unless I'm absolutely forced to.

[machonepointone]

From experience you don't have to be going for a medical to suffer from white coat syndrome. At my last place of work there was an excellent medical facility for the benefit of all employees and students (it was a university), and they had no part in my biannual medicals. Whenever I reported there for anything at all, a cold for instance, my blood pressure was taken. Results were usually in the 150/90 range and accompanied by much tut-tutting on the part of the doctor.

In the end I got my own blood pressure monitor and made detailed records of the results over a period of about six weeks. Next time I went I showed them to the doctor who immediately diagnosed me as having white coat syndrome. He admitted that about 20% of the population suffers from it.

Like a number of you I have an excellent AME with whom I get on well. I did the same thing with him at my last medical where his readings were around 140/85 and the average of mine was nearer 125/75. He actually wrote on the form that this more accurately represented my blood pressure.

I asked him what to do about lowering it since I have tried most things - decaffeinated coffee, regular exercise, healthy diet and I even gave up smoking. His answer surprised me a bit as he said to just eat, drink and be merry. I suspect that most AMEs don't worry too much about it unless the candidate is either seriously overweight or has something else majorly wrong with him/her. This would appear to rule out the majority of aircrew.

Bottom line I suppose is to lead as healthy a lifestyle as possible and to accept that the high stress we go through is on the medicals we are obliged to endure.