Blood Pressure

[mumraaa]

Hi

I am going to take my Class 1 medical in January and wondered if you could give me some advice?

Having been under a fair amount of stress lately I decided to buy myself a clinically validated blood pressure monitor. When I test my blood pressure in the evening after sitting down and chilling for half hour, my readings are around 130/80. I understand this to be normal. When I am at my busiest and most stressful part of the day it increases to about 140/90, and occasionally upto 150/100 if I am under a great deal of pressure (I do drink decafeineted coffee quite alot during the day but would this affect my blood pressure)? If I go and sit in my car and relax for 5-10mins i can usually get it back down to 140/90 and it always drops back to 130/80-90 in the evenings.

In the morning when I wake up it is usually 130/80 although I have occasionally seen it at 145/80-85. My resting heart rate is usually about 65-70 but can increase to 80 during the day.

I know that at home my BP is normal, but should it stay this level throughout the day?? or is it normal to increase when under pressure from work and moving about etc. I keep fit with vigorous exercise, and cycle to work at least twice a week (7 miles each way which takes me 30 mins).

I know you cant offer prognosis over the internet like this but do you think my blood pressure is ok?

cheers

[Captain Airclues]

Try Here (www.pprune.org/forums/showthread.php?s=&threadid=81105)

Airclues

[FireDragon]

Mumraaa

I'm not an expert, but you seem to be perfectly normal. Think about it logically: Your blood pressure HAS to fluctuate during any 24 hour period, in fact it fluctuates continuously as you go about your every day activities. You would be dead if it didn't!

Optimised blood pressure is defined by the measurements 120 systolic and 80 diastolic, but as said above will fluctuate. The true test for hypertension (deemed by the CAA to be 140 over 95 or higher), is when an individual continuously records a high reading, even when relaxing.

If you are concerned, you can ask for 24 hour pressure monitoring. This can be a little invasive, but will be worth it if it puts your mind at rest.

Interestingly, it always use to be thought that the most important reading was the diastolic, (the force exerted through the arteries when the heart is at rest), but recent evidence has also shown a high systolic reading, (when the heart is actively pumping), to be just as damaging.

To summarise, doesn't sound like you've got much to worry about, wish I was as fit as you sound!. BUT if you're really worried before a test, there are a few things you can do.

1. Don't eat during the day before the test
2. Take an asprin an hour before the test

3. On a long term basis, take garlic, with active anicillin, (the ingredient in garlic that is beneficial to the cardiovascular system)

I know I will probably be admonished for advocating garlic, but it's harmless if you're worried, (or borderline).

Obviously for true hypertension, you must be medically treated to avoid any future complications to your health

FD

[Whirlybird]

mumraaa,

CAA limits are actually 160/95, so you don't need to worry about your Class 1. And as Firedragon has said, it's normal for blood pressure to fluctuate...due to exercise, stress, and just at different times of day, usually being lowest when you're asleep. If the search function is working, there have been quite a few threads on this before; have a look, but you definitely don't need to worry as far as your Class 1 is concerned.

[Anti-ice]

When i recently took 3 months off flying , my BP dropped from 160/90 to 130/80 !!!!!

Not sure if it was the effect of recent cost-cutting at BA or not using the M25 for 3 months :)

[mumraaa]

Thanks for your replies. I am going to keep a daily record of my BP until I take my class 1 in January. Do you think this will help my cause if my blood pressure is high at the time of the test? I do get real nervous when the doc takes my BP. I tested it this morning and it was 125/83 and that was after a cuppa.

Also, I do get a bit nervous when taking passengers. Once I've started the engines I'm fine as I have plenty to do to keep my mind occupied. But, I do get the butterflies before a flight (unless its local and perfect weather) and I have passengers. Do many pilots get the same? Presumably this will increase my BP when i have the butterflies but dont want go taking my BP in front of my passengers!! that may worry them slightly me thinks! ha ha. quite a funny thougth tho!

[gingernut]

Mumraa, remember to keep some sense of proportion about this. BP is just part of the bigger picture. Yes, constantly raised BP is a risk factor for lots of nasty things, but it is usually taken in the context of other variables, such as smoking, weight, family history, cholesterol level etc.

Remember also, the medical dept. is there to pass you, not to try and trip you up.

Chill out and good luck !

PS I'd be a bit wary about taking anything other than deep breaths and an empty bladder, in an attempt to fiddle the test, you never know, it may trip you up !

[Northern Highflyer]

Monitoring your own BP so often will not help matters. You would only need to check it a couple of times a week, and even that might be too much. Checking it so much will only add to your stress levels and raise the BP.

Having spoken to the CAA myself on medical matters they can be very helpful and reassuring, but from what you have said I can't see that you will have any worries.

[Aerial Anarchist]

How much does drinking affect your BP?- I accept that heavy consumption will be a problem but does moderate drinking pose a problem and does no booze at all before your class one medical help?

Also can anybody confirm the CAA limits at the moment and which drug do they suggest for treatment and what limitations do they impose should a problem be identified?

thanks

[Flyin'Dutch']

AA,

Have a look up at the earlier posts, yup up there, you can see that a link was posted and this gives the values.

JAR 160/95.

With regards to your question about drinking. I take it you mean alcoholic beverages?

There is evidence which states that if you are a bloke and drink over 28 units per week or a girl and drink over 21 units per week, you are endangering your long term health.

HTH

FD

[Airbus Girl]

Interesting. My blood pressure is always pretty low. I tested it a couple of weeks ago (right in the busy season) and it was 93/76.
You often hear about high blood pressure but what about the effects of low blood pressure? Do the CAA have lower limits? I understand that 100-140 is normal, therefore I am under that.
How can blood pressure be increased? Or am I naturally chilled out?!!!!

[QDMQDMQDM]

As long as you don't pass out, having a low blood pressure in an otherwise healthy individual is not a problem.

re alcohol -- in excess it is a significant causative factor in high BP.

QDM

[Whirlybird]

Well...

In addition to officially having White Coat Hypertension (now down on one of my medical forms) I now apparently probably have "labile" blood pressure (I think that's what he said; is that right QDM?). At my medical a few days ago, my blood pressure measured 160/60. My AME glared at me and said: "Why is your blood pressure always so high when I take it". I said: "Because I'm totally paranoid about having it taken". Anyway, he looked back at my records, and said the diastolic of 60 was the lowest it ever seemed to have been. I agreed, and told him when I take my bp myself, it varies dramatically for no apparent reason. Hence the new label.

All medics here, please excuse me if I say that I now think deducing anything from blood pressure measurements is a complete load of ****e!!!!!!!!!!

[QDMQDMQDM]

Whirly,

Your experience typifies the difficulty in effectively applying population-wide statistics (overall, higher BPs correlate with higher death rates), to the individual, such as yourself.

In general it is certainly true to say that a lower BP correlates with a lower death rate. Applying that to the individual, however, and making treatment (or no treatment) decisions, requires as much art and alchemy as it does science.

QDM

[Flyin'Dutch']

Bloodpressure is a very dynamic value and especially the systolic value is very susceptible to every day activities.

Those activities which we find relaxing result in the measurement of lower values and those which are strenuous (either physical or mental) make the values go up.

The diastolic (or lower) figure is more stable and was therefore in the past regarded as the 'true' significant value.

Over recent (five or so) years it has transpired that long term health is not only dependent on a good (i.e below 80-85mmHg) diastolic bloodpressure but equally on a good (i.e. below 140-145) systolic blood pressure.

More recent it transpires that those who have higher bps when they are taken in formal settings, despite having normal bps during the rest of the day, actually are probably more at risk of developing high blood pressures.

A study comparing treatment of people based upon surgery readings vs. ambulatory readings (taken by 24 hour bp monitors) showed that by going on the more favourable (lower) ambulatory readings resulted in an undertreatment of this group.

Good things to do to ensure that your bp will stay in the desirable range are:

Control your weight; make sure you don't stem from a family of hypertensives(!); limit the intake of dietary salt; exercise; don't smoke; moderate alcohol intake; live stress free and.........

Have fun!

FD

[Whirlybird]

Hmm..............

Flyin'Dutch, I've been thinking about all that....

Stress causes blood pressure to go up. If we want to keep it down, we should, as you say, "live stress free".

Some people find having their blood pressure taken stressful, so much so that White Coat Hypertension is a wellknown phenomenon.

More recent it transpires that those who have higher bps when they are taken in formal settings, despite having normal bps during the rest of the day, actually are probably more at risk of developing high blood pressures.

If the above is true, it follows logically that doctors are actually causing such people to develop high blood pressure, by consistently taking it and monitoring it, and therefore putting such people under stress?

Is this a drug company plot or what?

[Flyin'Dutch']

Hi Whirly,

Well no. At least not that I am aware off!

I think it is important to keep in mind that the visit to the doc is not the causative factor merely a situation which is perceived to be stressful for those subjects with WCH.

And in those folks, it transpires, their bp is likely to go up in other stressful situations, more so than in non-WCHs.

To prove input -> result relations is notoriously difficult.

FD

[wellthis]

Generally, resting BP below 140/80, and mid-day heart rate of 70-75 are the median and regarded as normal, otherwise 2/3 of the population have to go on diet! But for a distance runner they're more like 110-20/65-70 and HR of 55, and a resting (morning) HR of about 40! They are like the sports cars that have a very low idle RPM and can rev-up to high RPMs quickly and maintain that for a while. The rest are four door sedans with a very narrow RPM band! Don't forget the lower the BP/HR, the less the heart is working to pump blood. If the heart rate is always 80 for instance, at 45 the heart is more like 55-60 (30-35% more work). Max heart rate is about 220-age (in years). At peak exercise/activity, one should be able to maintain 80-85% MHR for a few minutes. At MHR, heart may stop!

The health-nuts say if your BP is higher than 110-20/65-70 (male) 95-110/50-60 (female) and HR higher than 60-65, then you're always reving your engine while stopped at the light. True you may pass the medical, but slightly high BP/HR may be signs of trouble to come. Cut-down on meat, alcohol, salt, stress; stay away from fat and smokes; and run/jog/fast walk half hour a day. You lose weight, HR/BP, and never worry about the darn medicals anymore!

[Gerard123]

What are the requirements for a class1 medical ?

[Whirlybird]

How come I have a high-normal BP, and a very low heart rate - so much so it was mentioned on the print-out for my ECG, but the AME said not to worry? When I used to be really fit my BP was about the same, and my heart rate even lower, well below 50 if I remember rightly. No-one ever seemed to know why.

Now do you understand why I take this stuff with the proverbial pinch of salt?

[QDMQDMQDM]

Whirly,

To an extent, and very understandably, I think you're over-analysing all this stuff and looking for rational connections where there are none. On average, higher BP is associated with higher cardiovascular mortality. Some people's blood pressure tends to go up more when it is taken, while being normal at other times. There is some evidence that those people, too, have a higher cardiovascular risk. End of story. We just don't know much more.

This is all a very inexact science and the mechanisms of so-called 'essential hypertension' are poorly understood. You are therefore right to take it all with a pinch of salt. The danger, though, is of becoming so sceptical that one throws the baby out with the bath water.

On the issue of heart rate, resting heart rate in athletes is always lower and recovery time back to a normal heart rate after exercise is lower too. These are manifestations of fitness and are indirect pointers of the increased O2 transport which occurs in athletes.

Best,

QDM

[Notso Fantastic]

Mumraaa- sorry come into this a bit late. After a very high pressure 40s raising kids & dogs with one hand, fighting a protracted very long unpleasant divorce and flying ahigh pressure shorthaul environment, eventually my licence was pulled (at 180/120!). It took me 5 months to get it down to the CAA satisfaction with stable medication and it is now about 125/85 (under medication). Your figures look reasonable, but don't forget these little home machines don't accurately reflect the circumstances in a surgery with a proper BP device- mine bears little resemblance I will get in the surgery.
Try and not worry, have your BP done standing but leaning against something (if you can get away with it), and if you appear to have a problem you must take control now! Ensure your weight is not excessive and visit the gym 3 times a week. Believe me, you want to avoid those medications they put you on! But they do the job if you are a lazy bastard like me!

[lord melchett]

Also used to be obsessed about the BP thing when I started creeping up to the high side of normal (158/95). Did all the right things - no salt (ugh), drink in moderation, visit gym etc etc. Then bought BP monitor from Boots (the arm jobby @ 90 quid or so. Course the problem is the BP is always higher when done by man in white coat and they appreciate that fact when taking the reading, (which incidentally notso, HAS to be done sitting or lying down according to said Doc)

Paranoid about getting put on tabs, forgot about throwing weights about, increased the cardio vasc instead and bought a bike. Made all the differerence and its enjoyable too.

(Plus of course I get to bike to the pub!!)

Plan the medical for the afternoon, dont eat and drink only water. Spend the morning relaxing with a bit of light reading.

Lastly, aspirin thins the blood and has been accepted (unofficially probably) that it can be beneficial in the fight against strokes (so must also be good for BP) So pop one a day but not on an empty stomach.

All the above seems to work for me.

Good luck

[I. M. Esperto]

The FAA approves the use of Corgard, which is an excellent Rx with no side effects. I was on that when I retired, and still take it.

Find some sort of natural diaretic if you can. Elevated BP is often the result of water retention.

[Bad medicine]

Nothing has "no side effects". Maybe it works for you, but there is a reason that there are so many medications for hypertension. None of them work for everybody, or are tolerated by everybody.

[I. M. Esperto]

True.

Here they are:
Most adverse effects have been mild and transient and have rarely required withdrawal of therapy.

Cardiovascular: Bradycardia with heart rates of less than 60 beats per minute occurs commonly, and heart rates below 40 beats per minute and/or symptomatic bradycardia were seen in about 2 of 100 patients. Symptoms of peripheral vascular insufficiency, usually of the Raynaud type, have occurred in approximately 2 of 100 patients. Cardiac failure, hypotension, and rhythm/conduction disturbances have each occurred in about 1 of 100 patients. Single instances of first degree and third degree heart block have been reported; intensification of AV block is a known effect of beta-blockers (see also CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS).

[Notso Fantastic]

IM Esperto- the use of natural diuretics interests me. I have definitely been suffering water retention since before my BP problem, and still do even on a diuretic (Losartan). I don't want to pump up with even more of the damn pills so what are the suggestions?

[Flyin'Dutch']

NF,

Losartan is not a diuretic but an AT2inhibitor and further development of perindopril (Coversyl)

Your (well mine as well actually) bloodpressure is regulated by a rather clever and finetuned mechanism.

Losartan works on the process in the kidneys which senses bloodpressure and regulates this my modulating some substances.

Not sure what Corgard is but from the side effect profile I suspect it to be a beta blocker or calcium channel blocker.

They work in a different manner to the Losartan.

Some people are fine and well adjusted on one lot of medication. Recent research indicates that for most people more than one drug is the best way to regulate their hypertension.

I am not sure that there is a lot of evidence that 'natural diuretics' are effective in the prevention of high blood pressure or the treatment thereof. Healthshops may advice differently but obviously have a monetary stake in the uptake of any advice they give.

FD

[Semaphore Sam]

Last summer I went for FAA Class I; as usual, BP was high (135/100). Staff told me to rest, try later etc, finally passed me with a little 'help'. I went to friends, who recommended diuretics; also had high Cholesterol, especially high LDL (bad Cholesterol). Another friend gave me 'Dr. Atkins new Diet Revolution' book; it said first thing to respond to his diet is BP. I decided that's better than diuretics the rest of my life, if it works. I tried it, it did, my last 2 FAA's have had BP much lower than I've had in the last 10 years. Cholesterol much improved also, but the quickest most dramatic improvement is in blood pressure. Just a thought, Sam. (I've also lost a lot of weight, as another side benefit).

[I. M. Esperto]

Notso - Ask your Pharmacist. Usually there are many right on the shelves.

[Notso Fantastic]

Thanks Mr. Esperto- I shall snoop around.
S Sam- this thread has got me on a diet and just losing a bit of weight seems to have helped feeling better. I have gone for the Zone diet as the Atkins is for very hardcore meat eaters only. I only eat veggie and small amounts of fish. How much weight did you lose from what base weight and how much BP change was there if I may be so bold? I need motivation here!

[Flyin'Dutch']

For every kilogram you lose your BP should come down by about 2-4 mmHg.

FD

[Semaphore Sam]

Hi Notso
I was at 220 lbs, and dieted to 182 or so, by starving (1 meal a day, no fat at all, only veggies, including potatoes & pasta & other starches, and coffee & tea with sugar). I was 182 last summer, with blood pressure around 130 to 140 over 95 to 102, and with bad bloods. To get from 220 to 182 took 3 years of heavy running and starving, with no help with BP & Cholesterol. Since last summer I'm down to 160-164 lbs, BP has been as low as 96/66 (self-measured, so must beware, but 2 FAA exams have been around 125/82 max). The blood pressure went down within 2 weeks of starting Atkins. What helps is not the goodness of meat or fish, but the lowering of insulin, I think; whether Zone, or Atkins, the important thing is the elimination of BAD carbs (sugar based things, processed flour, potatoes) which give insulin overloads. It's important that what carbs are eaten have good nutrition, and low insulin-raising values. Good luck with the Zone, Sam.

[I. M. Esperto]

There are so many variants to this BP thing, I'm not sure if there is any real pattern.

I didn't get above normal until I was about 50, if I recall. All the while I was a healthy 240 pounder with no problems until then. Age is a factor, probably due to the loss of elasticity in the blood vessels.

I always had high cholesterol, up to 400 at one point. Back then, in the 1960's, not much was known about HD vs LD Cholesterol. Fortunately, I have a huge surplus of the HD stuff. At 72, I have never had a heart problem.

My skinny younger brother had a tripple bypass when he was 50 (Retired B-52 Jock).

My skinny father had 3 coronaries, but lived to 93. My overweight mother never had a heart problem, and died of cancer at the age of 60.

Go figure.

Eat, drink and be merry, be prosperous and multiply, and keep the faith.

[Flyin'Dutch']

Hi IME,

Good to see that you are in such good health.

However the parallel you draw between you and the rest of your family makes at best for anecdotal evidence that there is more to the causes of ischaemic heartdisease than Cholesterol and weight.

After all driving down the motorway @ 130 mph does not ensure that you will be dead before you reach your destination; but like smoking Woodbines it makes it a whole lot more likely!

:D

FD

[I. M. Esperto]

Dutch - There is a lot of data on the genetical aspects of health, including BP. I believe it is a vital link, and as such, we're stuck with what we were born with.

Of course, certain things can be improved upon with a great amount of effort. I consider myself to be one of the lucky ones.

I never did a thing in the way of diet or exercise. I lived a life that pleased me, and the Devil with advice to the contrary.

A sedentary lifestyle is part of being a pilot. I have seen many who spent their layovers in strenuous excercise. I have outlived them, after spending my layovers carousing around, drinking, etc..

I don't believe in these environmental factors such as lead, asbestos, second hand smoke etc.. In 1931, I was born in a house full of asbestos which had coal for heat. Lead pipes all over, leaded gasoline, you name it, all the things that are considered fatal today. Life aboard ship was the same way. I sailed on 3 merchantmen and 2 warships before I ever touched an aircraft.

Back in the 60's, aircraft cabins were filled with smoke. There wasn't even a no smoking section. I remember the TWA Red Carpet flightsout of NYC to CHI. Pax were led to the ramp with a red carpet, and when they boarded, a young (under 30) Hostess handed them a box from which they chose a cigar, and a snifter of brandy.

Look at what we have degenerated into today. It sucks.

Go figure.

[Flyin'Dutch']

I see with what you are saying but although it has worked for you it would not work for the majority of people.

The one thing which is vital to ensure longlivety, is the ability to chill. And if it did not ensure a long it sure as heck ensures a happy one!

From your postings I deduct that you have mastered this fine skill.

I'll join you for the whiskey but decline the cigar!

Cheers!

FD

[Anti-ice]

It' s certainly true what you say about weight - -it will dramatically increase BP.

Recently also it was reported that dangerous 'spikes' in BP can occur during weight-lifting.
These can lead to strokes if the the pressure is increased rapidly/over-exertion.

I believe stress is fundemental in this too.
As i said before, my BP dropped 30 points when i took 3 mths out of flying.

Water retention plays a big part in BP ,and with our bodies adjusting to ever-drier cabins, are we retaining fluid too???

I always remeber doing long nt flights back from the US on the DC10/767 and despite drinking 2-3 ltrs of water, barely passed it/if at all, all flight :confused:
However, operating similar sectors on the 744/742 , i would be free to go at will all night.
Explain that!

Potassium rich foods are good as they force sodium/salt from yr body. Banana=excellent source.

I got an excellent book (ISBN1-872362-81-8) 'High Blood Pressure at your fingertips' , a 350 page book that is factual, totally undramatic & userfriendly from Amazon.co.uk

It's mainly a question of lifestyle, keeping weight off , stress at bay,
Very low/no salt in your diet, reducing levels of fat content and of course exercise.
Then of course , if it runs in the family, you may have a struggle.

[I. M. Esperto]

Dutch - "The one thing which is vital to ensure longlivety, is the ability to chill. And if it did not ensure a long it sure as heck ensures a happy one!"

You lost me on that one, Buddy.
Chill? That's what I do to a Martini glass.

BTW, I just had my first Tanqueray 10 Martini. Excellent! I've now switched from Bombay.

[Flyin'Dutch']

IME,

To chill = to relax.

AI,

Anything in moderation! Too much potassium is not good either. Had several patients who started to use a salt substitute which contains potassium end up in hospital with hyperkaliemia (too much potassium) in their blood.

Too much potassium can cause heart arrhythmias.

FD