high blood pressure

[flightychick]

That could create some interesting scenarios in the CAA's medical department!!!

[Fly-by-Wife]

VP,

I can't give you any information about flying with high BP, but your tale rang so many bells for me!

Like you I exercise regularly, "drink in moderation, don't smoke, eat healthily and don't have any family history of high blood pressure and feel fit and healthy".

I had a heart "scare" in 2000, aged 37, being kept in hospital for 4 days under 24-hr observation while loads of tests were done. This was all down to an unusual ECG when admitted.

Upshot was a stress-test (treadmill + ECG), which was fine, then a discharge and a referral to a cardiologist (fine), and a battle to get my class 2 medical - again down to the unusual ECG (I've got some inherited oddity, that is perfectly healthy but non-standard). Finally sorted after several letters to Gatwick from GP and consultant.

All the above was, apparently, stress-related. No heart problem at all (the cardiologist even told me I had more chance of winning the lottery than having a heart attack in the next 10 years).

Four years later, a very stressful period at work resulted in me seeing my GP, who noted very high BP - I can't remember the figure, but it was sufficient to cause concern.

Like you, I had a 24-hr monitor (a bit weird, and rather hard to sleep), but it showed - happily - perfectly normal resting BP.

The point of all this is to show you just how much of an effect stress can have, and that it is perfectly possible that what you are experiencing is purely down to stress, and - literally - nothing to worry about.

The 24-hr monitor will - hopefully - give you a clear-cut indication, either no problem or genuine high BP.

If it's no problem- as it probably will be - you have to believe it, and concentrate on finding out about de-stressing and relaxation.

FBW

[The Jolly Roger]

Hey man,

I'm a controller and I get exactly the same feeling of dread at every medical. Can't help it. I do try tho. The doc that did it back at home a few years ago (i'm abroad now), made it worse by doin the lecture thingy too. I gave him some lip about it too.!! He put me on a 24hr monitor and all, as expected was fine. Nurses said white coat hypertension is absolutely endemic but they have to be sure. I wouldn't be too stressed. When you put it on first, the thing nearly blows up in your face its so high!!! Then when you forget about it a little, it starts to behave normally. They want to see that it drops when your sleeping and doesn't lower everytime you exercise. I'm your age by the way so I hear ya.

Best of luck and don't listen to the doc toooo much......I'd like to see them under a little stress...

[CharlieJuliet]

OK having got there: they will try various pills. From experience these will not work on the first pass. (or the second) I had one set of pills for one month, then a second set for the next month and finaly a 3rd set for the 3rd month, and these finally reduced my bp to acceptable levels ( still good after about 5 years). I was off for 3 months, but got my class 1 back. I think that the waiting time could be reduced but the docs are running on old pills!!
Anyway keep the faith - it will sort itself out after some time.
There does not seem to be any follow up to see if the dose is correct - if it works under the NHS it stays. I am sure that the doses that I take could be reduced!!

[gingernut]

It's unlikely that the readings you describe are likely to make a difference to the quality ( or quantity ) of your life, that much.

It'd be a cruel AME that would pull your ticket on the basis of the readings posted, but technically a persistent systolic of 164mmHg or above does warrant treatment. Previous postings on here suggest it'll make no difference to your career though.

I made a post about 2 years ago about this, I'll try and post it again.

[gingernut]

at the risk of repeating myself..... I'm pretty sure this evidence is still current.

And remember, stopping alcohol 1 week prior to your medical is likely to bring your readings to an acceptable level. (don't shoot the messenger !!)






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

[Murmur]

I'm 30, exercise 3 times a week

what kind of exercise?

[Earl]

There is a way to lower it very quick.
Nitro pills under the tounge, can buy them in Madrid and most middle eastern countries.
But you are only cheating yourself, pass your medical, but the problem will kill you if not treated.
Lifestyle changes are the only way, reduce the alcohol intake, garlic pills even work.
Exercise more, don't have to go to the gym, just take a long walk everyday.
Giving up or reducing smoking is not a immediate fix, but long term it can help.
If the B/P is that high and not reduced you will have a greater chance of stroking out during any high periods of stress or work related tasks.
This from my AME and personal experience, reduce alcohol, exercise and drop some weight, it works.

[Bob the Doc]

I can certainly concur with gingernut's post. He has summarised the current advice very well.

I would definitely say that white coat hypertension is a well documented issue but as GN says, while your BP may be normal, if it goes too high under stressful conditions, this may in itself be cause for concern.

Calibration of these devices is woefully poor in many situations and some of the automatic machines are not very accurate. Doing BPs with an old fashioned mercury sphygnomamometer is the most accurate but most places have banned them due to elfin safety issues!

Getting the cuff size right is also essential. At my last medical the nurse found my BP to be high but when the doc did it with a bigger cuff it was normal. Small cuffs over-read and large ones under-read. The standard adult cuff is probably too small for many larger adults and so they might be inaccurately defined as hypertensive

All in all, quite a crude measure but a useful one taken in combination with other things.

HTH

Bob

[Bob the Doc]

Oh....and on NO account should you EVER even contemplate buying drugs over the counter to treat this sort of problem without first discussing it with your AME. Many are either unsafe, untested or just don't work. The RAF takes a very dim view of its aircrew self-medicating (for example, even Piriton is a no-no) and I would be surprised if the CAA were any different

[C-N]

band aid remedy

I've tried munching garlic and it could lower your BP in minutes, its my bandaid solution every time my BP goes up abnormally. for a long term solution you must stop smoking and drinking alcoloholic drinks. i've heard lately coffee can also recude BP. good luck

[piggybank]

For natural treatments. Depends where you are in the world. Starfruit or "belimbing" gives a fast but short term drop in blood pressure. Ripe fruit will do but the best is the one that is as hard as wood, just developing. Don't juice it as it will make you cough. Slower drop but longer lasting is a "tea" from green leaves of the passion fruit, locals here say the leaves of the purple one is more effective than the regular yellow one.

[sharksandwich]

gingernut and Bob the Doc have given excelllent advice.
To save people wasting their money, the small electronic BP measurement devices advertised in magazines for about £70 are so un-reliable, my local NHS Trust has banned them from the wards.
A better option is to make an occassional appt with your local Practise Nurse (GP surgeries should all have one).
I was taught the most important figure is the lower one (diastolic), which is the pressure when your heart is at rest. Consistant readings of 90 or over may need treatment,because that is the lowest pressure your blood vessels achieve, and like a domestic plumbing system, consistently high pressure may cause leaks.
The higher figure (systolic) is often 100 plus your age (in normal,non-athletic, sedentary people), though a lower reading is preferable.
My own BP had reached a figure which worried me, but I managed to lose 10 kgs (cut down on my drinking), and it is now usually 140/80, which is fine by me (in my 50's).

[piggybank]

ref my post 72

In my last post I said about using Starfruit. There is a catch with this, that some prescribed medicines have considerably more effect if consumed with this fruit. Its worth a look at Wikipedia and Google about a bit, sorry for taking a while to mention this.