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Raised Blood Pressure

Old 18th Jul 2008, 19:26
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Raised Blood Pressure

Hay guys!,
I have to go to a medical class 1 examination next month. I just checked my blood pressure at home it is about 150 sometimes 160 to 80. I never had problems with the blood pressure and don't even know how the pressure was last year at my initial examination. Is this one too high or would the docotr don't mind? I don't know what to do so I hope, that u can help me :-)
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Old 18th Jul 2008, 20:39
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BP limit for a JAA medical is "consistently over 160/95" (if I remember correctly). He/she might give you a stern look, but if it's under that figure you've passed. When I did my initial Class 2 medical I'd cycled there, and was late. First thing she did was take my BP - through the roof, strangely enough. Calmed down by the end of the proceedings, so medical issued no problem.

Usual rules with BP - if you're overweight, lose some. If you drink too much, cut down. If your diet has a lot of salt in it, cut it out. If you smoke, stop. I did all the above (except for the tabs, which are still on the to-do list) and found mine dropped quite a notable amount.
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Old 18th Jul 2008, 21:09
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You will pass with those readings.

I wrote this last year, the advice is still the same, but maybe there's too much detail here...

Blood Pressure / Hypertension thread.
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
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Old 18th Jul 2008, 22:31
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Yeah! Sounds great! Thanks for the fast reply

Next week I'm gonna start to do a bit more sport so it might work

Have a nice evening!
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Old 21st Jul 2008, 06:11
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Hypertesion

Your blood pressure should be ideally below 140/90.
It may vary from day to day and place to place of measurement.
Ask a trained person to take your BP .
And do not worry.
Idea is to get yourself treated for hypertension and then continue flying.
You can fly on medication.
Resource- aeromedfroum.tk
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Old 21st Jul 2008, 11:37
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Viagra will get your BP down
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Old 22nd Jul 2008, 22:02
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I just read the JAR FCL 3 in the german version which is valid for medical classes.
They say that an examiner or an AMC can restrict the licence with "OML" if the pilot takes a medicine against high blood pressure, like ACE Inhibitor or something else. "OML" means that somebody is just allowed to fly with a qualified safety pilot or a co-pilot. Is that true? Would somebody get this restriction in general when taking some of these medicaments?

Maybe some of u guys have experience with that?
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Old 22nd Jul 2008, 22:53
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Went to the same AME for many years who never once commented on my BP. He eventually retired so had to find a new one for the next medical.

When this new guy took my BP, there was much sucking of breath and consternation. In his oppinion my BP was "close" to the limits. He did eventually give me the certifcate but twittered on a bit, saying I should consider going on to medication for a time, ie. stop flying for a bit!

Next medical I found another AME. He told me my BP was fine and was of the oppinion that having some BP was a lot better better than none!!!!
Needless to say I have been going to my new-found friendly AME for some years now.

The moral of this story is that if an AME tells you that you have a problem, try another AME!
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Old 23rd Jul 2008, 00:25
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Red face try a different approach . . . . . .

The moral of this story is that if an AME tells you that you have a problem, try another AME!
In recent weeks I've tried my level best to stay well away from this forum, but I really cannot let that one go unchallenged !

The REAL moral of your story is that if you find someone (ie an AME) with whom you can relate, get on well, interact, feel trust, etc, etc . . . . then by all means stick with him or her. All doctor-patient relationships should, at the VERY least, be relaxed and comfortable. As time goes by and trust builds up many become much closer ( no, stop sniggering ; I don't mean like that ! ) . I have known a few of my regular guys for over twenty-two years now.

The bottom line is : changing AME just because he appears to have found a problem, just COULD be the start of the slippery slope downwards towards your eventual stroke ( in the case of BP, anyway).

Relationships with AME's are like flying :- best cultivated carefully, continuity maintained wherever possible, and unnecessary changes avoided like the plague ! !

Happy Landings !
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Old 23rd Jul 2008, 09:21
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AMEandPPL,

unnecessary changes avoided like the plague
I entirely agree with that. I moved house nearly three years ago, and I now travel about 60 miles to see the chap who used to be my local AME, because I don't want to see anyone new. He's in Cheshire...it's not you, is it?
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Old 23rd Jul 2008, 09:59
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I must say, introducing patients to BP medication can be a tough sell.

After all, we're trying to get you to take a poison every day for the rest of your life, which may make you feel ill, when you probably feel fine at the moment.

As AME rightly say's though, the eventual possible endpoint of stroke is a disaster for the patient and his or her family.

Go and see 10 docs about some problems, and you may get 10 differing opinions. (That's why it's called a medical opinion).

This shouldn't happen with BP treatment, the evidence is robust enough to avoid that dangerous medical attribute, "clinical acumen."

May I respectfully point out, that the tutting head shaking doc you now avoid, is probably the guy who could save your life.
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Old 23rd Jul 2008, 11:56
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The moral of this story is that if an AME tells you that you have a problem, try another AME!
You might also want to try and consider the possibility that you do have a problem that should be looked at further, though. It could just be in your own interest (as well as your family, fellow crew members and passengers).
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Old 23rd Jul 2008, 12:44
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Go and see 10 docs about some problems, and you may get 10 differing opinions. (That's why it's called a medical opinion).

This shouldn't happen with BP treatment, the evidence is robust enough to avoid that dangerous medical attribute, "clinical acumen."
gingernut,
Just from reading your own post (the long one) it seems to me there might be quite a lot of scope for personal opinion in the case of people with bps of between 140/90 and 160/100. Eg slight personal history...not really sure what father died of actually, smoke the odd cigarette but very rarely, exercise but very intermittently...etc etc. Are you telling me every GP would agree on what ought to be done in such a case?
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Old 23rd Jul 2008, 13:24
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OK, for you guys who miss the point of "Try another AME", I'll put it another way. GET A SECOND OPINION !
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Old 23rd Jul 2008, 13:27
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Smile confer in private . . . . . . .

He's in Cheshire...it's not you, is it ?
The respective locations make it more than likely ! But it would be
ethically dubious to give any more detail in public !

By all means send me a PM, and we can discuss in private !
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Old 23rd Jul 2008, 14:15
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Are you telling me every GP would agree on what ought to be done in such a case?
Yes, the algorithms we use arn't perfect, but we're working on that.

And I think it is important to note that we (I'm not a GP), sometimes need to get away from the paternalistic "doctor knows best," - patient choice is important, indeed paramount in this case. I can prescribe as much poison as I want, it's down to the patient whether he takes it or not.

It's our job to give the advice, the patients choice whether to follow it.

(And please, don't get me started on "QOF"(targets))
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Old 23rd Jul 2008, 14:58
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AMEandPPL,

Check your pms. And I wasn't expecting you to say who you were on the forum, but just curious!
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Old 23rd Jul 2008, 15:51
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Very relevant thread for me today. At my last Class2 medical the doc thought I had a 'white coat' reaction re BP and suggested I monitor it. I did for about 8 months and it was up and down, when up it was about 165, when down it was around 130. I began to get too many ups and went to my GP. She measured and again it was up at 165. Blood was taken.

Today, after waiting 6 weeks, finally got results. My normally normal cholestrol is up and my bp is still up. Based on my age (56) and family history of high BP and high cholestrol, she strongly advised medication for both. The usual drugs for these things. It was a bit of a shock as up until now was the picture of health etc. Don't smoke, exercise and eat healthy diet.

Now got the drugs, and somehow a bit reluctant to take them. Still thinking, this can't be right, must be another way to overcome this.

It would appear that once I start taking these drugs, there is a two week period in which I should not fly to ensure no adverse side effects and then a further check.

Anyway I have a weekend of flying ahead, so the drugs can wait till Monday.

A relevant, cautionary thread. It can happen to even 'healthy' specimens.
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Old 23rd Jul 2008, 16:01
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Well of course, you are still healthy Grayfly.

And that's the way we want to keep you.
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Old 23rd Jul 2008, 17:06
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Grayfly; The good thing is that a lifestyle change may also assist in bringing the figures down. Perhaps like you I too viewed myself as healthy? ie.exercise often, smoked a bit, salads and moderation in meats, not overweight. So at 54 put on a tablet a day but quickly found I was going to bed early often at 2100 hrs and laying in but always tired. Also of more concern was my total lack of sex drive which no-one seems to have mentioned yet, now that did concern me. At 55 went back to Doc thinking that he would give me Viagra but took me off tablets and put me on six monthly monitoring which on balance finds me at 130/95, the lower figure as I seem to have understood is of more concern. Now 56 and still on six monthly checks, feel fine. result I ceased smoking all together, started cycling a bit and walking, I do/did cut down on some foodstuffs and alcohol intake is limited.
I have not found positively changing aspects of my lifestyle too difficult it is a bit like dieting I suppose and if it helps must be worth it. Good luck whatever.
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