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Blood Pressure & White Coat Syndrome

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Blood Pressure & White Coat Syndrome

Old 12th Nov 2018, 15:17
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Blood Pressure & White Coat Syndrome

I've been lurking for a few months and it's time for my first post I'm applying for my class 1 medical and have white coat syndrome. Blood pressure tests at home are usually normal, but usually record high at the doctors etc. I was looking at the CAA hypertension flowchart and was wondering about the limits allowed. Sorry, as I'm new, the forum won't allow me to post a link to it! It seems quite clear that during the medical you have to test 140/90 or below. If you're put on a 24 hour blood pressure monitor, what is the limit allowed on those? Is it 140/90 still or is 160/95 allowed without having to be referred to the cardiologist?

Thanks!
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Old 12th Nov 2018, 22:16
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sorry not sure of the CAA guidelines, but the NICE guidelines may be os some use
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Old 13th Nov 2018, 09:05
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You say that BP readings at home are usually okay but you imply that under stress, as white coat syndrome, the readings become elevated. Long term raised blood pressure can lead to permanent damage to many of the organs and elements of the human body. If you are young and prone to blood pressure problems why wouldn't one opt for a long term medication regime. That would greatly reduce the possibility of any long term damage to the body and obviate the need for worry with the CAA which seems to be quite tolerant of long term blood pressure medication as long as it falls within their guidelines.
An American or South African cardiologist would be likely to recommend just such a course of action. How you'd fare in Britain, either privately or on the NHS might be interesting. Perhaps they'll tell you that you are too young to have blood pressure problems. There certainly seems to be age limits below which it's impossible to have prostate cancer or breast cancer. On the other hand, perhaps the CAA will do the hard work for you. It is certainly possible in the UK to hold a Class 1 licence if you have BP problems as long as its under treatment.


https://www.caa.co.uk/Aeromedical-Ex...scular-system/
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Old 13th Nov 2018, 16:12
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I used a 24hr BP monitor and although I wasnít specifically told ďyou must have under 140Ē, I was told they were looking for something more like 135 or under with the daytime average. But Iím guessing the limit was still 140.
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Old 13th Nov 2018, 16:36
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@gingernut Thanks; I did have a look on the NICE site, but couldn't see anything specific to the 24-hour monitor.

​​​​​​@CJS12 My thinking behind it was if it's being taken whilst you go about your day-to-day activities, it will inevitably be higher than someone who is sat in a chair doing nothing and so a higher limit being put in place. Ah well, I might just have to wait and see what happens...
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Old 13th Nov 2018, 17:26
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I only have a Class Two so have only had to see an AME. But white coat syndrome is understood and AMEs are generally sympathetic. My bp is generally better during a medical than at the Dr's surgery where time is allowed to settle down and if your GP is happy with your bp management that should generally help. Ambulatory measurements will usually vary and it will be an average of daytime, and resting night measures that wil usually be looked at.

If you have genuine high bp many medications are allowed some are not AFAIK. I use an ACE inhibitor at quite a high dose and that doesn't seem to upset the CAA.

Bottom line is that if you have normal bp you should be ok and if you have high blood pressure you will need to get it within limits with acceptable medication.
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Old 13th Nov 2018, 17:40
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I have WCS too.
For the last couple of years I’ve taken a 24-hour reading a week or so prior to the medical.
My AME looks for an average reading of 140/90 or less.
On the day, he also checks (obviously). I’m not sure of the limits but I think he allows a small margin for WCS, on the basis that the 24-hr average is more typical.
I’m on a daily dose of 8mg Candesartan.
I agree with the bottom line above - getting it controlled and within limits is the important thing.
I have a class 1 UK CAA medical.
Hope this helps.
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Old 13th Nov 2018, 19:34
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MrOrange, NICE has gone to rat shit in terms of helpfulness to every day clinicians, but it is in there somewhere !

https://www.gpnotebook.co.uk/simplep...m?ID=268828745
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Old 13th Nov 2018, 19:43
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Ah, spot on; thanks!
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Old 13th Nov 2018, 21:37
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First off, ask that it be taken manually.
Second, insist that you are sitting on an exam table with your feet off the ground.
Third, make your arm "heavy" in the hands of the examiner.

If you do these things, and you're still hypertensive, you probably need treatment.

Automated BP machines are notoriously fickle, and will often stop at a "diastolic pause" giving a reading of something like "139/100" when in fact, the true pressure is more like 139/80.


Anyway, blood pressure is generally a cinch to control, and, at least on this side of the pond, really doesn't slow even a class one down too much once it's appropriately addressed.
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Old 14th Nov 2018, 08:01
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My AME has me sit down with my arm on a cushion on his desk. Then he does some paperwork and only then does my BP. That gets it close to my home readings. Above, but in limits.
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Old 14th Nov 2018, 11:21
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WCS ? It got worse with those 6 monthly medicals and the approach of retirement. Divorce did the rest !
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Old 14th Nov 2018, 14:27
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Originally Posted by 421dog View Post
First off, ask that it be taken manually.
Automated BP machines are notoriously fickle...
Agree that manual is best. And those automatic gizmos you have at home require some finesse to get anywhere near accurate.

Bought a new one and took it to doc's office to compare its "accuracy" to her manual reading. It was wildly off as I sat hanging off the exam table juggling that thing in my lap while taking a reading. Thought the machine was bad. Sent it back to manufacturer for testing but came back as normal.

Talked to the manufacturer's tech people who emphasized that you must follow the written instructions for use exactly...not just sorta/kinda close...EXACTLY.

Can't do that sitting in a doc's exam room on a table apparently.
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Old 18th Nov 2018, 10:47
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I have white coat syndrome. I am a few kilos overweight which certainly canít help but every 24 hour test Iíve done comes back with a 120/80 ambulatory average.
My AME has sympathy as her husband has a class 1 medical and also has wcs.
When it comes to medical time I do try to have some relaxation for half an hour beforehand and also make sure Iím properly hydrated.
I think they can have three attempts during the medical to get under 140/90.
There is some evidence to suggest that drinking beetroot juice a couple of hours before a blood pressure test will lower the reading slightly, which I can confirm worked for me. However donít get a fright when it comes to urine test time and your sample looks like Tizer.
I took my bp in the car before my last medical and it was 117/79, reading during the medical was 134/84.
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Old 3rd Dec 2018, 20:25
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Just to follow up on this, my 24 hour monitor came back with just over 140/90 and I've been referred to the cardiologist who prescribed me with blood pressure medication. I'll have to wait a few weeks and hopefully everything will be fine and I can crack on with it!
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