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Dr. Anil Kumar
Dr. Anil Kumar, General Physician
Category: Health
Satisfied Customers: 6537
Experience:  M.D. with over 30 years of experience in practice.
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For Dr. Anil Kumar: Hello, You offered to help me with a blood pressure question yesterday. I received an answer but it is different than I'd received in the past and so I would like to ask it of you. The question is too long for this space so what is the best way for me to present it to you? Thank you.

Submitted: 1 year ago.
Category: Health
Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Firstly it's my pleasure to help you.
What is your current blood pressure readings?
When have you seen your doctor recently?
Do you feel any associated symptoms like headache,lightheadedness,etc?
Stress and anxiety issues?
Any other medical history?
Are you taking any medications?
Alcohol and smoking history?


Thanks.
Customer: replied 1 year ago.
Thank you, Doctor.
I’m 61, see my doctor regularly (most recently two months ago), am on no medication, exercise regularly, don't smoke or drink to excess and am in excellent physical condition. I do have a history of borderline/labile blood pressure readings and my most recent 24-hour ambulatory blood pressure/ Holter monitor average was 138/78, with overnight (sleep) readings dropping as low as 108/64. During the day I get a range of readings from 118/68 (evenings) - 160/76 (some midmornings) and have lately noticed a more consistent elevated morning pattern which I’d like to ask you about.

When I first awaken in the morning, my readings are from 130/70 to 140/74, with occasional ones of 124/68 in there as well. Following periods of rather intense/analytical morning computer work, my blood pressure rises to levels of 150/76 to 160/78 and, now and then, it will remain there for 30-60 minutes (and sometimes will be at 150 for as long as 2 hours) after the computer work has completely stopped and I sit quietly at my desk reading and relaxing (I work from home so it's easy for me to take repeated readings while resting at my desk; I'm also certain that I become anxious about those elevated readings, which likely causes them to remain elevated longer than they would otherwise.
My blood pressure then tends to settle after that initial morning period of elevation and will subsequently be between 130/76 - 138/74 for the rest of the morning and afternoon, with several readings also in the 125/73 range (my diastolics are always fine) and with others from 136/76 - 140/72 throughout the day.
In the evenings, while I will sometimes record lower results of 115/70 - 125/72, I can typically depend on evening readings of 126/76 -134/74, with occasional quite-low ones of 112/70 (but that’s less common, perhaps once every week or so).

So, Doctor, it’s those fairly regular early-morning and mid-morning periods of elevated readings from 150/78 - 160/78 (i.e., those elevated readings don't happen every morning but likely a few days per week) , which last from 30 minutes to a maximum of a couple of hours of 150/78, before dropping to normal levels, that have me wondering whether I should be concerned or considering medication. On the positive side, it’s apparent from the ambulatory results that my overnight readings do drop nicely to the 108 area so I know that my blood pressure is not chronically or consistently high and I also know that, often during the day and on many midmornings, the readings are in the 122/78-136/74 areas, with near-daily, lower results of 119/68 - 125/70 also reported.
There’s no question that I’m sometimes getting a bit intense as I work on these computer issues and that, when I do see a couple of higher readings, I become anxious about them and thus prevent their quicker dropping.

Please let me know your overall assessment.
Thank you.

 

Expert:  Dr. Anil Kumar replied 1 year ago.

Hello,
Thanks for providing more information.


Sorry for late reply and inconvenience.

At your age(61) , the minimum blood pressure should be 121/83 mm Hg, and the maximum blood pressure should not exceed 147/ 91mm Hg.

As you describe you have morning surge of Blood pressure .
As blood pressure is constantly changing, depending on activity, position, mental state, and even the time of day (blood pressure is lowest during deep sleep, but often peaks during the early morning hours).

 

There is a variation of blood pressure readings throughout 24 hours in a normal person. Usually there is a -
morning surge i.e. increase in BP in the morning
nocturnal dip - a dip in BP at night.
Usually a difference of 10-15% BP is normal. But a dip more than 15% might need medication or further investigation.
Mental or physical stress can result in blood pressure fluctuations.
Having a hot drink also changes it. It can increase after meals.
Also blood pressure should be monitored with patient in lying down position with sphygmomanometer at the level of the heart.
Also the reading should be from a mercury based sphygmomanometer as it gives best reading as compared to electronic instruments.

 

Now main question is regarding start of medication.

Well as you have normal blood pressure throughout the day except sometimes spikes in BP in morning.

So at this stage, dietary and lifestyle modifications should be considered for few weeks before starting medications.

Specific diet-(DASH DIET).
For further reading -
http://www.justanswer.com/health/www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Do regular exercises like walking, etc 30-45 minutes a day.

Yoga, deep breathing exercises, meditation give you good results.

Also take short breaks of rest while doing work on computer.

Hydrate yourself with plenty of fluids.

I would advise you to see your doctor for further investigations like blood cholesterol levels, EKG ,Chest auscultation for further evaluation and management.



I hope this helps.
If you have any further query then feel free to ask.
Positive feedback and bonus are highly appreciated.
Thank you.

Customer: replied 1 year ago.

Thanks for the reply, Doctor.


 


I do have good cholesterol levels, had a recent 24-hour Holter monitor and do use a high quality mercury-filled sphyg in addition to a high quality, portable electronic one.


 


With regard to your comment, "As blood pressure is constantly changing, depending on activity, position, mental state, and even the time of day (blood pressure is lowest during deep sleep, but often peaks during the early morning hours)."


 


...and, as it relates to my own situation where I have many, many good readings during the day (120-136) and as low as 108 overnight, would you please address the significance of my occasional midmorning elevations of, say, 150/78, lasting for an hour or so, and with also the occasional 160/78 (at that level, it's due to stress; that is, whenever my blood pressure gets to 155-160, it is virtually always due to mental stress/anxiety and is not a chronic BP situation and it would not stay at 160 long, before dropping to 150, where it might remain, as noted, for an hour before becoming normal).


 


1. Re. the midmorning 150/78 which could last for an hour or so, is that a large concern or is it considered fairly normal for that to happen if I am intensely engaged in a work-related computer project and if the blood pressure subsequently falls after one hour to normal levels?


 


2. And re. my less common result of 160/78, which is stress-related, is that a large concern or, again, is it considered fairly normal for stress to do that now and then as indicated above, with the pressure falling within a few minutes to 150, where it might stay for 1/2-1 hour?


 


Thank you.

Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Thanks for the follow-up.
Firstly you should try to change your working schedule to see if this surge in blood pressure related to your work stress.
If you have still high blood pressure even after relaxing in morning then you may require low dose of anti-hypertensive medications directed to be taken early morning.
Usually occasional mid morning high blood pressure in your case can be related to stress.
If it continuously persistent for few weeks then consult your doctor for further clinical examination.

I hope this helps.

Positive feedback and bonus are highly appreciated.
Thanks.
Customer: replied 1 year ago.

Doctor, I don't think you directly answered this question; could I ask you to do that for me, please:


 


"Re. the midmorning 150/78 which could last for an hour or so, is that a large concern or is it considered fairly normal for that to happen if I am intensely engaged in a work-related computer project and if the blood pressure subsequently falls after one hour to normal levels?"


 


Thanks, Doctor!

Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Yes,it's common to get some rise in blood pressure when you are intensely engaged in work.
So it's normal if it occurs occasionally as you have described.


I hope this helps.

Positive feedback and bonus are highly appreciated.
Thanks.

Dr. Anil Kumar, General Physician
Category: Health
Satisfied Customers: 6537
Experience: M.D. with over 30 years of experience in practice.
Dr. Anil Kumar and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.

Doctor, as I re-read your answers, I'm somewhat confused by a part of your reply and would appreciate a clarification.

 

You stated:

 

"If you have still high blood pressure even after relaxing in morning then you may require low dose of anti-hypertensive medications directed to be taken early morning.
Usually occasional mid morning high blood pressure in your case can be related to stress.

 

Doctor, since my recent 24-hour ambulatory-monitor average was an acceptable 138/74--and since I get so many other readings during the day in the 120-134 range and even much lower ones overnight--I'm wondering why you suggested even the possibility of medication at this stage, given that I have so many normal readings in the course of the day.

 

1. Please explain that to me.

 

Also, you added:

 

"Yes,it's common to get some rise in blood pressure when you are intensely engaged in work. So it's normal if it occurs occasionally as you have described."

 

Again, Doctor, I'm wondering why the realistic possibility of medication for me was raised if, as you noted above, even my most elevated readings are simply attiributable to that "...normal (rise) if it occurs occasionally as you have described."

 

2. Therefore, please also describe the medication possibility in light of my above point. (I.e., if it's a normal rise as you state, then why treat it?)

 

3. Is it therefore possible and realistic--even if my elevated, morning readings were to remain exactly the same as I described them above and if they continued that pattern indefinitely--and for the same duration--is it possible and realistic that I would not require medication at all based on those readings because so many of them, during each day, fall into the "normal" range?

 

Thank you, Doctor!

Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Persistent high blood pressure more than 150/100 mm Hg for more than 1-2 weeks may require medications even if it's related to work stress.
Sometimes work stress is so intense that blood pressure can go up high than 160/110 mm Hg resulting symptoms like lightheadedness,headache and can be serious.
So at your current stage,you may not require medications if you have rise in blood pressure occasionally.
As i have mentioned in previous replies that occasion rise in BP is normal and it's good to not worry about it.
If you have no other medical issues then you are in good health and keep your lifestyle active.
Yes,you would not require medication at all based on those readings because so many of them, during each day, fall into the "normal" range.

I hope this helps.
Customer: replied 1 year ago.

Thanks, XXXXX XXXXX final point of clarification with regard to your answer regards XXXXX XXXXX definition of "persistent" when you say, "persistent high blood pressure more than 150/100 mm Hg for more than 1-2 weeks..."

 

Am I correct that, by "persistent", you mean consistent and chronically high readings that do not tend to fall below that 150/100 level at all during the day...and that my morning elevations of 154/78, even if they occur almost daily, do not fall into the "persistent" category of concern because they always fall and I also have so many other "normal" readings during the rest of each day?

 

(By the way, thank you for your detail and patience; you definitely deserve a bonus.)

 

 

 

 

 

Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Yes,this persistent means consistent and chronically high blood pressure readings that don't tend to fall below 150/100 mm Hg during the day.




I hope this helps.

Positive feedback and bonus are highly appreciated.
Thanks.

Dr. Anil Kumar, General Physician
Category: Health
Satisfied Customers: 6537
Experience: M.D. with over 30 years of experience in practice.
Dr. Anil Kumar and 7 other Health Specialists are ready to help you

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