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