Hello, I’m a healthy, 61-year-old, fit and active male on no medications and would very much appreciate some guidance in determining whether I should be on blood pressure medication. My diagnostic problem is that my readings are all over the map, making it difficult to ascertain an average. On one occasion, I can get repeated readings of 125/72 - 133/76 for much of the day (with a few mixed in of 150/85), while the next day the readings could more frequently be 145/84 - 150/84 for much of the day (with a few of 160/86 thrown in but also with a few in the normal range of of 128/75-136/80...so those normal ones do invariably appear. That is, each and every day, I do get readings at some point during the day of, for example, 128/72 (every few days I’ll see 118/65). So the pressure is definitely not up “chronically”. I’ve become confused by the two primary medical opinions I’ve encountered regarding when to intervene with medication. Some doctors have written that they’d medicate when blood pressure is “consistently or chronically above 140/90 or 140/85". That appears to not be my situation, since–-even if the BP is 160/86 for a few hours of home readings while sitting –-I can always get readings (that day) of, say, 126/73 or, if not that low, of 133/74. Or, I can go a few days with heightened emotional arousal when the BP will be up much more than down (145/80), but then go several more days when readings are consistently more like 133/74. So, by that ‘chronically and consistently high’ approach/definition, I interpret it to mean that I would not require medication. Other opinions, though, stress that the ongoing blood-pressure “average” is key and that, if that average reading is over, say, 140/90, medication is recommended. And that’s where my emotional makeup makes it difficult. My problem in getting an accurate average reading is lability and volatile readings: because I tend to get very anxious even during some home readings (especially if they start off higher or if I haven’t taken them in a while and am anxious about the result), it has become very difficult to get an accurate idea of what my ‘average’ blood pressure might be. I’ve had 24-hour ambulatory sessions but get so intense during them that they are significantly higher than my home results (which are taken on a variety of quality, calibrated units, both automatic Omron models and a desktop Baum mercury unit; also, my left and right arms have very similar pressures). So, while every day I might sit down and get several readings of 156/86, I do know that, at some point in either that session or later in the day or for sure the next day, I’ll also get many readings of 128/73 - 136/80...so there is no question that the higher readings do fall and do not remain consistently elevated. In addition to welcoming your comments regarding my above circumstances, my questions are: 1. Given that my BP always typically falls (sometime within minutes, sometimes within hours and occasionally not for a day or so) from, say, 150/80 to the normal range of 128/72 - 135/80 and, at times, to 118/66, is it reasonably safe to say that I do not, at this time, require medication? 2. Generally speaking, which approach to prescribing blood-pressure medication do you favor for your patients: based on the “average” readings (as noted above, almost impossible in my case) or the “consistently above 140/90 or so” cutoff? 3. For those doctors who prefer the “consistently above 140/90" definition, what would the likely definition of “consistently” is? That is, if I have 6 readings during the day of 148/78 and 3 of 130/72, would you suspect I should be considering medication...or does the mere fact of the inevitable daily drop to that normal range of 130/72 rule out chronic hypertension? Thank you very much!
I have no other medical problems and, as noted in my query, am taking no other medication.
My doctor has, to this point, not recommended medication.
I have no objection whatsoever to taking BP medication and, to my knowledge, did not suggest that I did. Rather, it simply has not been recommended by my doctor and I am wondering whether it should be...and thus would like to get your opinion regarding the specific questions asked in my inquiry.
As an example of a typical day, upon awakening this morning, my blood pressure was 134/70 but, an hour later when I began taking a few readings, was mostly around 150/82, where it mostly stayed for the next few hours as I worked on a computer project.
Then, in midafternoon, I got readings ranging from 118/64 to 124/70 to 139/72.
Does the additional information I provided allow you to answer my question?
Could I ask you which part of my presented BP pattern causes you the greatest concern and results in your suggestion that medication is required? I'd like to be able to discuss this with my doctor in case she is not convinced. In the past, I believe it was the fact the my BP always dropped to a normal range that prompted him to avoid the medication prescription. Why do you feel this is a potential harmful situation?
Also, would you mind addressing the question I'd included in my query:
"Generally speaking, which approach to prescribing blood-pressure medication do you favor for your patients: based on the “average” readings (as noted above, almost impossible in my case) or the “consistently above 140/90 or so” cutoff?Generally speaking, which approach to prescribing blood-pressure medication do you favor for your patients: based on the “average” readings (as noted above, almost impossible in my case) or the “consistently above 140/90 or so” cutoff?"
Finally, doctor, does much of today's blood-pressure medication do the job with few (or no)side effects or is that always an issue with this type of medication?