Blood Pressure and Doctors

Some questions to ask yourself and GP....what is your diet like? Plenty of runners are fit and at a good weight yet eat crap and still have metabolic health issues. Diet is still far more important to overall health than running/exercise. Second, what are your other markers/blood tests showing? HDL/LDL levels, triglycerides, fasting glucose, inflammation markers..etc. At one point I was recommended BP meds myself, but have been able to avoid them after making changes to diet. It also helps to have a Doctor that will work with you on this. Treating the root cause is more important while most Docs want to just treat symptoms. Take advice carefully including this...you are the best advocate for your health!

BP readings after exercise are not useful in guiding treatment. Ask your doctor when she wants you to test.

It's your heart attack, do what you want. Howevere, please note that the American Heart Association just released new criteria for treatment of hypertension, and, based upon your vitals, you fall into the key at risk category of developing serious heart disease. But your doctor is probably an idiot since he only trained for seven years. I'd say stop taking the medication and have a MI, they're not that bad, or maybe don't because you need it.

My apologies, I realise I have misrepresented my BP after two days on the medication. I was getting readings of 90/60 or slightly less. That is extremely low, yet when I go to the doctors to have it measured, it will nearly always read slightly high. No idea why I wrote that figure wrongly.

When on the medication at the prescribed dose, with the low blood pressure, I felt pretty terrible and unable to train properly.

The doctor seems unable to take into account anything other than the slightly elevated bp reading taken by her in her surgery, and I am afraid of being over-medicated.

Diet contains no fast food or alcohol or coffee.

Okay, so a couple of things any systolic pressure over 130 and any diastolic over 80 indicates you're at risk for heart disease. You may notice a slight increase due to exercise, but your heart, kidneys, and brain work very hard to keep your blood pressure very close to a normal window. If you take pressure readings after exercise and think they're faulty then I recommend you take them any time other than after exercise. As for the medication lowering your blood pressure, there is a common expression that I think applies here and it goes, well no explitive Sherlock. As for the side-effects, yes there will be some with most if not all medications. You can likely ask your physician to try other medication, but they will likely all have some side-effects, but the side-effect of no treatment is a heart attack. Ultimately if you don't like your doctor's advice go to another one, but they'll probably tell you the same thing.

I have attached an article that explains why runners need to be concerned about heart attacks more than the general population. There are also numerous sources on PubMed, but most of the general population won't have access to or understand the results and discussion, but feel free to search them out on your own.

https://www.outsideonline.com/1923831/runners-ticking-time-bomb

Thanks. Interesting to read that athletes are at risk of death, as compared to the general population who are presumably not...

I'm actually interested in any academic standard research of treating those who exercise fairly regularly with BP medication.

I don't feel good when my BP is 90/60. I have trouble with dizziness in the mornings, my vision is blurred for an hour or so after getting up, I feel weak and I have no energy. One 2.5mg tablet seems to last me at least 3 days, sometimes more, so that my BP does not exceed 120/80 and the only times it exceeds that are if I eat very rich food, or following exercise for about 1n hour and a half, or on going to the doctor's surgery to get it measured.

My doctor seems unable to take in or process that information. Its one size fits all, sweeping statements.

I simply can't take 2.5mg Ramipril every day. Its too much for me, I get too many side effects, it makes me feel like an old, weak person and I basically can't function. I was previously on a different class of drug and that made me feel even worse. It makes me feel so bad that I feel like a totally different person, who struggles to do the normal day to day things in life. I also seem to develop trouble with digesting Vitamin B when I take a daily dose of that stuff.

FWIW I'm a retired middle distance runner, not international standard, who still exercises to some extent every day and does one or two interval sessions a week, nothing is very long and I never was a long distance athlete.

It's called white coat syndrome. You don't have high blood pressure. Your blood pressure is supposed to go up when exercising and then go back down to ' "normal" at rest.

Lab Coat pressure wrote:

It's called white coat syndrome. You don't have high blood pressure. Your blood pressure is supposed to go up when exercising and then go back down to ' "normal" at rest.

White coat syndrome is indeed real. If you're anxious about anything there's going to be a temporary increase in BP, it's a natural response. Now, if you're checking yourself after resting for a bit and say your 160/95, yeah that's a problem. Check yourself at random times, as I have in the past. I'd get super anxious before seeing my endo and my BP would be anything from 125-145/80s usually. I could feel it. That anxiety restlessness in your stomach. My Doc expressed an understanding of my nerves and said my heart was always in perfect rhythm and just to check it routinely in different scenarios. I've been told, if you really had high BP even accounting for nerves, BP would register much higher in most cases than a slight increase. As long as your metabolic blood panel is clean and your heart is beating appropriately, I'd chalk it up as classic white coat.

I am a specialist in kidney disease and treating hypertension (but then again, this is LRC where anybody can be anybody).

You need to keep a BP log of recordings done at home - early AM, midday, PM but not just after you exercise. Also BP recording when you feel bad. Take this log and show your doc. This would be infinitely more valuable than a one time reading in the office.

Your initial post seems to be complaining that your doc wants to do blood tests on you. That would be practicing good medicine, screening for diabetes, kidney disease, etc.

What nationality/race are you? Your English doesn’t seem to be American. Certain races are more susceptible to heart disease/HTN. Also there are many different classes of BP med, and an ACE inhibitor like Altace/Ramipril is not necessarily first line therapy.

runningrummie wrote:

https://www.outsideonline.com/1923831/runners-ticking-time-bomb

This article talks about 1,860 athlete deaths over the past three decades. That's a ticking bomb? Good grief.. in a nation where 20 states have counties with adult obesity rates over 40 percent, running too much does not seem like the problem upon which to focus w/ regard to blood pressure.

Speaking as a family physician that likes to gear themselves more towards athletes and is more "conservative" minded when prescribing medicine - blood pressure oscillates through out the day depending on activity, sleep, stress levels, anxiety, etc. Hypertension requires 2 separate readings in conjunction with readings at home to truly diagnose hypertension. Now, if your walking into the office with 200/110 - thats a different story. The real concern with elevated BP (besides all the risk association issues) is arterial injury over time and renal (kidney) injury over time. These don't develop over night. I explain to people that if you control your diet, lose weight, exercise, etc etc and I give you 3-6 months before talking about initiating medication.

Here is my reasoning for that - once I start you on a medication - besides the side effects that most physicians won't tell you, most people will never come off of that medication for two reasons: 1) Most people see it is as a "need" and are scared of coming off it 2) Most physicians will not have the balls to pull you off of it despite your blood pressure being normal month after month and you losing weight, changing diet, etc.

Unfortunately, a lot of physicians especially the typical Type A personality physicians are regimented and just treat numbers instead of patients with no regard for side effects. They don't always fully understand the disease process and just push medication.

I have found if you work with patients more and give them options and explain to them the actual disease process they are better able to make a decision rather than the approach of "I am the doctor, do what I say".

Unfortunately the reality is it is easier for most doctors to just add a medication and/or continue medicine than remove and educate or just educate and give people the opportunity to self-motivate rather than just add a medicine.

BP can be very easily controlled with meditation, deep breathing and diet modifications. Very possible metabolic syndrome may be more to blame. Some personality traits are also very susceptible to increase BP throughout the day. Ones BP fluctuates a great deal throughout the day, let alone sitting in doctors office and dealing with the stress there. By a good home BP cuff and take your BP consistently.

Pharma is pushing the docs to write more scripts.

Proper protocol for accurate blood pressure readings is for the patient to be at rest for 5-10 minutes. Than 3 readings, at least one minute apart should be taken. I always have higher readings at my doctor's office. The nurse, assistant, etc. usually takes one reading and rushes you into the exam room. Insist on multiple readings. The numbers will likely come down each time (assuming you don't have an issue). I run the protocol at home and take readings at varies times and my numbers are usually okay. I do limit salt intake, exercise and I eat a ton of fruits and veggies. Diet and stress management are key factors in keeping it low. Good luck.

How many times are you going to write: “I can’t take ramipril 2.5 mg every day...”

So talk to your doctor about taking 1.25 mg every day. Or change to a less potent ace inhibitor: lisinopril 5 mg daily would be about half the dose of ramipril 2.5 mg.

Source: Am Love Doctor

OP, can you answer the following?

How tall are you?

How much do you weigh?

How many miles per week do you run?

Using an incorrectly sized inflation cuff can result in a erroneous reading.

Why not diet changes instead of medication recommendation? When the pipes are clogged, no duh BP will rise, because the salt in take remains the same makes it more concentrated. salt is not at fault, processed food is

Neph wrote:

I am a specialist in kidney disease and treating hypertension (but then again, this is LRC where anybody can be anybody).

You need to keep a BP log of recordings done at home - early AM, midday, PM but not just after you exercise. Also BP recording when you feel bad. Take this log and show your doc. This would be infinitely more valuable than a one time reading in the office.

Your initial post seems to be complaining that your doc wants to do blood tests on you. That would be practicing good medicine, screening for diabetes, kidney disease, etc.

What nationality/race are you? Your English doesn’t seem to be American. Certain races are more susceptible to heart disease/HTN. Also there are many different classes of BP med, and an ACE inhibitor like Altace/Ramipril is not necessarily first line therapy.

I'm English.

I'm not overweight, I feel healthy as long as I don't take that damned Ramipril and every time I go near my doctor, she wants yet more blood. Blood tests never find anything wrong with me, probably because there is nothing wrong with me and I haven't complained of anything being wrong with me. I have no idea how I got into this cycle of being treated like this by health professionals. I honestly question whether some of them have some kind of Munchasusen's by Proxy going on.

The health system is the NHS, hence my one size fits all comments. In my experience, you are not treated as an individual, you are rushed and assumed to have certain conditions commensurate with your age or one symptom and treated according to a protocol mainly tested for and designed around overweight, sedentary people. Possibly with an aim of turning you into a sedentary person - my doctor constantly tells me to stop exercising whenever I go into see her. Asthma flared up - stop exercising. Recovering from flu - don't exercise for 6 weeks. etc..

I did a log at home and took the Ramipril twice during that week, 3 days apart. It showed very low blood pressure which rose slightly higher on day 3 after the Ramipril but after taking the Ramipril, it would drop ridiculously low for two days. However my readings can change quite dramatically depending on time of day, exercise timing and if I eat a big meal or not. I find I can achieve a very low reading by eating very little that day and relaxing in the evening following an interval session. ie a reading so low that it would be classified as too low. The log was filled in and handed to the doctor, but it seems to have been ignored. However my

I was previously on a minimal dose of an ARB inhibitor and that made me feel even worse.

The thought of yet another pointless blood test is already putting my BP up.

The Love Doctor wrote:

How many times are you going to write: “I can’t take ramipril 2.5 mg every day...”

So talk to your doctor about taking 1.25 mg every day. Or change to a less potent ace inhibitor: lisinopril 5 mg daily would be about half the dose of ramipril 2.5 mg.

Source: Am Love Doctor

I'm going to say it again because no smaller tablet size is available on the NHS for Ramipril. I'm not sure if the other medication is available on the NHS but apparently if you split the tablet in two, some terrible thing will happen. Likewise if you take it every few days as I would rather do, apparently some other terrible thing will happen. However, if i do take the stuff every day, after about five days I feel like death. I think I'd actually be suicidal if I continued taking that dose, it makes me feel that bad. I feel like I'm dying, I struggle to get out of bed in the mornings, struggle at work and can't exercise properly.

I've never had blood pressure as low as 80 over 55 in my life before and I don't see why I should suddenly have it forced upon me by medication at the age of 50. Its too low. 120/80 is better and that's what its around if I take one damned Ramipril every few days - the stuff is so effective.

I am being given this advice by medics who are generally quite overweight, unfit and who look in quite bad shape, who don't exercise and who don't have a good attitude towards exercise. I don't trust what they are telling me to do, because what they tell me to do is actually making me feel quite unwell when normally I feel great.

I don't have any issues with being overweight, metabolic syndrome, diabetes or abnormal blood test results other than slightly elevated cholesterol as mentioned on here. Its a mystery as to why all these blood tests are being ordered or what they are looking for. There seems to be quite a lot of imagination at work. And its not on my part.