# Can we talk blood pressure?



## Janderso (Sep 21, 2020)

I’ve been struggling with high blood pressure these last few months.
I know, diet and exercise will solve all my problems. Meanwhile, it’s too high.
I was on a beta blocker for years, it quit working. My BP spiked and my pulse went to 50 and below.
Now I’m taking Amlodipine twice a day. 2.5 m. Per dose.
When I got home today from work, my ankles are swollen and my BP was 169-89.

I have struggled with calcium blockers and ace inhibitors.
What works for you?
Thanks for your help.
Jeff


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## alloy (Sep 21, 2020)

I'm on Linsopril 30 mg per day.  

I sometimes have of high pressure and then low.  Occasionally  when I stand up I get light headed.  They are still working on it trying to get t figured out.

So far the Linsopril work the best for me.


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## higgite (Sep 21, 2020)

Janderso said:


> ........
> I have struggled with calcium blockers and ace inhibitors.
> What works for you?


A good cardiologist. 

Tom


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## Janderso (Sep 21, 2020)

higgite said:


> A good cardiologist.
> 
> Tom


I have thought maybe it’s time.
I see a physician’s assistant.
I keep asking for a new direction and she wants to increase the same med.
Swollen ankles says no.
I see her in the morning. I should just ask for a referral to a real doc.


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## benmychree (Sep 21, 2020)

Yes, Jeff, good advice!  I finally asked my MD for a referral to a cardiologist; less than a month later, I was on the "table" for a bypass surgery, BP, cholesterol all in the low normal now; my MD was conservative with drugs, the specialists do not shrink from ordering drugs that work, as long as insurance pays the bill.  I take several drugs for BP, a beta blocker (Metaprolol),  Hydroclorothiazide (diuretic)  and Benazapril.


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## westerner (Sep 21, 2020)

30mg lisinopril, 18 mg hydrochlorothiazide is working well for me. Only recently went to this dose, from 20/12.5 that I was on for 15 years. 

Recent audits/exams suggest that retirement practice (3 months off) may hold the key to lasting improvement.....


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## westerner (Sep 21, 2020)

My Doc put me on  Amlodipine  as a trial, a year or so ago. The swelling was immediate and disconcerting, at least to me. He downplayed it, and was reluctant to simply increase my lisinopril/HCTZ dose. I insisted that the swelling was unacceptable. He agreed to the current therapy, and now agrees that it is doing what needs to be done. 123/78 is a good 'average' reading lately. I have a good cuff at home, and check enough to gain a reliable sample database. 

I truly believe that my retirement will go a long ways to lower BP in and of itself. We shall see, very soon


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## Z2V (Sep 22, 2020)

The lisinopril/HCTZ works for me. 20/12.5 x 2 each day. If I can stay on an exercise routine I can cut it down to one a day but my old junk joints make that hard to do.


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## silence dogood (Sep 22, 2020)

Jeff,  get a full physical pronto.   I had high blood pressure,  my cholesterol was too high, and what ever else that was wrong.   A month before my next appointment, woke up from a three day coma.  In the EM ward where my wife brought me, they told her that she will be a widow.  My blood glucose level was over 1100.  My body just was not producing enough insulin.  I got the take shots and what ever that needs to be done.  Once, the diabetes was under control,  all the other problems including high blood pressure got back to normal.  Do what you got to do and don't put it off.


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## Aaron_W (Sep 22, 2020)

Janderso said:


> I have thought maybe it’s time.
> *I see a physician’s assistant.
> I keep asking for a new direction and she wants to increase the same med.*
> Swollen ankles says no.
> I see her in the morning. I should just ask for a referral to a real doc.



It is the person not the paper, PA's can be great because they often come from a background at a more human level, nurse, paramedic, military corpsman etc where they learned to listen to the patients concerns. This does not sound like one who has developed those skills.

If you are not happy with your "doctor" ask to see someone else, but don't believe that having an actual MD instead of a nurse practitioner or PA means you are getting a better care giver. The MD has more formal education, but may have less practical experience. 
Specialists are another thing entirely. When I was younger I bounced around several doctors for some intestinal issues, when they finally sent me to a GI specialist he had narrowed it down to a small number of options within minutes, none of which involved the phrase "you just need more fiber in your diet" (I didn't) which was all that several of the previous doctors had focused on.  


It is a huge turn off to me when I have a doctor that give me a canned answer or responds in a way that indicates they were not paying any attention to what I was saying or giving any weight to my concerns.

I'm dealing with this currently, I changed insurance plans so had to get a new doctor. They assigned me a nurse practitioner, nice lady but she is a serious pill pusher, and I am not a pill taker without good cause and she has no interest in discussing why. I will find another, someone who provides options and will discuss the advantages for each. I liked my last doctor, drugs were always his last option.


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## mksj (Sep 22, 2020)

It boils down to the the therapy is unique to each person and their lifestyle (and compliance). I am not a big fan of Nrvasc (amlodipine) but it is frequently perscibed as a first line agent. Swelling of the legs and ankles is a common side effect.  In either case, it takes many days for people to stabilize on a new treatment regiment for HTN.  There are also ethnic and genetic differences between individuals so too say XYZ drug works for me, may not be appropriate for you. Edema in the legs is usually an indication that a diuretic is needed typically I use them in addition to an ACE or ARB, but I recommend you get a full cardiac workup. I would get a referral to a cardiologist, as there may be other cardiac pathologies that need to be evaluated, and/or a different combination of HTN medications.


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## savarin (Sep 22, 2020)

Type 2 for 20 years, high blood pressure, high bad cholesterol.
Meds stopped working, insulin was the next step but I didnt want to go there.
I went on a strict Ketogenic diet.
Within 4 weeks I had to reduce all the meds, after 12 weeks I had to stop all the meds.
Lost 25 Kg but plateaued at 93Kg.
I stayed on the diet for two and a half years and felt great and no meds.
Last christmas I started eating the so called normal diet, I'm now back on 2x diabetic meds, 1x blood pressure and 1 statin and putting weight on.
I WILL re start keto pretty soon as it really improved my general health all over.
I believe it will be difficult for americans to do this diet as its no sugar or carbs in anything.
Its worth looking into but finding a doctor who will believe in it is very very difficult.
I was lucky and found 2 of them.
Keep taking what they prescribe you but start keto and track whats happening.
If you do it properly it will do no harm.
Most people have to drastically reduce or stop their meds .
BUT, and its a big but, removing all the sugar, bread, pasta, rice potatoes etc etc is not easy for some  and if you cheat it takes a couple of days to get back into ketosis. (not to be confused with ketoacidosis)


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## fixit (Sep 22, 2020)

I'm  78 years old sleep 5 hours a night, donate platelets every 3 weeks, cholesterol 165, BP 128/60, pulse 58, O2 96%, hemoglobin 14,4. I take thyroid med, vitamin D3, 2 Tylenol 650 mg morning & night for arthritis. work in my shop or cut grass for some local widows 12 hours a day. I can still outwork most young folks. I have worked this way all my life, I retired 20 years ago but never stopped. I am afraid to stop.

fixit


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## WCraig (Sep 22, 2020)

I'll just add a couple of things.  I have moderate high blood pressure and significant family history of cardiac problems.  I did a suite of cardiac tests and was relieved that they didn't indicate any serious problems.

Re medication, my doctor said that there are 5 classes of drugs used to treat high blood pressure.  The initial dose of a drug tends to provide most of the benefit.  Increasing the dose often only gives a small incremental benefit.  Therefore, combining two classes is often more beneficial than increasing the dose of any particular med.  Each class has its own side effects and each person's tolerance is different.  Unfortunately, you need a few months to really see how a new med is working.

Even better than meds, though, is making the changes in diet, exercise and lifestyle that reduce or eliminate the need for meds.  Even a few pounds (kilograms) of weight loss can make a difference.

BTW, I've become a big fan of the Apple Watch.  (Only works with iPhone, though.)  It measures my heart rate regularly during the day and will provide alerts if it is dangerously fast or slow.  It provides gentle reminders prompting me to be more active and keeps track of my exercise.  It doesn't measure blood pressure directly, but it is simple to transfer the reading from my Omron cuff to the iPhone.  The phone makes it easy to review trends in my blood pressure...and show the doctor.  When I went for my cardiac tests, I noticed that the technician was wearing an Apple Watch.  She said that the Watch measurements were bang on with testing equipment in their facility!

HTH

Craig


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## Papa Charlie (Sep 22, 2020)

I have two stents in my heart and did have high cholesterol. I take a statin and to protect my heart I take a mild blood pressure med. My left ankle will swell by the end of the day if I am on my feet too much or if I sit with my foot not flat on the floor. I have a bad habit when sitting at the desk of rolling my foot onto its side, which restricts the blood flow. All a sign of poor circulation in my leg. I have gotten my cholesterol under control by taking fish oil and flax seed oil daily. I take three capsules each in the morning and at night. The meds were never able to put my cholesterol where it belongs, but the oils have it down to a young mans level.

Jeff,
Bottom line, you need to get checked out by a doctor, preferably a cardiologist. They may call for a stress test, where they put you on a tread mill all wired up. But you need to get checked out properly. This forum is not the place for medical advice other than as stated by others, you need to see a cardiologist.

You have just decided to stay in your home, let's make sure you can enjoy it.


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## Janderso (Sep 22, 2020)

Papa Charlie said:


> You have just decided to stay in your home, let's make sure you can enjoy it.


These are my thoughts.
I appreciate the opinions. I know we are all different and IU would not ask my PA for a specific drug based on this site. It is interesting to compare and see what has worked for some of you.
I agree, losing a few pounds does make a difference.
Regarding fish oil for cholesterol, I take prescription Lovaza, It's a highly refined fish oil. It works great. My insurance wanted me to go on Lipitor. I stick with the benefits of fish oil.
I just know I need to get the BP down. It's too darn high.
The good thing, I just had an eye exam and the doc said there is zero evidence of capillary damage from high BP.
That's good.
Thanks guys,


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## ACHiPo (Sep 23, 2020)

savarin said:


> Type 2 for 20 years, high blood pressure, high bad cholesterol.
> Meds stopped working, insulin was the next step but I didnt want to go there.
> I went on a strict Ketogenic diet.
> Within 4 weeks I had to reduce all the meds, after 12 weeks I had to stop all the meds.
> ...


Carb restriction certainly is the key to weight loss for me as I find a little carbs leads to a lot more carbs.  I had great luck with a Paleo diet--not as restrictive as keto as it allows fruits, although there can be quite a bit of overlap.  Like everything it only works if you stick to it, however, and the pandemic has given me an excuse to fall off the Paleo wagon.  

What amazed me after about 18 months on Paleo with bacon, butter, etc. (all the things that are supposed to be bad for you), my lipids were better than ever.  It really does make me question conventional wisdom of the evil of fat vs. sugar/carbs.


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## Janderso (Sep 23, 2020)

The only thing that concerns me about that kind of diet is the lack of fiber.
I am a carb addict.
Breakfast is always protein-fat-eggs, cheese, bacon on an english muffin. 8 hours later I eat my carb lunch.
Apples, mango, strawberries (fruit) greek yogurt and granola. =LOVE THIS. been eating this lunch for ten years.
Dinner is always healthy and well balanced.
Carbs for dinner = Coors light too. Only 2-3.  A man has to have a vise.
My cholesterol is great, we rarely eat meat for dinner. If we do it's chicken or fish.
You would think with this diet I wouldn't weigh 215 lbs. I am 6 feet though. Lean, good looking 
Ah hell, my modeling days are long gone.
I'm off on my daily walk......


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## ACHiPo (Sep 23, 2020)

Jeff,
Fiber can be an issue--it's amazing how much kale, etc. you need to eat to get the 27g of recommended daily fiber!  I eat 1-2 Quest protein bars per day that have 10-12 g of fiber.  Not technically Paleo, but pretty clean and satisfy cravings for chocolate, etc.









						Protein Bars
					

Quest Protein Bars are available in a variety of flavors. Each bar packs 20-21 grams of protein with minimal net carbs and sugar. From chocolatey indulgence to fruity favorites, there’s a flavor for every craving.




					www.questnutrition.com
				




Evan


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## Janderso (Sep 23, 2020)

I HATE KALE


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## westerner (Sep 23, 2020)

ACHiPo said:


> It really does make me question conventional wisdom of the evil of fat vs. sugar/carbs.


Do you know why they call it 'Practicing' medicine?

Cuz they STILL aint got it perfected


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## savarin (Sep 23, 2020)

ACHiPo said:


> Carb restriction certainly is the key to weight loss for me as I find a little carbs leads to a lot more carbs.  I had great luck with a Paleo diet--not as restrictive as keto as it allows fruits, although there can be quite a bit of overlap.  Like everything it only works if you stick to it, however, and the pandemic has given me an excuse to fall off the Paleo wagon.
> 
> What amazed me after about 18 months on Paleo with bacon, butter, etc. (all the things that are supposed to be bad for you), my lipids were better than ever.  It really does make me question conventional wisdom of the evil of fat vs. sugar/carbs.


Same here, fibre was not a problem as I boosted it with various bran type fibres in very very low carb breads.


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## DavidR8 (Sep 24, 2020)

Janderso said:


> I HATE KALE



There’s a little known secret to cooking kale. 
To bring out the flavour and take away the bitterness it needs to be massaged before cooking. 
Strip the leaves from the stem and roll them into balls in the cutting board or in hands. 
The colour will change to a deep green before your eyes. 
And the bitterness will disappear. 


Sent from my iPhone using Tapatalk


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## savarin (Sep 24, 2020)

I never knew that I will give it a try, thanks


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## vtcnc (Sep 24, 2020)

Janderso said:


> The only thing that concerns me about that kind of diet is the lack of fiber.
> I am a carb addict.
> Breakfast is always protein-fat-eggs, cheese, bacon on an english muffin. 8 hours later I eat my carb lunch.
> Apples, mango, strawberries (fruit) greek yogurt and granola. =LOVE THIS. been eating this lunch for ten years.
> ...



Exercise? Otherwise, I’d say you are one of the lucky genetics lottery winners.


Sent from my iPhone using Tapatalk


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## Janderso (Sep 24, 2020)

DavidR8 said:


> There’s a little known secret to cooking kale.


Yeah, from the skillet to the compost bin


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## higgite (Sep 24, 2020)

The only kale I ever cared for was spelled with a "C" and drove a race car. 

Tom


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## Shootymacshootface (Sep 24, 2020)

I have been on blood pressure meds for years and my bp has been well controlled. This summer I started using a cpap machine, and a week or two into my sleep apnea therapy I started feeling light headed and dizzy, especially when standing up. It turns out that my bp was now too low. I just had to have a lower dose of my bp meds to fix the low bp.

Just something else to consider. If you snore at all, and are over 40, you probably have sleep apnea.


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## vtcnc (Sep 24, 2020)

I stopped drinking last year and a sleep study resulted in me being on a cpap as well. Cardiologist recommended all of this and my AFIB is all but gone. AND I pop out of bed in the mornings well rested, no more headaches due to low pulse oxygen levels. Best thing I ever did.


Sent from my iPhone using Tapatalk


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## Janderso (Sep 24, 2020)

vtcnc said:


> I stopped drinking last year and a sleep study resulted in me being on a cpap as well. Cardiologist recommended all of this and my AFIB is all but gone. AND I pop out of bed in the mornings well rested, no more headaches due to low pulse oxygen levels. Best thing I ever did.
> 
> 
> Sent from my iPhone using Tapatalk


How much were you drinking?
The reason I ask, I was diagnosed with sleep apnea. I don’t have it any more.
Breathing excersizes and I walk everyday.
I just checked my blood pressure. 143 78.
I took my first water pill today. Not a big deal, low dose.
Im gonna lose ten lbs. and I will be in tip top shape.


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## vtcnc (Sep 25, 2020)

Janderso said:


> How much were you drinking?
> The reason I ask, I was diagnosed with sleep apnea. I don’t have it any more.
> Breathing excersizes and I walk everyday.
> I just checked my blood pressure. 143 78.
> ...



I was consuming 1-2 beers some weekday evenings, 3-5 on some weekend days. Not a lot in one sitting but too much over the long haul. 

I started meditating daily as well and breathing I think helped too. Lastly, I started to take a supplement for sleep L-Theanine. I was very skeptical but notice a difference in calm and quality of sleep.

I digress. My sleep apnea is pretty severe and I’m not obese...5’-11”, 205# - but that is a matter of opinion. But my study resulted in more than 25 apneas per hour on average. One hour had over 100 apneas. With the mask that has been reduced to 2 per hour. 

I’m hoping if I shed the excess weight and can start exercising regularly - someday the apnea will go away away too.


Sent from my iPhone using Tapatalk


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## Janderso (Sep 25, 2020)

vtcnc said:


> L-Theanine


Interesting, I'll have to check that one out.
The apnea numbers are scary. You never really sleep.

My 88 year old mother went to a new doctor yesterday. When discussing her blood pressure, the doc said it depends on where in the world you are located.
According to him, the British theory of high BP is over 170. I thought that was interesting. He mentioned another country that considered normal around the 140 range.
My BP last night after work was 141-79. That's better.
I started taking a mild diuretic yesterday. I had to go a little more than usual but I wasn't running to the bathroom as I have heard others describe the process.


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## Papa Charlie (Sep 25, 2020)

Janderso said:


> Interesting, I'll have to check that one out.
> The apnea numbers are scary. You never really sleep.
> 
> My 88 year old mother went to a new doctor yesterday. When discussing her blood pressure, the doc said it depends on where in the world you are located.
> ...



That is the sad part of this. I believe that a lot of the medical standards that they work to (What is Normal) is based on the pharmasutical companies desire to sell drugs and the kick backs that they give out.


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## Janderso (Sep 25, 2020)

Unfortunately Papa Charlie old boy, you are right.
Between insurance and the drug companies, I don't think we are getting the best care for the best price.


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## mikey (Sep 25, 2020)

Papa Charlie said:


> That is the sad part of this. I believe that a lot of the medical standards that they work to (What is Normal) is based on the pharmasutical companies desire to sell drugs and the kick backs that they give out.



While I respect your opinion, the reality is that blood pressure standards are based on data and have nothing at all to do with the pharmaceutical industry kicking back, especially to doctors in the field. And while I'm at it, if you are overweight, don't exercise or get adequate amounts of sleep, eat excessive amounts of salt, consume excessive amounts of alcohol and have the family genetics that favors HTN or heart disease then the ability of your doctors to influence events is limited. A physician can only do so much and a lot of it is up to the patient. 

Another point is that your doctor has only so much in his arsenal and he will choose the best medication regimen he can based on the patient's individual needs or condition; there are no perfect drugs or drug regimens. Given that even with perfectly controlled blood pressure, cholesterol, blood sugar and even with a negative family history of heart disease, a patient can still have a heart attack. So, it would be wise to consider that it may not be your doctor; it may be genetics and the confluence of other existing conditions that contribute to adverse events occurring that are beyond your doctor's ability to control. 

Quite frankly, the fact that life expectancy in this country is over 75 years of age is a testament to modern medicine and the people who provide our health care. If you must lay blame at someone's feet, I suggest to you that much of that lies at our own feet.


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## Janderso (Sep 26, 2020)

Mikey,
You bring up some good points. 
When you look around it seems so many people are on self destruct.


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## Papa Charlie (Sep 26, 2020)

Good points Mikey. We are our first line of defense and our home physician. I do suffer from excessive weight. I have tried many things to loose weight. Even went on a special diet for a year and lost 100lb. But when I went back to regular foods, I gained it back. I don't eat much, walk often, only use small amounts of Sea Salt and don't eat breads of any kind. It is just what I have to deal with. Not everyone can remain thin. I know some people that can eat anything and be never gain an ounce. On the other side of the proverbial coin, I can look at donuts and gain 2 lb.

I wanted to add to the discussion of your feet/legs swelling. As I said earlier I have the same issue. I wear pressure socks to combat that. They help with the blood flow. In fact they help so much that I wear them every single day. Make a world of difference if you are on your feet a lot.


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