6 Steps to Better Hypertension Treatment in Aging Adults

Have you been concerned about high blood pressure (hypertension)? Or are you worried about an older relative having a stroke or heart attacks?

You’re not alone. After all, hypertension is the most common chronic condition among older adults, and medications for blood pressure (BP) are among the most commonly taken drugs in the US.

Even more important: poorly controlled hypertension is a major contributor to the most common causes of death and disability in older adults: strokes, heart attacks, and heart failure.

So it’s certainly sensible for older adults – and for those helping aging parents – to think about blood pressure.

And once you start thinking about high blood pressure, you’ll probably start to wonder.

Are the blood pressure medications you’re taking enough? Is your blood pressure at the “right” level or should you and your doctors work on changing things?

And what about that major research – the SPRINT trial — that made the news in 2015? (In this study, older adults randomized to aim for a lower BP did better than those who got “standard” BP treatment. )

These are excellent questions to ask, so I’d like to help you answer them.

Now, I can’t provide exact answers on the Internet. But what I can do is provide a sensible process that will help you successfully address these questions.

In this article, I’ll share with you the process that I use to:

1. Assess an older person’s blood pressure management plan, and
2. Determine whether we should attempt changes.

If you’re an older adult, you can use this approach to get started assessing your own BP management plan. This will help you to better work with your doctors on assessing and managing your blood pressure.

If you are helping an older relative manage health, you can follow these steps on behalf of your relative.

But first, let’s review a few key terms related to blood pressure.

Key terms about blood pressure and hypertension:

• Systolic blood pressure (SBP): the “top number” when BP is checked.  This reflects the pressure in the arteries when the heart squeezes. It’s by far the most important number to consider when it comes to older adults.

• Diastolic blood pressure (DBP): the “lower number” when BP is checked. This reflects the pressure in the arteries when the heart relaxes.

• Pulse: the heart rate. Automatic BP monitors report pulse along with BP. Doctors must evaluate a person’s heart rate when considering a change in BP medication.

• Hypertension: Usually defined as BP> 140/90, assuming the readings are taken in a doctor’s office. (There is a slightly lower cut-off if the readings are taken at home.) If only the systolic BP is high, this is called “isolated systolic hypertension.” This type of hypertension is very common in older adults, as aging is associated with both increases in systolic BP and decreases in diastolic BP.

How to better measure blood pressure

As you can imagine, a key component of optimizing BP management is to measure an older person’s BP and pulse.

Measuring BP allows us to:

• Diagnose people with hypertension,
• Determine how severe it is (which helps us all decide how important it is to intervene),
• Evaluate how well people are responding to a treatment plan, whether that plan involves lifestyle changes or medication or both.

Measuring BP usually sounds straightforward.

People assume it’s just a matter of finding out what the BP was at the doctor’s office, or getting a reading from a home monitor, or maybe even a reading from a health fair or drugstore.

But in fact, research has shown that a single office-based BP reading often does not represent a person’s usual BP. One study even found that the “usual” way of measuring BP misdiagnosed 24-32% of volunteers!

This is because people are often anxious when at the doctor’s office, which can temporarily raise BP. Studies estimate this “white-coat hypertension” affects 10-20% of people.

Furthermore, BP is constantly changing a bit, moment to moment. So experts agree that it’s much better to obtain several readings and average them, in order to properly assess a person’s usual BP.

For instance, in the ground-breaking SPRINT trial of intensive BP lowering in older adults, the researchers checked BP by having participants first rest quietly in a room for five minutes. Then an automatic monitor checked BP three times in a row, with a one-minute interval between each check. The average of these three readings was then used to assess BP and make changes to hypertension medications, if necessary.

As you can imagine, this is not the way most people’s blood pressure is measured by their doctors.

So what’s better?

Currently, the “gold standard” for evaluating blood pressure is called “ambulatory blood pressure monitoring” (ABPM). It involves wearing a special monitor that checks BP every 15-60 minutes over 24 hours. The doctors then receive a report showing the average daytime BP and average nighttime BP.

Such monitoring provides excellent information for patients and doctors. In fact, research shows that ABPM is a better predictor of future cardiovascular events (e.g. heart attacks, strokes) than conventional office-based BP measurements are. However, ABPM is not yet widely available, since it requires special equipment and may not be covered by insurance.

So what is considered next best? Research shows that home BP measurements are better than “usual-care” office BP measurements. Meaning, home BP measurements correlate better to the BP that is measured if one uses the fancy 24-hour ambulatory monitoring approach.

Based on these facts, in 2008 the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association issued a joint scientific statement calling for home BP measurements to become a routine component of BP measurement in people with known or suspected hypertension.

They also suggested that clinicians review a week’s worth of home BP readings before making a clinical decision or changing a person’s medications.

(You can read the whole scientific statement, titled Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring for free! I especially recommend reading the abstract at the beginning, which summarizes the proven benefits of home blood pressure monitoring. You can also read the American Heart Association’s 2019 guidelines on measuring blood pressure at home here, in section 4.)

Now that I’ve made the case for checking BP carefully at home, let me share the six-step process you can use to assess your blood pressure management plan.

A 6 step process for assessing a blood pressure management plan

1.Obtain a high-quality home blood pressure monitor.

Why: Studies have found that home-based measurements are better than office-based BP measurements. They better reflect a person’s BP over 24 hours.

Notes: See “Choosing & Using a Home Blood Pressure Monitor” for more details on choosing a monitor. Be sure to get one that measures BP at the upper arm (those wrist ones are not accurate enough!). Ask your doctor for help validating that your home monitor is getting accurate readings.

2. Check blood pressure twice a day, every day for one week.

Why: Since blood pressure is constantly changing a bit — or sometimes a lot — in the body, checking several days in a row means that you’ll have several readings that can be averaged.

Aim to check at the same times every day. An average of several daily readings provides a more accurate picture of a person’s BP.

Checking in the morning and evening is recommended by many experts. This is because BP can vary during the day, especially in people who are taking BP medications. But if checking twice a day seems too hard, just check once a day.

Experts also often say to check BP in the morning before any medications are taken. However, if there have been any concerns about falls, I like to review readings taken about an hour after medication. This is because I want to make sure the BP isn’t falling too low when a person takes their medication.

Optional but helpful: Use a “three measurements in a row” technique if possible. The SPRINT trial measured BP by letting participants rest quietly for five minutes, and then having the monitor check the BP three times in a row, with a one-minute pause between each check. Those three readings were then averaged into a reading for the day.

Some home blood pressure monitors have a feature that makes this easy to do.

3. Make an up-to-date list of all current medications.

Why: Your doctors will need to know exactly what medications you are taking, in order to evaluate your blood pressure treatment plan.

Notes:

• Start by listing those for heart or BP.
• But list all others, because some medications that are not prescribed for BP can still affect BP (such as Flomax, which can be used to improve urination when a man has an enlarged prostate).
• Also list all supplements, vitamins, herbs, and over-the-counter medications.
• Be sure to note if any medication is not being taken exactly as prescribed. It’s especially important for the doctors to know if an older person has been skipping any of the medications that affect BP.
• Note any concerns about side-effects, cost, or other concerns related to continuing the medication.

4. List the lifestyle approaches to lowering BP that you are following (or interested in).

Why: Although prescription medications are the main way doctors often try to treat hypertension, many lifestyle changes have been shown to help lower BP as well.

You’ll want to let your doctor know which of these you are using. Also, let your doctor know if you’d be interested in incorporating any of these into your BP management plan.

Many of these lifestyle changes are great for older adults, because they benefit health in many ways but have fewer risks than taking prescription medication.

Note: Proven approaches to lower high blood pressure include:

5. Make an appointment to discuss blood pressure management with your usual doctor.

Why: Your doctor can help you identify a good target blood pressure goal, and can help you develop a plan to reach that goal. Be sure to bring up any concerns regarding falls, or other potential side-effects of treatment.

Notes:

• Bring in your home BP readings and your up-to-date medication list.
• Consider asking the doctor to check BP sitting and standing, especially if you’ve had any concerns about falls
• Ask your doctor what target BP goal they recommend for you, given your health history.
  • Research indicates that the biggest benefit is in getting systolic BP down to the 140s. A systolic BP target goal of <150 is a good starting place for most older adults, as recommended by major guidelines in 2013 and also by more recent high blood pressure guidelines issued in 2017.
  • Results from SPRINT suggest that if you’re similar to the SPRINT participants, you may experience additional benefits by aiming for a systolic BP close to 120. If you’re considering this, be sure to read my article explaining SPRINT and related research, so that you’ll have a clear understanding of how likely you are to benefit (at best, an estimated 1 in 27 chance based on the research) and what are the risks and burdens.
• Ask your doctor about taking most (or maybe even all) of your BP medications at night.

6. Plan to follow up to see how your BP plan is working, and to make adjustments if needed.

Why: Whatever you and your doctors decide to do, you’ll want to make a plan for seeing how your blood pressure responds to the changes.

Note: Remember that experts say a week’s worth of home BP monitoring is more accurate than a follow-up BP check in the office.

Be sure to ask your doctor to specify:

• When should you undertake this home monitoring? (Most BP medications will take their full effect within 1 week. Lifestyle changes will take weeks to months to have an effect.)
• When will you be meeting — by phone or in-person — to discuss the results of the follow-up BP monitoring?
• What level of high (or low) BP should trigger a call to the office?

And that’s it!

Make the effort

Now, this approach is more work than usual. It takes a little more time and effort than just going to your doctor and having them check your blood pressure.

But the benefits make this time well spent. Think about it.

You and your doctor get a more accurate picture of what is going on inside your body.

You get to help create a blood pressure management plan that is just right for you.

You may even help prevent some serious health problems. Like a heart attack or stroke, or a serious fall due to incorrect medication.

No one likes the thought of letting a chronic condition get dangerously out of control. And no one likes to take more medication than they need to.

You can help keep this from happening.

Just follow this process for assessing a blood pressure management plan, and you’ll be on your way to confirming that you’re following a blood pressure management plan that’s right for you, or for your older parent.

This article was last reviewed and updated on 8/26/21. (Don’t miss the recommendation to try BP medications at bedtime!)

High Blood Pressure Guidelines | FAQ

New guidelines released by the American Heart Association and the American College of Cardiology in November 2017 have lowered the bar for what is considered high blood pressure (hypertension). Under these new guidelines, it is estimated that 46% of Americans will be diagnosed with hypertension. Prior to this amendment, 32 percent of the population had been diagnosed with high blood pressure. 
Meet our team or call 773-878-6888 to schedule an appointment with a board-certified cardiovascular specialist.  

What is High Blood Pressure?

Blood pressure is defined as the force of the blood flowing through your blood vessels. Although you may not experience symptoms, high blood pressure can be damaging to critical organs and may lead to life-threatening conditions such as heart failure, stroke and kidney disease.  

What Are the New Blood Pressure Guidelines?

One of the main changes made to the blood pressure guidelines is the redefinition of what high blood pressure is. The new guidelines are as follows:

• Normal—Less Than 120/80
• Elevated—130-139/80-89
• High Blood Pressure (Stage 1)—130-139/80-89
• High Blood Pressure (Stage 2)—140-180/90-120
• Hypertensive Crisis—More Than 180/120*

*This is considered an emergency situation. Consult your doctor immediately and report to the nearest Emergency Department. 
According to the American college of Cardiology, other changes include:

• Avoiding the prescription of blood pressure medication for Stage 1 hypertension unless the patient has had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke.
• Acknowledging many people may need more than one type of medication to regulate blood pressure. In addition, there is a higher likelihood of patients following prescriptions if multiple medications are integrated into a single pill. 
• Recognizing that facts such as stress and socioeconomic status may influence the presence of high blood pressure.  

Why the Change in Blood Pressure Guidelines? 

The change in blood pressure guidelines is due primarily to the study of the risks of high blood pressure in patients over time. Experts believe that these new guidelines, if followed correctly and consistently, will assist more patients in avoiding preventable conditions such as heart attack and stroke through proper management of blood pressure earlier than before. 

What Are the Health Risks Associated With High Blood Pressure? 

According to the American Heart Association, high blood pressure can cause a number of life-threatening conditions, including:

• Stroke
• Heart Failure
• Heart Attack
• Kidney Disease or Failure

High blood pressure can also be responsible for life-changing conditions including vision loss, sexual dysfunction and peripheral artery disease (PAD).  

What Do the Numbers Mean?

Blood pressure is measured using two numbers, written with one over the other. For example, 120/70 would be read as “one-twenty over seventy.” In this example, 120 refers to the pressure of your blood against blood vessels when the heart is actively pumping, while 70 refers to the pressure on your artery walls when your heart is at rest between beats. 

What Are Some Ways You Can Prevent or Manage High Blood Pressure? 

The best way to prevent or manage high blood pressure is through proper diet, regular exercise and consistent weight and stress management. Lowering your sodium intake through reducing your consumption of salt and processed foods, reducing your daily caffeine intake and establishing an effective and appropriate exercise routine are good places to start. 

Related: Six tips to naturally lower your blood pressure>>

Contact Us

Meet our team or call 773-878-6888 to schedule an appointment with a board-certified cardiovascular specialist.   

How Does COVID-19 Affect People With High Blood Pressure? – San Diego – Sharp HealthCare

Aug. 12, 2020

When cases of COVID-19 began to surge around the world, experts realized the virus was particularly dangerous for people with heart disease and related conditions, especially high blood pressure. Nearly half of all adults in the U.S. — 103 million people — have high blood pressure, also known as hypertension.

More concerning is that only 1 in 4 adults have their blood pressure under control. Blood pressure that’s not well-managed can lead to serious complications, such as heart attack and stroke. As COVID-19 outbreaks continued, a new concern emerged. People with high blood pressure may be at greater risk of more serious complications from the coronavirus, including death.

Possible link between blood pressure regulation and COVID-19
“Early reports from areas of the world most affected by COVID-19 showed higher morbidity and mortality rates in patients with conditions like hypertension, coronary artery disease, diabetes and obesity,” says Dr. Steven Rough, a cardiologist affiliated with Sharp Chula Vista Medical Center. “What was found is COVID infects the cells that help regulate blood pressure, suggesting a possible link between hypertension and severe COVID infection. More studies are needed to determine if there is, in fact, a cause and effect.”

While the link between hypertension and serious complications isn’t entirely clear yet, what is clear is keeping blood pressure under control is extremely important.

COVID-19’s other dangerous implication is that it has kept many patients away from local hospitals and emergency rooms due to fears about getting the coronavirus. Hospitals across the country are reporting fewer visits for urgent medical needs, which some experts believe isn’t because patients are having fewer of them, but rather they’re avoiding or delaying seeking treatment.

In San Diego County, there have been 20 to 40 fewer heart attacks reported each month since the COVID-19 pandemic began, as well as a 70% decrease in calls to the Emergency Medical Services (EMS) system. With high blood pressure being a risk factor for serious conditions like heart attack, stroke and heart failure, it’s important that patients do all they can to keep it under control despite the pandemic.

Blood pressure measurement includes two numbers: systolic (top number) and diastolic (bottom number). People with a systolic above 130 or a diastolic above 80 — a reading of higher than 130/80 mmHg — are considered to have hypertension. Extreme high blood pressure, a reading of 180/120 mmHg or higher, should seek immediate medical attention. Anyone with a reading of 180/120 mmHg or higher who is also experiencing chest pain, shortness of breath, or changes in vision or speech should call 911.

“Having high blood pressure can lead to serious complications like heart attack, stroke, heart failure and aneurysm formation,” says Dr. Rough. “There is a lot that can be done for prevention, though. The best thing I can tell my patients with high blood pressure to do throughout this pandemic is to eat as healthy as possible, make time for exercise, stay current with appointments with your doctor, and don’t ever delay going to the emergency room for a serious medical need. We’ve already taken a lot of steps, and continue, to make the ER and hospital safe for patients to come in.”

To learn more about the extra safety precautions in place at Sharp Chula Vista Medical Center, visit sharp.com/getcare.

For the news media: To speak with Dr. Rough for an upcoming story, please contact Erica Carlson at [email protected].

Blood Pressure: Highs, Lows & What’s Normal

Blood pressure is one of the vital signs that doctors measure to assess general health. Having a high blood pressure, also called hypertension, that is not under control can result in heart problems, stroke, and other medical conditions.

Almost half of U.S. adults — 46 percent — have high blood pressure, according to the American Heart Association. High blood pressure is sometimes referred to as the “silent killer” because it often has no symptoms.

Certain lifestyle factors, such as diet and smoking habits, can greatly impact a person’s risk of developing high blood pressure.

“Having a healthy lifestyle really makes a difference in your life because you can avoid high blood pressure,” said Dr. Mary Ann Bauman, an internist at Integris Baptist Medical Center in Oklahoma City. “If you do have high blood pressure, make sure take your medication. You may not necessarily have symptoms until your blood pressure gets really high.”

What is normal blood pressure?

Blood pressure reflects the force of blood as it hits the walls of the arteries. When the heart squeezes and pushes the blood out, the blood pushes against the walls of the blood vessels. People are born with very elastic vessels that can expand easily, and bounce back when the pressure on them is low.

As people age, they get plaque buildup inside the blood vessels, and the flexible walls of the arteries become stiff. Now, when the heart squeezes and pushes the blood out, the blood vessels can’t expand like they used to do and sustain higher pressure. Over time, the heart has to push so hard against the pressure that it starts to fail, Bauman said.

Blood pressure is recorded as two numbers and written as a ratio: the top number, called the systolic pressure, is the pressure as the heart beats. The bottom number, called the diastolic pressure, is the measurement as the heart relaxes between beats. According to guidelines announced in November 2017 by the American Heart Association (AHA), people’s blood pressure measurements fall into the following categories:

• Normal: Less than 120 millimeters of mercury (mm Hg) for systolic and 80 mm Hg for diastolic.
• Elevated: Between 120-129 for systolic, and less than 80 for diastolic.
• Stage 1 hypertension: Between 130-139 for systolic or between 80-89 for diastolic.
• Stage 2 hypertension: At least 140 for systolic or at least 90 mm Hg for diastolic.

A number of factors can raise blood pressure, including stress, smoking, caffeine, binge drinking, certain over-the-counter and prescribed medications and even cold temperatures. 

Those who are fit — including those who regularly exercise and professional athletes — tend to have lower blood pressures and heart rates, as do those who do not smoke and are a healthy weight.

Checking your blood pressure

Starting at age 20, the AHA recommends a blood pressure screening at your regular healthcare visit or once every 2 years, if your blood pressure is less than 120/80 mm Hg.

People who have high blood pressure are encouraged to check their blood pressure at least three times a week, Bauman said.

People can check their blood pressure themselves. In fact, monitoring blood pressure at home may be better than doing so at the doctor’s office, partly because people are especially susceptible to a spike in their blood pressure when they visit a doctor, a situation known as white coat hypertension. [Related: Heart Rate Monitors: How They Work]

“We have many studies that indicate people taking their blood pressure at home is much more accurate than at the doctor’s office,” Bauman said.

A manual or digital blood pressure monitor (sphygmomanometer) typically comes with instructions that should be followed carefully to get the most accurate results.

The first step is to find your pulse by pressing your index finger on the brachial artery, which is at the bend of your elbow, slightly to the inside center. On a manual monitor, place the head of the stethoscope in the general area, or for a digital monitor, place the cuff in this area.

For a manual monitor, you have to hold the pressure gauge in one hand (your weaker hand) and the bulb in the other hand. Inflate the cuff until it reads about 30 points above your normal systolic pressure. At this point, you should not hear your pulse in the stethoscope. When you hear the first heart beat, this is the systolic pressure. As you deflate the cuff, keep listening for a heart beat. When you can no longer hear it, that is your diastolic pressure.

A digital monitor does the inflation and deflation and recording of the systolic and diastolic heart rates.

Risk factors

Risk factors for high blood pressure include too much salt in the diet, excess weight, inactivity, and smoking.

The dangers of high blood pressure include hardening of the arteries, or atherosclerosis, kidney disease and heart disease. High blood pressure can also result in stroke, either because of a blocked arteries or a burst in a blood vessel.

Low blood pressure, known as hypotension, can also cause health problems such as fainting and dizziness. Quick, dramatic drops in blood pressure can reduce the adequate blood supply to the brain. Most of the time, hypotension goes undetected and is typically not dangerous unless it produces symptoms.

Treating high blood pressure

Treating high blood pressure includes lifestyle changes and prescription medication for those with readings of 140/90 or higher, according to the AHA.

“The first thing we tell people to do if their blood pressure is in prehypertension range, is to lose weight, exercise more, and reduce salt in diet,” Bauman said. “If they reach higher levels, we then treat them with medications.”

Additional reporting by Kim Ann Zimmermann, Live Science Contributor.

Additional resources

General information on pressure – Microlife / Microlife

Medical questions and opinions of specialists

What pressure is considered normal and at what pressure should I go to the doctor?

• The following table of blood pressure values ​​(in mmHg) is provided by the World Health Organization (WHO):

• It is advisable to measure the pressure as often as possible and discuss the measurement results with your doctor.If you find that your systolic pressure is often above 140 and / or diastolic above 90, you need to see your doctor for treatment. It is considered normal if the pressure rises or falls from time to time – this is not a cause for concern. But high blood pressure is detected in most cases, you need to go to the doctor.

What is White Coat Syndrome?

• White coat syndrome is a common name for the blood pressure increase effect that occurs when a patient’s blood pressure is measured by a doctor (usually in a white coat) or a nurse.This effect is caused by the fact that the patient in such a “formal” setting may be worried or nervous, which leads to an increase in blood pressure. The problem is that the patient under normal conditions may have normal blood pressure, but in the doctor’s office, based on the readings, he may be diagnosed with hypertension. Home gauges are the best way to avoid white coat syndrome. Long-term studies have shown that people who have high blood pressure when visiting a doctor have a high risk of developing hypertension.Therefore, these patients need to measure their blood pressure more often.

Does blood pressure depend on age?

• In the average population, blood pressure increases with age. This is because the elasticity of blood vessels decreases with age.

• But even in the older age group, the pressure should not too often exceed the maximum permissible norm of 140/90 mm Hg.Art.

Medical questions and expert opinions

Below you will find medical topics and answers to questions about high blood pressure and its control. They were taken and translated from the patient information of the Swiss Heart Foundation. We express our gratitude for permission to use this information.
– Swiss Heart Foundation
Schwarztorstrasse 18
CH-3000 Bern, Switzerland
phone: +41 / 31 388 80 80
fax: +41 / 31 388 80 88
(info @ herzstiftung.ch)

Is blood pressure measured primarily by the “oscillometric” method? What does it mean?

• In medical practice and in hospitals, blood pressure is measured mainly by the traditional “sound method”. With this method, the heartbeat is listened to with a stethoscope. Pulsation occurs in the blood flow of the brachial artery as the cuff pressure slowly decreases. The first audible beat determines the systolic pressure, the last audible beat determines the diastolic pressure.Blood pressure values ​​are determined by the column of mercury, and therefore are measured in millimeters of mercury (mmHg).

• Oscillometry uses a different measuring principle. This method is used in most instruments for self-measurement of pressure. In oscillometric devices, the blood pressure is calculated by electronic microprocessors based on pressure fluctuations (oscillations) that occur in the bloodstream as a result of the heartbeat. Since heart beats do not play a role in this technique, neither a stethoscope nor a microphone built into the cuff is required for measurement.Blood pressure and pulse rate are displayed on the screen of the device after the measurement. Pressure is displayed in mmHg. Art., although such devices do not contain mercury. If your heart rate is irregular, it is recommended that the measurements be taken by a physician.

What should be considered when taking a self-measurement?

• For patients with high blood pressure, it is recommended to measure blood pressure regularly, as this will allow your doctor to receive data on the effectiveness of treatment.The measurement results must be recorded in a special notebook, and in the “Notes” column, write down your observations, such as: feeling unwell, dizziness, poor sleep, missed medication, physical or psychological problems. In addition, it is very important to measure the pressure on the same arm or wrist at the same time in the morning and evening. Do not smoke, drink coffee or alcoholic beverages before measuring. Take the measurement after resting for 5 minutes in a seated position in a relaxed environment.Make sure that the device is at the level of the heart. Compare your readings with those measured by your doctor. You should periodically calibrate your instrument (every two years) at the manufacturer’s service centers.

Can wrist tonometers be used for home measurements?

• Modern devices that measure blood pressure on the wrist also use the oscillometric method.They are fully automated: they automatically inflate and deflate the cuff to the correct level. Wrist-based devices, when used correctly, give fairly reliable results.

• Automatic blood pressure meters with sensors installed on the index finger measure blood pressure and pulse, but often show unreliable results, since the index finger is not held still at the level of the heart, and the vessels on the finger are compressed due to the cold.

Can blood pressure drop too low due to medication?

• Blood pressure may drop too low as a result of drug treatment. This can lead to dizziness when standing up suddenly or bending over, to increased fatigue or lack of energy. If you notice these typical symptoms of low blood pressure (hypotension), you need to talk to your doctor about adjusting your treatment.However, if you have low blood pressure, but you feel fine, there is no reason to change your course of treatment.

Are there any side effects of drug treatment?

• At the beginning of the course of treatment, if blood pressure drops very sharply, medications may for some time cause psychological or physiological reactions associated with fatigue, dizziness, difficulty concentrating.The body gradually adjusts to the lower pressure, and these problems disappear over time. Only a small number of people taking blood pressure medications have consistent side effects. There are side effects that are inherent only to a certain type of medication that cannot be eliminated by reducing the dose of the medication. An example is a persistent but harmless dry cough that can be relieved by taking ACE medications. If the cough is very annoying, you need to change the drug after prior consultation with a doctor.

• Skin symptoms such as itching or rash also indicate a need to change the medication. When taking calcium blockers, symptoms such as headache, facial flushing, swelling of the legs and lower legs (edema), and constipation are observed. The most common side effects of beta blockers are constant fatigue, potency problems, and cold feet and hands. Low blood calcium, gout attacks and seizures are the most common side effects of diuretics.The drug with the least side effects is angiotensin.

Can I stop taking medication if side effects occur?

• If you experience any side effects from medicines that regulate blood pressure, do not stop taking them immediately. In this case, you should immediately discuss this problem with your doctor. Usually, the situation is corrected by reducing the dose, changing the drug, or changing the treatment with one drug to treatment with a combination of two drugs.

Can I stop taking medication on weekends or holidays?

• No matter how you spend your weekend: actively, on a trip or passively, you need to continue taking medication, because as soon as you stop treatment, your blood pressure will start to rise. If you are flying by plane, it is advisable to keep the medicine in your carry-on baggage in case your baggage does not arrive on time. If you are flying across the ocean due to time zone differences, consult your doctor at what time to take your medication.

Can I stop taking medication if my blood pressure has returned to normal?

• Stress and nervous stress sometimes lead to a temporary increase in blood pressure and this is normal and should not be confused with the disease of hypertension. Your doctor gave you this diagnosis because your blood pressure was elevated not only during activity, stress, or tension, but also at rest. Therefore, you cannot stop taking your medication, even if it has returned to normal, otherwise it will rise again to the level at which you were diagnosed.

Will I have to take medications to lower my blood pressure for a long time?

• Only with proper blood pressure control can damage to the walls of blood vessels, excessive stress on the heart, brain and kidneys be avoided. Control of a dangerous level of blood pressure is carried out by long-term administration of drugs, if other methods of lowering the pressure to the level of 135/85 mm Hg. Art., do not help (dietary recommendations, weight loss, rejection of salt and alcohol, smoking cessation).

• Changing lifestyle and reducing risk factors have a very good effect, and often allow you to reduce the dose of medication after a while.

Medicines led to a decrease in potency. What to do?

• In addition to medications that can cause or contribute to potency disorder, there are many other factors that affect potency: age, physical and psychological condition, alcohol and smoking, as well as concomitant diseases such as diabetes.

• The degree and rate of reduction in blood pressure, as well as the use of a drug, can also have a definite effect. At high doses, drugs such as beta-blockers and diuretics can lead to potency disorder as a side effect much faster than calcium blockers, ACE inhibitors and angiotensin. Do not put a discussion of any violations of potency with your doctor. If your medication is the cause, your doctor may reduce the dose or change the prescribed medication with another.

What sports are contraindicated in high blood pressure?

• At elevated blood pressure, small branches of blood vessels (capillaries) are compressed, which, in turn, prevents free blood circulation. Muscle movements contribute to the expansion of the capillaries, since the work of the muscles requires more oxygenation of the blood. With elevated blood pressure, regular exercise for at least 30 minutes has a positive effect on human health.Sports activities such as brisk walking, mountain walks, jogging, cycling, skiing, swimming (no competition for time, neither too cold nor too warm water), dancing.

• During such exercises, groups of large muscles move simultaneously and rhythmically. The pulse quickens and the blood pressure rises, but not too sharply. However, you should not engage in sports in which the muscles are sharply tense, and not moving rhythmically. Such sports (for example, weightlifting) cause a sharp increase in blood pressure.

How to measure blood pressure correctly?

The blood pressure of each person is subject to strong fluctuations. It depends on physical activity, time of day and mood. The stress and tension of everyday life lead to fluctuations in pressure levels up to 30 mm Hg. within a few minutes, which is completely normal. For this reason, people who monitor their blood pressure with a blood pressure monitor and often take home measurements do not understand why the results of their measurements are so different from each other.Unlike measurements made by a doctor, who obtains the result of one measurement at a given time, a home blood pressure monitor gives an idea of ​​the normal range of pressure fluctuations throughout the day.
Therefore, leading blood pressure experts recommend self-measurement with a home blood pressure measuring device. In this case, the clinical certification of the device is important. All Microlife blood pressure monitors are designed in close collaboration with physicians to ensure optimal accuracy in patient pressure measurements.

To obtain reliable results and reduce the measuring range, we recommend that you follow the advice below:

• Do not measure during stress or stress. We recommend taking at least one measurement a day at the same time in a calm state. The difference in the measurement results will be much smaller if you measure the pressure 30 minutes after dinner and evening rest, and not during the day. Of course, measurements should be carried out occasionally during the day to obtain a complete picture of the blood pressure level.
• Make it a habit to take a few minutes of rest before measuring to relax. The result of a measurement taken without prior rest (for example, immediately after sitting down at the table), or in the presence of a large number of people, is of no use. You should also not take measurements immediately after eating, drinking, smoking, after active movements or excitement.
• Measurement should be carried out after 5 minutes of rest, while sitting in a comfortable position.Fit the cuff correctly according to the instructions for use.
• After inflating the cuff, breathe evenly and do not speak. Don’t move, don’t tense your muscles.
• The average of several measurements taken under the same conditions over several days corresponds to your typical pressure.
• If you want to take several measurements in a row, be sure to take a break of at least 15 seconds between measurements.
• If the measurement is done with a wrist device, keep it at the same level as your heart.
• Comparative measurements are taken from time to time in pharmacies or specialty stores. The results of such measurements are generally useless because the conditions in which they are carried out are unacceptable for correct measurements. Only in cases where peace and quiet are strictly maintained, and the necessary intervals between measurements are observed, such comparisons are advisable.

High accuracy wrist measurements
The two arteries on the wrist are located just under the skin and are not surrounded by as much soft tissue as on the shoulder.In addition, these arteries are much thinner than those in the shoulder.
Therefore, for users wrist-based devices have certain advantages and disadvantages:

• Devices on the wrist are closer to the signal arteries. The cuff, when worn over the wrist, is not surrounded by as much soft tissue as when it is worn over the shoulder. Therefore, patients with more soft tissue on the shoulder have fewer problems measuring pressure on the wrist.
• The thin vessels in the wrist are more susceptible to arteriosclerosis, which accompanies the aging process.If the vessels are susceptible to arteriosclerosis, the device on the wrist shows incorrect results.
• Measurement on the wrist is more convenient and faster than on the shoulder. Therefore, they can be carried out much more often.
• Measurements on the wrist are very sensitive to movement, and there can be many errors due to this.
• During measurements, the device on the wrist should be at the level of the heart.

All of the above means wrist devices are better suited:

• Concerning young and middle-aged people [with the exception of those with arteriosclerosis].
• People who need to have a blood pressure monitor with them.
• People for whom, due to the oversized shoulder size, it is difficult to correctly put the cuff on the shoulder.
• People who can sit in a comfortable position and hold the device at heart level during the measurement.
• People who need to check their blood pressure frequently.

Devices on the wrist are less suitable:

• Older people [but only if they suffer from arteriosclerosis].
• People who cannot sit up and hold the device at heart level during the measurement.

Excerpts from statements on blood pressure control with home electronic tonometers.
From the symposium 19. / 20. Juni 1996, Dublin, Ireland

Prof. O’Brien, Dublin, Ireland. Prof. Eoin O’Brien [The Blood Pressure Unit, Beaumont Hospital, Dublin, Ireland] *

90,000 Insulin content and blood pressure in obese women | Ginsburg

Abstract

The pathogenesis of obesity hypertension requires further study.It is believed that hyperinsulinism and insulin resistance contribute to this. The relationship between the levels of basal and glucose-stimulated immunoreactive insulin (IRI) and blood pressure (BP) was studied in 36 women aged 18 to 37 years, suffering from first to fourth degree obesity. The basal IRI level was markedly increased and directly correlated with systolic and diastolic blood pressure, but was not associated with overweight. The blood pressure level directly depended on the severity of obesity and on the duration of the disease, but did not depend on the age of the patients.The level of hyperinsulinism in obese women does not depend on the degree of excess weight. These data suggest that insulin contributes to the pathogenesis of hypertension in obese women, but more research is needed to clarify the type and mechanisms of this contribution.

Hypertension is the most frequent complication of obesity and occurs in this disease with a frequency of up to 60% [2, 5]. It is assumed that one of the mechanisms of increasing blood pressure (BP) in overweight is insulin resistance [2, 5-7], which is usually observed in obesity [2, 3].Indeed, a number of studies have found a relationship between the level of insulin in plasma, tissue sensitivity to this hormone and the value of blood pressure in obesity [6, 7], however, there are not enough works devoted to this issue. In particular, we have not come across studies on the effect of endogenous insulin on blood pressure parameters in obese women. This was the goal of this work.

Materials and methods

We examined 36 obese women (body mass index – BMI – the ratio of body weight in kilograms to the square of growth in meters more than 27), aged 20-36 years with a disease duration of 6-17 years, with normal carbohydrate tolerance, no signs endocrine and renal pathology.The patients were divided into 2 groups: patients with a BMI <35, which corresponds to obesity of the I-II degree (1st group) with a BMI> 35, which corresponds to obesity of the III-IV degree (2nd group). The groups of patients did not differ significantly in age and duration of the disease. Healthy women of the same age group with normal body weight were taken as controls.

The content of immunoreactive insulin (IRI) was determined by radioimmunoassay in blood serum taken from the cubital vein at 8 hours on an empty stomach.The glucose level in capillary blood was established at the same time by the glucose oxidase method. Further, the level of IRI and glucose was determined 60 and 120 minutes after oral load with 75 g of glucose. BP was measured on the right hand according to Korotkov after a night’s rest immediately before blood sampling.

Statistical analysis was carried out on a computer in the environment of the Microsoft Excel package according to the generally accepted method [1]. Differences in mean values ​​were considered significant at p <0.05.

Results and discussion

As can be seen from the table.1, in obese patients, both systolic (SBP) and diastolic (DBP) are significantly higher than in controls, and in obesity of III-IV degrees it is significantly higher than in patients with I-II degrees. Obesity was accompanied by a significant increase in heart rate, which may indirectly indicate an increase in the activity of the sympathetic-adrenal system.

In obese patients in both groups, there was a significant increase in the basal and stimulated levels of IRI. At the same time, basal and stimulated glucose levels did not differ from control.Higher insulin levels with normal glucose levels suggest that the hyperinsulinism seen in obesity is associated with tissue insulin resistance. There were no significant differences in the content of IRI in patients of groups 1 and 2.

The results of the correlation analysis (Table 2) showed that in obese patients there is a direct reliable dependence of blood pressure parameters on the basal level of IRI. This pattern is described by the following regression equations:

Uh! = 0.0011l ² – 0.0562l: + 131.5 (L ² = 0.50; p <0.05), y ₂ = 0.168l: + 75.5 (R ² = 0.31; p < 0.05),

where Y1 and Y2 are , respectively, the values ​​of SBP and DBP, and x is the basal level of IRI.

With IRI values ​​close to the control values, the SBP level is within 130 mm. rt. Art. SBP begins to increase at IRI concentrations of more than 50 pmol / L (see figure).

The dependence of DBP on the basal level of IRI is linear. As follows from equation-

Characteristics of patient groups

Table 1

Note.Asterisks – reliability of (p < 0.05) differences: one – with control, two – in groups of patients with obesity.

, the control values ​​of IRI (32.4 ± 4.8 pmol / l) correspond to a DBP level of about 80 mm Hg. Art.

In obese women, there is a significant relationship between blood pressure parameters and BMI, as well as between blood pressure and the duration of the disease. There is no significant dependence of blood pressure on the age of patients, which can be explained by the relatively young age of our patients.

We did not find a significant correlation between the basal IRI level and the BMI value (r = 0.30; p> 0.05). This allows us to conclude that the hyperinsulinism observed in obesity in women is practically independent of the severity of obesity. The absence of this connection can also be explained by the fact that the IRI value, in addition to BMI, is influenced by the distribution of adipose tissue [4, 8], which we did not study in this work.

Positive correlations between basal insulin levels and blood pressure parameters in obese patients without gender division were demonstrated in the works of R.Weinsier et al. [9] and T. Pollare et al. [eight]. In a study by D. Johnson et al. [4] in obese men, there is a relationship between blood pressure parameters and insulin values ​​during a glucose load test, whereas, according to our results, this relationship is absent in women of the studied age group.

The mechanism of increasing blood pressure against the background of hyperinsulinism is not fully understood. It is assumed that it is associated with sodium and water retention in the renal tubules, as well as with insulin stimulation of the activity of the sympathetic-adrenal system [2, 8].An indirect confirmation of the latter can be the observed increase in heart rate in obese women. At the same time, we did not obtain a significant correlation between the basal IRI level and heart rate (r = 0.15; p> 0.05).

Thus, the presence of a relationship between the basal level of IRI and blood pressure parameters may indicate the participation of hyperinsulinism in

Table 2

Correlation dependence of blood pressure indicators on the severity of obesity and the content of IRI

Note.Asterisk – the value of the correlation coefficient is reliably (p <0.05).

Dependence of SBP on the basal IRI content in obese women.

The abscissa is the basal IRI level (in pmol / l), the ordinate is the SBP (in mm Hg). pathogenesis of hypertension in obese women. However, further research is needed to clarify the nature and mechanisms of this participation.

Conclusions

1. BP parameters in obese women directly correlate with the basal IRI level.This suggests that an increase in serum insulin may play a role in the mechanisms of BP increase in obese women.
2. The level of blood pressure in women aged 18-37 years, obese patients directly depends on the severity of obesity and the duration of the disease, but does not depend on the age of patients.
3. The level of hyperinsulinism in obese women does not depend on the degree of overweight.

1.Uglov B.A., Kotelnikov G.P., Uglova M.V. Fundamentals of statistical analysis and mathematical modeling in biomedical research. – Samara, 1994.

2. DeFronzo R. A., Ferrannini E. // Diabet. Sage. – 1991. – Vol. 14, No. 2. -P. 173-194.

3. Golay A., Felber J. P., Jequier E. et al. // Diabet. Metab.Rev. – 1988. – Vol. 4, No. 6. – P. 727-747.

4. Johnson D, Prudhomme D, Despres J P. et al. // Int. J. Obes. – 1992. – Vol. 16. – P. 881-890.

5. Lucas C. P., Estigarribia J. A., Darga L. L. et al. // Hypertension. – 1985. – Vol. 7, No. 6. – P. 702-706.

6.Manicardi V., Camellini L., Bellodi G. et al. // J. clin. Endocrinol. Metab. – 1986. – Vol. 62, No. 11.-P. 1302-1304.

7. Modan M., Halkin H., Almog S. et al. // J. clin. Invest. – 1985. – Vol. 75, No. 7. – P. 809-817.

8. Pollare T., Lithell H., Berne C. // Metabolism. – 1990. – Vol. 39, No. 2. -P. 167-174.

9.Weinsier R. L., Norris D. J., Birch R. et al. // Int. J. Obes. – 1986. – Vol. 10, No. 1. – P. 11-17.

Arterial hypertension: myths and truth

Arterial hypertension (more commonly known as high blood pressure among patients) is the most common reason for seeking medical attention. Moreover, in the modern world, both young people and the elderly are treated with high blood pressure.

What exactly is arterial hypertension?

Myth 1: “arterial hypertension is a disease of the elderly”

Arterial hypertension is rapidly getting younger. Today, there are cases when arterial hypertension develops in people a little over 30 years old. If a person began to suffer from this disease at the age of 30–35 and did not know about it for the next 15 years, and therefore did not receive treatment, then he will come to retirement age with the risk of developing heart failure and stroke.Every person, starting from the age of 25, should measure blood pressure at least once every six months. If you find your blood pressure figures above 140/90 mm Hg. You need to contact a therapist and together with him determine further tactics of action.

Myth 2: “With hypertension, the head hurts”

Headaches in the same percentage of cases in people with normal, high and low blood pressure. More often than not, headaches are not related to pressure.Most people, even with high blood pressure, do not have a headache. The state of health of such a person can remain good for a long time. And when symptoms do arise, the time for disease prevention is often missed. The only way to determine blood pressure is to measure it at least occasionally. Most often, such pains, oddly enough, provoke diseases of the cervical spine.

Myth 3. “This is my ‘working pressure’! No need to be treated “

Indeed, there is such a thing as “working pressure”.This is the pressure at which a person feels good. However, its values ​​do not always coincide with the normal one. When the normal values ​​of blood pressure are exceeded, the load on the walls of blood vessels, on the heart, kidneys and other organs increases significantly. It is well known that every 10 mm Hg. Art. higher than normal increase the risk of complications by as much as 30%. High pressure may not always cause significant discomfort, but urgent measures must be taken to reduce it.

Myth 4.”Pressure pills” can simply be taken the same as at the neighbor’s “

There are really a lot of antihypertensive (reducing) drugs. They have different mechanisms of action, have their own characteristics, indications and contraindications. Therefore, for the selection of therapy, contact a therapist who will prescribe a medicine taking into account individual characteristics, concomitant diseases, indications and contraindications. Self-medication is always a risk. At best – the use of an ineffective drug, and at worst – life-threatening!

Myth 5: “If your blood pressure is high, you need to take medicine, if it is normal, you don’t need to drink medicine”

Many patients think so.Arterial hypertension, once having arisen, remains with a person for life. It is imperative to take all medications prescribed by your doctor. Most drugs have a cumulative effect. This means that after two weeks the drug will accumulate in the body. And when you stop taking it, it will still work for a while. And the patient will think that he has recovered from hypertension. But with the complete elimination of the drug from the body, a sharp jump in blood pressure will occur.

Myth 6. “If you lead a healthy lifestyle and lose weight, you can get rid of hypertension without pills”

Lifestyle changes are the basis of antihypertensive therapy. It is worth giving up salt, walking 10-15 thousand steps every day, monitoring the waist (less than 102 cm for men and 88 cm for women), quitting smoking and stopping alcohol abuse. However, all this will help only at the very early stage of the disease. In other cases, it is imperative to immediately prescribe antihypertensive therapy.

Lead a healthy lifestyle and get tested on time! Be healthy!

Intraoperative hypotension – Bulletin of intensive care named after A.I. Saltanova

E . A . Leonova , G . B . Frost , B . A . Shmyrev , B . B . Lomivorotov

FSBI NMITs im. acad. E.N. Meshalkin “Ministry of Health of the Russian Federation, Novosibirsk

For correspondence: Vladimir Vladimirovich Lomivorotov – Professor, Corresponding Member of the Russian Academy of Sciences, Deputy Director for Research of the acad. E.N. Meshalkin “, Novosibirsk; e-mail: [email protected]

For citation : Leonova E.A., Moroz G.B., Shmyrev V.A., Lomivorotov V.V. Intraoperative hypotension. A.I. Saltanov. 2018; 3: 87–96.

DOI: 10.21320 / 1818-474X-2018-3-87-96

The main task of the anesthesiologist is to maintain the homeostasis of the patient’s body during surgery. Of all the physiological parameters, perhaps only blood pressure (BP) has such a significant amplitude of fluctuations, and the relationship between postoperative complications and fluctuations in blood pressure is often not obvious.BP is a modifiable parameter and can be adjusted by infusion therapy, as well as the use of vasopressor and inotropic drugs.

Intraoperative decrease in blood pressure can be a consequence of the action of anesthetics, antihypertensive drugs, non-physiological positioning of the patient on the operating table, artificial lung ventilation (ALV), surgical procedures, artificial circulation, hypovolemia, acid-base and electrolyte balance disorders, acute heart failure, arrhythmias, anaphylaxis and other factors.

The difficulty in analyzing the effect of hypotension on the patient’s body is created by the lack of a unified definition of this condition. More than 140 different absolute and relative values ​​are used as the boundaries of hypotension. However, the information accumulated over the past few years makes it possible to trace the tendency that intraoperative drop in blood pressure of varying severity increases the risk of complications from the nervous, cardiovascular, excretory and other systems of the body, which ultimately leads to an increase in morbidity and mortality in patients after surgery. interventions.The frequency and degree of development of adverse effects directly depends on the degree and duration of the drop in blood pressure.

Each patient has an individual set of genetic, physiological and pathophysiological characteristics that determine the level of blood pressure that is optimal for the functioning of internal organs. Therefore, there are certain prospects in relation to the development of a strategy for maintaining individualized blood pressure, which is based on the “working” pressure of the patient before the operation.

Key words: blood pressure, hypotension, stroke, delirium, myocardial infarction, acute renal injury

Received : 24.07.2018

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