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Support Forum Topic: How often when to take readings???
Started by: rexall
Date: July 1, 2009

Thu 2 Jul 09, 8:50 am

Good Morning,

Newbie here.  Sorry for the long-winded  post, but I don’t know how to make it meaningful and brief at the same time.  Obviously, this query verges on the medical, but is mostly about how to use MyBP software to get an accurate reflection of my BP situation.  I have been using MyBP for about one year now, and ironically, because it is such excellent, powerful tool, I am driving myself crazy  Huh trying to make sense of my readings!

PROBLEM :

(1)  I am an American in Thailand, and although the standard of medical care is good here, communication can very frustrating, and I am not 100% satisfied with (what seems) the Thai approach to treating hypertension.  I don’t know.  That is one of the reasons I am writing.

(2)   I have one year of hundreds of readings over the past year  (some months more consistent than others) and I cannot determine what that reflects as an overall pattern.  In other words is my BP under control or notHuh

(3)  My readings have always varied  tremendously, and are time/event related.  

112-120/___  Usually very low after bike + yoga
150-160/ ___  High first thing in a.m. before meds, also in p.m.,
150-160/ ___  High in the p.m., although I am a bit remiss in taking p.m. readings
160-170/___  At docs office
120-140/___   At various times during the day not specified above.

(4)  Doc seems interested in and satisfied with my averages which have always been somewhere in the 130s/___ , and feels this reflects BP under control.  My concern is that averages may be helpful when there is only 20 mm fluctuations, but  if I still get frequent readings in the 140s, 150s, and 160s  Sad doesn’t that indicate that I am still hypertensive regardless of the averages Huh Or what Huh

(4)  In using MyBP software, when I get a high reading, I am naturally alarmed, and have the urge to take another reading 30-60 min later.  When I do, the reading is usually lower, thankfully, but what does this meanHuh And doesn’t the “extra”  reading skew the average?


SIMPLE QUESTIONS :

(1)  How often should I take readings?

Specifically:

a.  How often (how many times during the day)
b.  At what times of day
c.  and/or preceding what events/activities?  Before meds, after, after exercise … Huh
d. How many days/weeks/months of readings establish a reliable, accurate, meaningful  baseline that doc and I  can work with?

(2)  What numbers are a reasonable end goal of successful treatment?  Considering what I have already explained, how aggressive should we be about changing dosage and or changing meds over say one year ?

BACKGROUND :

Age 59
Health :  good, generally
Height :  5’6”
Weight  :  High school weight was 150#.  Today 178, down from 185 one year ago.  Most of weight seems to be in my gut, unfortunately.  Embarrassed

I am an American living in Thailand, and some or much of my questions relate to concerns over Thai medicine and limited communication with my Thai internist.  If I had a good, working relationship with a doc in America, I would probably not be posting here, and probably would not be making myself crazy!

MEDS

One year ago, started with 7.5 mg. ramipril (TritACE) and 5 mg. amlodipine in a.m.  

A few weeks ago, changed to  5 mg. ramipril and 5 mg amlodipine in a.m. + 5 mg. amlodipine in p.m. due to high  morning and evening readings.  

Too soon to tell if that is making a difference.

Probably hypertensive most of my adult life.  When docs first started pointing out high readings to me  in the 1970’s, 150/__ was not considered high, and I only got “Harrumph!  You’re a little high.” from docs, but no treatment.  Decades passed.

About  one year ago, got routine reading of (if I recall) 180/110 which alarmed me and caused me to decide to treat this seriously and aggressively, as follows:

STEPS I AM TAKING

1. Have not had a drink or a cigarette in 25 years.
2.  Meds as above, past year, + .5 mg Xanax for insomnia.  No other except aspirin.
3.  Diet, about 50%-75% vegan.  Some months more consistent than others.
5,  Weight slowly down from about 185 one year ago to 178 today.
6.  Daily green tea and grape juice
7.  Salt minimal, although Thailand is a “salty place” and it’s difficult to control.
8.  30 min. stationery bike ride + 30 min yoga, five days per week (consistent past 12 weeks,  although some months more consistent than others)
9.  Employment is inactive;  at my computer many hours per day, at home.

Any general insights and info greatly appreciated, but to restate, the thrust of my post is to get very definite, specific instructions of when/how often to take my BP as explained earlier.

Thank you very much for your help.

Aloha,

Rex

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4 Responses to “How often when to take readings???”

  1. Kellie says:

    Hi rexall,

    How frustrating! Your blood pressure is up and down and hard to find the reasons why. Part of your frustration seems to be the lack of medical care you receive in Thailand.

    I wondered whether you should post your blood pressure story on a medical forum to get advice from Doctors. Our forum is a small community and one which doesn’t offer medical advice. I haven’t used medical forums myself but a forum like medhelp.com has an “Ask a Doctor” forum. You could ask your question to a doctor in their Heart Disease topic. It may be a way of getting the medical care and advice you need whilst you live in Thailand.

    Have a look at the medhelp medical doctor forum:
    http://www.medhelp.org/forums/list

    Another active forum that may give advice from other blood pressure sufferers is Healthboards Forum. They have a very active community discussing ‘High and low blood pressure’. Some who post there may have some suggestions also.

    http://www.healthboards.com/boards/

    I am impressed by the steps you are taking to lower your blood pressure. You are certainly on top of diet and exercise. Though I do agree with you that Thai food is salty. That could be why I love it. Smiley

    Some of your readings definitely seem high and monitoring them will help a doctor to make a diagnosis. Just make sure that when you take a reading that you take it accurately so you are able to compare readings. The American Heart Association recommends that you don’t smoke, exercise or drink caffeine for 30 minutes before taking a reading. It also recommends that you rest for 5 minutes sitting in a chair with feet flat on the floor before taking a reading. They suggest to take readings 2-3 times a day, say morning and night, at the same time each day. The AHA website on home monitoring may be of help to ensure the readings you take are accurate and can be compared.

    http://www.americanheart.org/presenter.jhtml?identifier=576#record

    I know I have not been able to answer all your questions, but perhaps one of our forum members may have experiences they can share too. I do suggest you try a medical doctor forum like medhelp to see if they can help.

    I wish you all the best! I would love to hear how you go and if you are able to control your blood pressure.

  2. rexall says:

    Fri 3 Jul 09, 8:14 am

    Good Morning Kellie, all,

    Thanks so much for the thoughtful reply. I understand that this is not a medical forum, and I am tenaciously pursuing answers from the links you provided and other sources as well.

    Beyond the medical, maybe I simply don’t understand the principle very well. And/or maybe I incorrectly took to heart a snippet I read on the internet somewhere? My sense is that readings of 140-160 that occur more than occasionally represent untreated hypertension regardless of how low other readings may be. Is that more or less accurate?

    To expand on what I mean by not getting the principle. Here is a little excerpt from AHA Scientific Statement regarding Treatment Resistant Hypertension: Diagnosis, Evaluation, and Treatment. The part I don’t understand is in bold face.

    > http://hyper.ahajournals.org/cgi/content/full/51/6/1403
    Two of the most common mistakes—measuring the blood pressure before letting the patient sit quietly and use of too small a cuff—will result in falsely high blood pressure readings.11 Although the degree to which inaccurate measurement of blood pressure results in falsely labeling patients as having uncontrolled hypertension is unknown, assessments of office blood pressure measurement technique suggest that it is likely a common clinical problem

    If, presumably, readings are lower after sitting quietly for five minutes (and this does indeed seem to be the case), what do the higher readings mean when you have not been sitting quietly for five min. Do they just not count? It seems to me that if you have (more than the occasional) high reading, that reflects hypertension. What am I missing?

    As we say in Thailand, “Thanks, lah!” for any additional info.

    Aloha,

    Rex

  3. Steve says:

    Hi Rex,

    Kellie is away from work this weekend so I thought I would jump in.

    I don’t think I will be able to help you with your questions. They are a bit above the pay grade of a computer programmer Smiley

    My understanding is that blood pressure is supposed to go up and down depending on what you are doing at the time … that is just the way the body works. I also believe, and the way I read your AHA quote is that you should sit quietly for 5 minutes before taking a reading and applying the standard hypertension guidelines to that reading.

    I know that you can get wired up with a machine (ambulatory monitor) that will measure and record your bp continuously over a 24 hour period. I have never used one of those machines, but I am sure they would have many different ways to analyze the data. However I do vaguely recall Kellie writing about a study that compared ambulatory monitoring to home monitoring and finding that home monitoring was just as effective at determining hypertension.

    Hope this helps!
    Steve

  4. richinqld says:

    This condition is called labile secondary hypertension if the systolic is consistently over 150 and the diastolic is consistently over 100. The diastolic blood pressure is the most important diagnostic tool in the control of hypertension. Some people do not respond to potassium based anti hypertensives.

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