BP Follow-up- Improving But Not There Yet

I worked pretty hard on my blood pressure since my bad reading at my new doctor’s office last week. Measures I took included :

  • cut back on exercise volume and intensity a bit (possible overtraining)
  • stop taking phenylephrine
  • remember to drink more water (being slightly dehydrated can drive up blood pressure)
  • do a better job at quality of yoga and meditation

This combination helped a lot. This is the lowest reading I got each day, the last one before bedtime. The numbers on the chart are just the days since the last visit:

It came down from a worst day of 164/88, very high (stage II hypertension) to a best of 120/64, normal. But here is the chart for the highest reading of the day, on arising in the morning:

Preview(opens in a new tab)

This came down significantly too, from a high of 171/91 to 131/67. The diastolic is now normal but the systolic is still “prehypertension“. It’s not ok that just the systolic is high, I just found out that is called “Isolated systolic hypertension” and is the most common form of hypertension ins folks overs 65. As a review, the high number, systolic, is while the heart is beating, the low number, diastolic, is while it is resting in between beats. The fluid dynamics of all this is fascinating, it is pulses traveling in elastic tubes. But the tubes aren’t just elastic, they are active: they can dilate or constrict due to the action of smooth muscles in their lining. I’m going to go into a lot of detail about that in future posts because it is important and interesting.

So Ok, I’ve improved a lot, but still some work to do. Then I go to my doctors office for my followup, and the reading is 155/78 in the office! Lelah, the technician, rechecked it with my meter from home and it was similar. So we know we can trust my readings at home. But why did it rise only about an hour or so after the much better reading above? Do I still have “white coat disease?”. Even if that is true, that condition is not benign, so I still have some work to do.

Now as far as the doctor is concerned, yes I improved a bit from a high of 170/90 on my last visit, but here is a patient that just presented, in her office, with significant high blood pressure. What would probably 99% or more of the doctors in the US at least, if not the world, do? “I’m going to start you on a dose of xxx and see if that fixes it”, here’s your little white piece of paper, see me again if that doesn’t fix it. Instead, Dr. Moayed gives me a list of foods that enhance vasodilation, and encouraged me to keep working at my lifestyle interventions. If that doesn’t work we’ll try supplements or other plant-derived remedies (nutraceuticals). Only if I don’t respond to that will we try drugs. She then gave me an interesting examples of why a BP drug (lisinopril. one I used to be on) causes side effects.

My only concern was that my BP is elevated in the AM, which is when I like to do my longer and harder workouts. She recommended sticking to easy stuff like yoga and meditation on arising, and workout out more vigorously later. So that’s where I am on my blood pressure adventure. I’ve every confidence we’ll lick this, hopefully without drugs.

Dr. Moayed also was not satisfied that I passed my gait evaluation. Yes my gait is ok now, but I have to show I am doing enough to prevent it deteriorating in the future as it commonly does with age, such as gait-related muscle strength and flexibility training, and balance. My post about my gait eval was a little superficial, in retrospect. I’ll do a more detailed one soon.

It’s starting to sink in to me how serious the preventive medicine viewpoint is. She wants to be sure the patient is in good shape now, and is doing what’s necessary to stay that way in the future, in various aspects of their health. I think you’re getting an idea of why I so much like working with Dr. Moayed. I’ll go into why in more detail in my next post.

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