A Secret about Age and High Blood Pressure

 – it may NOT BE High Blood Pressure.
Tips to Safeguard yourself.

I generally have good blood pressure (BP) levels – but I still watch it periodically.  Not everyone is so lucky.  What if your doctor tells you that you have high blood pressure (or hypertension) and that it is natural as you age?  Are you surprised?  Should you be sure you REALLY have High Blood Pressure?  It is possible that YOUR diagnosis of a high BP is really something else.  Ever heard of ‘pseudo-hypertension?’   Perhaps not, but some studies show that 7% of older patients have it  (info from the Systolic Hypertension in the Elderly Program). Other studies have even suggested a possible higher percentage.

It doesn’t take a genius to figure out that this term pseudo-hypertension translates to ‘false high blood pressure.’  Hypertension (or high BP) in and of itself is NOT a disease, but neither is it a condition you want to dismiss out of hand.  It can heighten the risk of threatening diseases such as stroke, kidney disease, coronary heart disease or cardiovascular events.  And statistically those over 80 years old have an increased rate of developing high BP and very low rate of ‘compliance’ (read that as not wishing to do enough about it, or sick of being told what to do).  The stats are true, and probably add to a physician jumping to the conclusion of hypertension.

Why is it important?  Because you could suffer effects of being over-medicated.  But let’s not go there yet.  What IS pseudo-hypertension?

To paraphrase the medical dictionaries of Dorland’s and Mosby’s, this false reading of elevated blood pressure (when using a BP cuff)  is most often seen in elderly patients and is the result of ‘loss of arterial compliance.’  It is basically a side-effect from calcification (hardening) in the arteries, mostly the brachial arteries in the arm.  You might hear them called ‘pipe-stem’ arteries.  INVASIVE procedures can be used for more accurate readings, but this is not always appropriate for everyday findings.  [Invasive means that your body is ‘invaded’ and in this case means that a catheter is inserted directly into the brachial artery – Yuck.  Although for pseudo-hypertension apparently only a very small tip of the catheter is needed. And these days some other methods are being put forward.]  Yet it is possible – and maybe advisable – to avoid this invasive procedure with a few simple tricks and instead rely on typical monitors (whether self-administered or with the doctor listening to arterial “Korotkoff sounds”).

 

First, White-Coat Syndrome seems to play a significant role in pseudo or false readings.  Most people our age know very well what this syndrome is and how it can affect us.  For younger readers, suffice to say that when the doctor in her (or his) white coat walks in we get very nervous and it can send our bodily systems into turmoil, or at least agitation.  When this happens, readings like BP can be inaccurate.  To rule out this situation as a reason for high BP, it is actually suggested that the ‘patient’ (read that as YOU) take your own readings at home on a consistent basis until a proper diagnosis can be determined.

NOTE: as I mentioned, hypertension isn’t actually a ‘disease’ and doesn’t cause symptoms; yet you often hear it called the ‘silent killer’.  Figuring out whether or not you have false readings is not strictly about withholding medications, because those with pseud-hypertension OFTEN have  stiff arteries (or what we used to call ‘hardening of the arteries’) and as such can be at increased risk for cardiovascular problems.  Thus they may need medication or certain lifestyle adaptations.  Finding the truth is about appropriate choices.  Choices made without putting our bodies through unnecessary stress, our pocketbooks through unnecessary expenses or our daily routines through unnecessary efforts.

Second, is the small cuff issue.  Don’t let the doctor diagnosis you with hypertension if the cuff (the part that wraps around your arm) is TOO SMALL.  This happens more often than one would think.  Different body types visit the doctor but only one sphygmomanometer may be used in the doctor’s office.  If the cuff is too small or your arm too large for the cuff, the BP may seem elevated even if in reality it is not.  It may be difficult or awkward to suggest that your doctor is using the wrong size cuff, but if you are going to rely on their opinion and you suspect the cuff is the wrong size, say something.  More importantly, if you are going to monitor yourself at home make sure the cuff fits you correctly.

Third, the fine line of OVER-MEDICATION.  Drugs to help actual high blood pressure (especially if accompanied by life style changes) can certainly reduce the risk of stroke, heart failure or other cardiovascular diseases.  BUT when it is a matter of pseudo-hypertension (especially if the second number or ‘diastolic’ BP is not very high) people taking such medicines may suffer serious complications.  Often these stem from unfavorable interactions between hypertensive and other medications, or simply too many drugs or excessive doses.  We won’t even talk about the waste of money for such treatment.
The doctor may feel that it is ‘better safe than sorry’ and put you on meds before ruling out pseudo-hypertension.  Thus, as uncomfortable as it may be, you need to be prepared to delve into the decision and ASK your doctor for the reasoning behind the prescription.  But before you do, put them on notice that your concern is the possibility of pseudo-hypertension.  Even if you forget that term and call it something like false High BP or ‘older person’s High BP’ they will understand your point.  Of course if they don’t, there are always other doctors who will.

Fourth, make your trip to the doctor’s office really count for something – even if you feel you are being rushed.  Advertisements talk about ‘when your doctor takes your blood pressure.’  I think many of us realize that more often than not it is someone else in the office who does this, a nurse or physician assistance or nurse practitioner. If we are lucky it is one of the two latter.  I say ‘lucky’ because while anyone in the office may be able to take your BP, it is likely that the doctor will be most rushed and least willing to talk more about it and the nurse (while quite knowledgeable) may not want to say too much about it for fear of overstepping the relationship between nurse and doctor.  No matter who does it, insist on a couple things.

• Ask them to look at your home monitor and see if when they use it, instead of their own equipment, the results are the same. [Yes, this means they have to do it twice.] Hopefully this will show that your home unit is ‘calibrated’ correctly (or at least is fairly well in sync with the doctor’s equipment). If not, further investigation is needed.
• Make sure you are using proper arm position when monitoring yourself by having them either watch you OR show you the correct position.
• Have them make a copy of your home log (or bring them a copy) and have it placed in your file. If nothing else, this puts them on alert that YOU are a team player in your health care who is aware and interested in your health and want treatment based on your own needs rather than office habits.

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Monitoring Yourself

It is imperative to know if your BP is high (due to its risks) and to have it checked regularly – no matter who is doing it.  Of course it is less expensive for you to do it yourself, IF YOU LEARN HOW TO DO IT ACCURATELY.  Many physicians find it hard to accurately evaluate BP in older or elderly patients when they are in the office, so the DIY (do-it-yourself) method can be very handy for you both, and provide a better overall assessment.  Here are some tips.

What are you looking for when you monitor?

Before we mention the ‘how’ to take your BP, let’s review the basics. Generally, you want a goal of less than 120/80 (meaning the systolic or first number is less than 120 and diastolic, or second number is less than 80). Results greater than 140/90 are usually diagnosed as hypertension. If taken at home with results repeatedly at this level it is probably wise to pay a visit to your physician. Any readings between 120 and 140 (systolic) or 80 and 90 (diastolic) are considered borderline and need attention and at the least more frequent monitoring.

What to use when you monitor? 

Electronic devices at home are fine. Take if from one who has tried to use a regular cuff and stethoscope on herself – forget it. It is possible, but I like the easy to use digital arm cuffs better. Nowadays FINGER and WRIST BP monitors are often recommended for people monitoring at home. Additionally, with finger or wrist monitors you don’t have to worry about cuff size. Frankly, I haven’t tried them on myself, so I cannot attest to their accuracy, but that brings me back to the point above about ‘calibrating’ with your doctor. Whatever monitor you use, follow the directions that come with THAT device exactly. AND make sure if you are using a battery operated model (most of them) that your batteries are fresh or charged regularly.

HOW to monitor at home?

When I was in school they taught us how to take BP as part of several other procedures known together as ‘George’s test’ (technically to determine vertebrobasilar insufficiency). The reason I bring this up is that unlike so many experiences patients have; this test demands that BP be recorded for BOTH arms. You can imagine the surprised looks I received when attempting to do that. However, I suggest that it IS a helpful thing to do, even more so for older people (and definitely for the elderly). It is particularly important for pseudo-hypertension as it can point out problems. This is only one of the tips for monitoring yourself at home. Let’s review some other best practices. (Several adapted from a Canadian study.)

• Avoid taking BP if you are in pain, are cold, uncomfortable, or emotionally upset. Empty your bladder or bowels beforehand if you can. Also wait a couple hours if you have just exercised or half an hour if you smoked a cigarette (hiss) or had strong caffeine. Wait until you are not rushed, but relaxed. You might find that you like your results better if you learn to systemically relax for 5 minutes before taking readings.
• Sit up straight with both feet on the floor (not dangling nor crossed). Support both your arms on a surface that places them just about level with your heart. Notice that most pictures depicting someone taking blood pressure show this INCORRECTLY. The picture here is an exception.

  

• Take readings in BOTH arms. Record the date, time and results. It would be beneficial to try to do this at the same time of day on a regular basis, or even twice a day in the beginning while you aren’t yet bored with your new monitor. Some physicians will suggest taking the readings twice, one minute apart from each other. That is good. BUT if you are not willing to take the extra time (for 4 readings) it is even more enlightening to test both arms. Not to insult anyone’s common sense, but to be absolutely clear, readings from both arms are not taken simultaneously.
• Keep your log and share the results with your physician’s office. It will make you a better player in making decisions about blood pressure medications.

If diet is of interest to you in controlling hypertension, you may want to read about the DASH diet. And other than previous links I provided, if you would like to learn more on the subject of BP, and medications with an alternative look at tips and treatments, try this. Visit a site by Alvin Hopkinson, a researcher on BP, and download his free report on how to lower blood pressure naturally. His site is http://www.minusbloodpressure.com .

 

As I finished writing this post I learned of the death of Leonard Nimoy. Sadly as a fan, let me add in his memory.
Live Long and Prosper. 

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