Recent learnings about blood pressure & meds

Introduction

I sometimes do research for friends and family on diagnoses or treatments. This usually involves finding the best papers on a health condition and/or clinical pathways suggested. People want as much information as possible and a second opinion when they are diagnosed with something. Invariably, I have not looked into the condition before, so I’m starting with no pre-conceived ideas.

I recently had a query from (let’s call him) John. John is in his 50s. He’s slim and fit (exercises daily). He eats a real food, low-carb diet. He has a couple of health conditions unrelated to lifestyle but looks and feels mostly healthy. He shared that his blood pressure had been flagged as a concern at recent medical appointments. He was the last person you’d suspect of high blood pressure, but his conditions (and medications for those conditions) could be a factor.

I made the usual first suggestion – measure your blood pressure at home a number of times during the day and keep a record in case it was high at appointments because of the well-known ‘white coat syndrome’ (Ref 1). People are often stressed in clinical settings, and this can raise blood pressure. John did this and his readings were quite varied (170/80 mmHg at the highest and 135/70 mmHg at the lowest). There was no clear pattern with time of day, meals etc. The simple average of the first few readings was 156/80 mmHg. That’s not ideal.

Systolic blood pressure (SBP) is the top number and refers to the amount of pressure experienced by the arteries while the heart is beating.

Diastolic blood pressure (DBP) is the bottom number and refers to the amount of pressure in the arteries while the heart is resting in between heartbeats.

The difference between the SBP and DBP numbers struck me as large and that was the first thing I researched. The difference between the two numbers is known as the pulse pressure (Ref 2). That number ideally should be 40 mmHg. As pulse pressure rises above 40 mmHg, the risk of problems with the heart and blood vessels increases. Pulse pressures of 50 mmHg or more can increase the risk of cardiovascular disease. John’s average pulse pressure (from those early numbers) was 76 mmHg.