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Tuesday, August 12, 2014

MY BODY IS LIKE THE UNITED NATIONS: Part 3--Blood Pressure

What is the relationship between the United Nations and my blood pressure?  Perhaps the clue on how to make that international body work better can be gleaned from my experimentation with blood pressure.  This posting is long and sometimes arcane, so you should award yourself a medal if you stick with me till the end.  I'm providing details to show my doctor next week.

In case you missed it, last year, the American Medical Association, AGAIN, adjusted their guideline for blood pressure:

Adults aged 60 or older should only take blood pressure medication if their blood pressure exceeds 150/90, which sets a higher bar for treatment than the current guideline of 140/90, according to the report, published online Dec. 18 in theJournal of the American Medical Association.

The following chart for blood pressure categories by the American Heart Association, though, apparently remains unchanged:
Blood Pressure Category  Systolic                    Diastolic
                                            (Upper)                      (Lower)      
                                            mm Hg                       mmHG

Hypotension                       less than 90              less than 60

Normal                                less than 120            less than 80

Prehypertension                120-139                     80-89
Hypertension Stage 1        140-159                     90-99
                      Stage 2          160 or higher           100 or higher
Emergency care needed    higher than 180       higher than 110


For at least the past decade, I've been taking 12.5 mg of Irbesartan-HCTZ (I-H) once a day.  Actually, it was Avalide for the greater part of this period, whose patent protection expired in March of 2012, so I-H must be a generic and, thus, cheaper.  The I is an angiostatin (left) and H a diuretic (right).


To gain a sense of why my blood pressure varies, during the past month I  have taken measurements at least ten times/day.  The variance has been from greater than 180 for the systolic to lower than 60 for diastolic, at pulse rates from 50 to 140..  I'm beginning to get a sense of when these highs and lows occur.  By the way, this OMRON wrist blood pressure device is amazing.  Two 3A batteries, with all the whirring sounds and tight pressure, can take around 250 measurements.

I have had several previous postings on this subject, pretty much focusing on hypertension, or  high blood pressure, and here are two you might want to peruse if you're into these sort of things:
As salt is said to mostly increase blood pressure, Maggie Danhaki, assistant marketing manager for Healthline, sent me an excellent link:

          (The cottage cheese will surprise you.)
My blood pressure is almost predictable (and, in a way, similar to the UN, for you know what they will do, which is normally nothing much):
  • When my pulse rate is low, my blood pressure is high, and when my pulse rate is high, my blood pressure is low.   I must be anomalous because the AMA indicates that THERE IS NO RELATIONSHIP BETWEEN PULSE RATE AND BLOOD PRESSURE.  But my biochemical engineering training says that my body simply follows standard unit operations:  if my pulse rate is high, then there is sufficient blood, so the pressure can be lower; if my pulse rate is low, my cells at the extremities need more blood, so the pressure is raised.  That should be a fundamental relationship...but the American Medical Association disagrees.
  • When I'm really hungry, my blood pressure zooms up.  According to those AMA guidelines, I should be in the emergency room sometimes, for I've experienced, and survived, a systolic of 180.  The AMA says there is a relationship between extreme hunger and high blood pressure:
          Or, worse:

  • After I eat, the pressure usually returns to normal within the hour, but then goes up after a few hours, for my body begins to get hungry again.  I definitely should do everything possible to eat on schedule.  Small portions throughout the day might be necessary, but I enjoy a fabulous meal, and snacks just increase my weight.  I don't eat to live.
  • When I first awake, my blood pressure is high, but that is because my pulse rate is low (50 beats/minute) and I'm hungry.  Plus, the shock of waking up and the fact that I took my pill 24 hours previously.  I think needing to go to the bathroom also increases the pressure.  Most strokes and heart attacks occur when you first awake.  Here is what the medical profession says:
The cardiovascular system follows a daily pattern that is oscillatory in nature: most cardiovascular functions exhibit circadian changes (circadian is from the Latin circa and diem, meaning "about one day"). Now, a heart attack depends on the imbalance between increased myocardial oxygen demand (i.e., a greater need for oxygen in your heart) and decreased myocardial oxygen supply — or both. And unfortunately, some functions in the first hours of the day require more myocardial oxygen support: waking and commencing physical activities, the peak of the adrenal hormone cortisol [which boosts blood-pressure and blood-sugar levels] and a further increase in blood pressure and heart rate due to catecholamines (adrenaline and noradrenaline), which show a peak when you wake up. All those factors lead to an increase of oxygen consumption but at the same time contribute to the constriction of vessels. So you have reduced vessel size and reduced blood flow to the coronary vessels.

           I think my explanation makes more sense.
  • In general, when my pulse rate is around 60, the pressure rests at 140-150/85-90.
  • When I walk on a golf course at a relatively slow pace, with my pulse at 100 or lower, my pressure stays in the range of 110-120/65-80, lower than my normal, but good.  The last time I went to the Ala Wai Golf course:

                                              TIME  SYST  DIAST  PULSE RATE
    • Before golf         1442    167        89                   74
    • End of 1st hole   1503    130        77                   94
    • End of 5th hole  1556    114         77                 100
    • End of 7th hole  1623    117         75                   84
    • End of 9th hole  1650    123         75                   96
    • Home                 1725    147         90                   75
    • After dinner       1904    141         74                   83
    • 1/2 hr aft din      1934    134         72                   71
  • When I ride a golf cart, my pulse rate averages 125/70, with a pulse rate of 67.  Again, a lot better than normally.
  • However, what is worrisome is that if I walk on a hilly course, or when I need to walk faster, my pulse rate increases to beyond 120, and my blood pressure can fall to 90/60 at a pulse rate of 123.  Worse, if I quit at that point, my pulse rate can drop to 100, but the pressure further declines to 80/50 15 minutes later, and is still 85/64 at 103 an hour and a half later.  During this period, I feel a bit dizzy when I bend down to pick up a ball, but am otherwise okay and can function normally.  Why does this occur?  When I stop walking, my pulse rate drops, but not fast enough, for my body does not need all those nutrients, so it reacts by further dropping the blood pressure. 
  • Here is what happened yesterday on the Ala Wai Golf Course:
                                                  TIME SYST DIAST PULSE RATE
      • Before golf            1500     136        90                  78
      • End of 21st hole    1535     108        67                114
      • 2nd hole                1548     107        76                108
      • 3rd hole                 1603     108        74                123
      • 4th hole                 1614     106        70                124
      • 5th hole                 1625       98        65                119
      • I  thought the blood pressure was too low, so I took a ling hing mui lemon.
      • 6th hole                 1639       96        56                116
      • Maybe salt takes half an hour to register, like my meals to cure hunger.
      • 7th hole                 1654     103        68                116
      • 8th hole                 1705     108        68                110 
      • 9th hole                 1729     101        68                  98
      • Home                    1610     122        77                  95
      • At dinner               1901     130        77                  84
      • 1/2 hour after        1931       98        64                  82
      • One hour after      2001     140        77                  69
      • Why did this suddenly rise?  Because the pulse rate dropped.
      • Two hours after    2101     134        70                  60
      • Why did the pressure drop?  The body is stabilizing at a low pulse rate.
    So what should I do?
    • Clearly, golf is good, for that is when my blood pressure is normal to low.  
    • To avoid the real lows, when I walk on a course, I need to stroll at a leisurely pace and avoid hills.
    • My pulse rate increases into the 6th hole, then tends to stay even or drop.  Thus, my blood pressures reaches a minimum on this hole, then usually recovers up a bit.
    • While this does not particularly help maintain weight balance, riding a cart on a golf course is a lot better than working on my computer.  Golf = 125/70, sitting = 150/90.
    • Exercise does help control blood pressure.
    • Avoid certain foods:
      • Salt is probably bad, but maybe not as terrible as you think.  In fact, salt might be an antidote for hypotension.  I'm thinking ume the next time on a golf course, for the li hing mui lemon did not have much sodium.
      • Consider the DASH (Dietary Approaches to Stop Hypertension) eating plan.
      • Avoid processed meats, pizza, Chinese food, frozen TV meals, pickles, most soups and sweetened beverages.  Yes, sugar is bad for blood pressure.  Hmmm...maybe a can of coke might be safer than that Japanese pickled plum for low blood pressure.
    • Don't sit around all day hunched over a computer or watching TV.
      • Read the book, Get Up, by James Levine.
      • We lose two hours of life for every hour we sit.
      • Maybe this is because your blood pressure goes up, but that is my contribution to this discussion.
    I'll show this posting to my personal physician next week.

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    1 comment:

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