Blood Pressure Variation

[JamesP]

I have had permanent AF since at least 2008 but lead a normal conservative life style with otherwise good statistics. However my blood pressure varies dramatically on a daily basis, up to thirty points, but can be reduced considerably by exercise and meditation. There is a school of thought that says variation of BP is more dangerous in terms of strokes than constant high values. Has anybody any experience in this respect? What advice were you given?

[BobD Volunteer]

Never mind over a day, my BP is quite different in each arm by about 20/10. Doing things, anything, affects BP and when I am asked to produce a seven day chart the instructions are to sit quietly for five minutes then do two readings two minutes apart and discard the first one. Max three per day. You then take an average of all readings to produce a mean figure.

Obsessing about BP only makes it worse and I used to joke that I only started to feel better when the batteries in the machine went flat. Now I seldom touch it unless asked for a chart,

Not being a time lord neither I nor my GP understand why the left side of me is fine but the right hypertensive.

Bob

[JamesP in reply to BobD]

Bob,

That is very reassuring! I think I was becoming obsessive about it too. I will take your advice. Thanks.

[PeterWh in reply to BobD]

Read an article in the Daily Mail or the Sunday Times about four months ago or so about difference of BP between arms.

When at the beginning of May I had to call paramedics they took readings in both arms and explained to me (without asking) that 10 to 15 is normal for most people and that a big difference of 30 plus is an indication of heart / circulation issues.

[jeanjeannie50]

Hi James, just by doing deep breathing for a minute I can drastically reduce my BP. Unfortunately, for me it doesn't reduce my heart rate too.

Jean

[JamesP in reply to jeanjeannie50]

Jean,

That seems to chime with my experience with good meditation. I have just completed a 20mile bike ride and my BP is now 121/60 when it was 150 this morning. I think the message for me is to keep up the meditation and exercise and don't be obsessed with reading BP, all other things being equal.

[Lcpatrol]

My AF has been controlled for seven years or so with medication ( bisoprolol 10mg OD & flecainide 100mg BD). However this has been without a hospital follow up to check how things are in all this time. They said come back if there was a problem and as my AF was controlled , I didn't request an appointment.

Over this last year I noticed a change and requested an appointment and the consultant was surprised that I had been on this quite high dose for so long, but didn't change things as I'm quite a fit 63 year old.

Anyway a few months later I still wasn't right and was hospitalised briefly with high blood pressure (for the first time in my life).

My meds were reduced (Bisoprolol 5mg OD & flecainide 50mg BD) and a calcium blocker (amlodipine 5mg) added to control my BP.

Three weeks later, after one or two hiccups with high BP, I have settled down.

My wife bought a blood pressure monitor (which is excellent) and initially I took 3 readings 3 times a day but reduced it to 3 readings 2 times day. Now my BP is back to normal I'll take readings only when I feel unwell.

Bob says "obsessing about BP only makes it worse" and he's right. In the early phase of starting blood pressure treatment, I found the monitor very reassuring though.

[JamesP]

Initially I was put on amlodipine 5mg but this did not tend to reduce my bp consistently. I went back to a regime of exercise, diet and meditation which had more effect. I am also averse to heavy medication with all the side effects particularly fatigue and damage to liver and kidneys. I take vitamins and enzyme Q10.

As I am now 77 and still active I must be doing something right. I am venturing on a month long trip to Canada to see my daughter next week and have resolved not to take bp monitor. I can now tell when my bp is on the high side anyway especially a.m.

I am of a mindset where I don't like to waste time or opportunities. We shall see!!

[seasider18 in reply to JamesP]

I took my BP monitor to Switzerland. The higher up the Alps we went in stages the higher my BP. We came back down by train over one day and I could feel it falling all the way.

Be careful in the Rockies

[PeterWh]

I'm the total opposite.

I take my BP and HR most mornings and evenings (say 4 or 5 instead of 7) but not as consistently / regularly as the EP asked, particularly the time of the recording

I must admit that I don't take too much notice of them since the BP machine and the Kardia log them electronically and I download the BP ones when I have an appointment. About a month ago my physio asked to see my BP readings and so I downloaded them. Then I noticed that instead of being on the low side (say 105/65 average) they had crept up and were about 130/95 over 4 to 6 weeks. Physio suggested that I saw my GP. Went into GP and she took one look of them and said not worried about the systolic being high but "I am about the diastolic being high". She didn't even take my BP as she knows that the BP monitor is approved by NICE and BHS. Tablet for BP added.

The moral of that story is that I probably should write on a piece of paper or download more regularly so that it doesn't gradually change and go out or range!!!

[seasider18 in reply to PeterWh]

I met a lady who goes round companies and industrial sites doing health and BP checks. If any have a diastolic over 90 she tells them to see their GP.

Over this month I have had diastolic readings from 58 to 122. Two or three times over the years I have mentioned such readings to registrars who airily say it doesn't matter.

[MarkS]

I too read a story about large variations in BP being dangerous. However I think they mean really high swings. In this article (I know in the Daily Mail!!) in the examply the variability is between 137/62, 208/68 and 156/76.

Read more: dailymail.co.uk/health/arti...

I think your average BP is what counts and there is always a natural variation. I also deep breath slowly whilst taking a reading. As long as your average is below 140 and preferably 130 you should be OK. The research was done on people who already have high BP, e.g. average 160 spiking at 200+.

[PeterWh in reply to MarkS]

As you may have seen above GP was more worried about diastolic rise rather than systolic, especially because of AF / heart conditions.

[seasider18 in reply to MarkS]

I did a massive sneeze once during a reading and the diastolic said 158.

[Goldfish_]

Please note that automatic blood pressure machines do not give accurate readings in people with atrial fibrillation and it is recommended that manual methods are used bhsoc.org/resources/how-to-...

The diastolic measurement is particularly poor ncbi.nlm.nih.gov/pubmed/229...

[PeterWh in reply to Goldfish_]

Good to identify Goldfish.

That paper was published in 2011 and no doubt was based on research done in 2009 and 2010 before the advent of AF designated BP monitors. I was told from two sources that AF designated ones were suitable for people actually in AF. In the private hospital where I had my cardioversion done the senior nurse actually said about the fact that a non approved BP machine found its way onto her section of the ward whilst she was on holiday for a few days because hers was newer. It would be interesting if they do publish an update this year.

What is very interesting is the following extract regarding ,measuring on both arms [my boldings]:

When considering a diagnosis of hypertension, measure blood pressure in both arms.

• If the difference in readings between arms is more than 20 mmHg, repeat the measurements.

• If the difference in readings between arms remains more than 20 mmHg on the second measurement, measure subsequent blood pressures in the arm with the higher reading.

.

How many people have had it measured in both arms?

[Goldfish_ in reply to PeterWh]

Interesting. I had thought that the new machines just identified af, but on checking I see that they exclude the beats that vary more than 25% from the average rate, so should certainly give a better reading. As you say an updated paper looking at this is now required or the updated Nice guidance.

[PeterWh in reply to Goldfish_]

Good point. Sorry I should have said that because that is what I found when I did my research almost 2 years ago when I bought my "AF Friendly" BP monitor!!!

I suspect that this is one of the reasons why you can get Error on the BP monitor and have to repeat the readings. Normally on my Microlife it is three readings before it produces the result (waits 15 secs, does the measurement, stops, waits 15 seconds and then repeats). If it one reading is unsatisfactory it tries a fourth time but if two were unsatisfactory it shows Error on the screen (and you have to start from the beginning again).

However I was told that not all the BP machines in hospitals are "AF Friendly". One sister in one of the hospitals I have been in said they were all "AF Friendly" in key areas such as coronary, theatres, intensive care, A&E, ambulatory care, etc but not necessarily on other wards due to the cost of replacing and some of the existing ones were less than a year old when the newer "AF" ones came out (and of course the AF ones would have been considerably more expensive at the start.

The worrying thing is that I have come across quite a number of nurses who are totally unaware that there is an issue with automatic BP monitors and that AF does make a difference to automatic BP monitors!!!! One of Beancounter's (Ian's) gripes!!!

Also the elimination I suspect is one of the reasons that the HR is not always the same as that shown when using an electronic device such as a Kardia (AliveCor).

[seasider18 in reply to PeterWh]

In another answer you mentioned an Omron machine for ECG readings. What is it actually called. The Kardia one is evidently not compatible with my phone.

[JamesP in reply to seasider18]

The Omron MX3 Plus just gives a digital read out but cannot be connected to a computer.

[seasider18 in reply to JamesP]

I was looking for one that Peter indicated took ECG readings.

I have an Omron MIT Elite Plus BP monitor that stores 100's of readings and connects to my computer.

[seasider18 in reply to PeterWh]

I had a session with a professor at Imperial College when trying to get on his renal denervation programme. On arrival his nurse took several readings on each arm with me sitting and standing. They were all in my 'white coat' range. She then sat me out in the corridor with a machine taking automatic readings for about 40 minutes. She then took the lowest of the figures as my reading.

[JamesP]

Thanks. The only thing I can say is that my bp is always lower after I have exercised or meditated so I should assume these activities are good for me. I did take my bp monitor down to my gp and he said the correlation was quite good. However I am sceptical and will assume I have high blood pressure and act accordingly.

[PeterWh in reply to JamesP]

How good was his machine or did he take it manually? Sometimes GP's may not be the latest because they have to pay for them!!!

[JamesP in reply to PeterWh]

He used a Hg manometer as I have come to expect and compared the result to my Omron MX3 plus which is a few years old and may well not be af friendly.

[PeterWh in reply to JamesP]

Were you in AF?

[JamesP in reply to PeterWh]

Yes I am in permanent af.

[seasider18]

My 'specialists' all seem to disagree with that school of thought and keep on telling me it is the average that counts. As my readings can be 210/110 in the morning and 106/69 by night I rather disagree with them.

Now I tend not to take it first thing in the morning and wait till 10.30 or 11am.