Newbie here so please be gentle if my query is in the re-inventing the wheel category.
I've had elevated BP for many years and have been on Amlodipine and Irbesartan for 5+ years. I was called into my GP surgery yesterday morning for a BP check. The clinician checked it manually and got a reading of 175/101 followed by another reading about the same. Not too much of a surprise because I seem to suffer from white coat syndrome. When I check it at home, the readings are usually between 135 and 160 over 70-85. The diastolic never goes above 85 at home. My wife, who thinks of everything, was with me at the GPs and had brought our home monitor with her. So, we asked the clinician to check it out. He took a reading on it which came in at 217/107. He then checked it against his recently calibrated electronic monitor, which produced a very similar result. He said our monitor was fine in view of the consistency with his electronic monitor. The upshot is that I now have to see the surgery's pharmacist in a couple of week's time.
Not long after arriving back home, I checked my BP again. This time it came in as 144/80!! That was about 30 mins after the checks made at the surgery.
Does anyone have any thoughts on what's going on here?
By the way, when I queried why the monitor systolic reading (217) was way above his sphygmomanometer reading of 170, he said it was because the monitors are more sensitive and pick up on the pulse earlier than when doing it manually.
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I am also on Irbesartan, and have been for over 20 years, and BP readings can be all over the place, whether at home, in the GP surgery, or on a hospital ward. However I think that's down to time of day, what I have been doing prior to the reading, and how I am feeling at the time. And even if I have sat calmly in a chair at home for 5 minutes and then take three consecutive readings they will all be different. Personally I don't worry about any of this although my systolic readings are usually a bit less than yours, whereas the diastolic are about the same. It will be interesting to find out what happens when you meet with the pharmacist.
Hello, youre doing well. I have similar readingsand like yours they vary. I take 50 gms Losartin and 2.5 bisoprolol. If I take another 1.25 bis I feel dizzy and brain fog so I avoid unless having palpitations start.I wonder if I need to increase my Losartin?
I get very stressed by high BP readings which makes it even higher. If I take 500 gms of paracetamol it seems to help but maybe just calms me?
I don't know a lot about blood pressure or machines. But that's way too high the217 from your machine and 170 over 101 from his. But that "white coat syndrome" my dad had that and was always high when was taken by gp or hospital setting. Does seem to settle when you're at home though. There's also a site for blood pressure "Blood Pressure UK" I'm afraid other than that I'm kind of just learning about such things too. Am on beta blocker bisoprolol which lowered my heart rate and BP too much so the dosage was halve from 2.5 to 1.25mg. I've always had pretty low BP though.
Hopefully someone with more experience and knowledge than me will also post some advice here. Take care....
Coincidence! On Thursday I had a routine check-up with my GP's pharmacist, who noted my BP as 174/87 - one of the highest I've ever recorded. I'd walked 20 minutes to the surgery, but sat in a chair for 12 minutes before she saw me. I said that my recent occasional readings since my TAVI in July had been highish 140s, middling 70s. She asked if I was anxious and I said no: she was very pleasant and I felt quite relaxed.
I walked home, waited 20 minutes and recorded 143/76 on my own machine, though four hours later it was 165/82 - and 127/70 the next morning.
I record the second reading. I take Ramipril 2.5 after the evening reading, so guess it's losing its effect by then.
The pharmacist asked me to do readings morning and evening for a week and send the results to her, and if necessary I can take my monitor to our next appointment to compare it with hers.
your blood pressure does vary depending on what you’re doing, how you’re feeling, when you took the medication etc. Personally I take mine at the same time, roughly, each time.
The website to go for is the charity Blood Pressure UK
Thanks, I've been doing that for some time and my home results are nothing like the elevated results I get at the GP surgery. I can't get my head around my BP taken manually at the surgery being way below the results I got, during the surgery visit, on our own monitor and also the surgery's monitor. The clinician said it was because the monitors are much more sensitive to pulse detection so pick up on the pulse earlier and while the pressure is still high. However, that doesn't explain the readings I get at home because if it comes in at say 144/80, using his logic the manual procedure should give a reading way lower than 144/80!
Generally at the surgery they take BP under exactly the wrong conditions. You are led rapidly to the room, sat down, the cuff is immediately slapped on you-not always at the right height or place-then three readings are taken.
Quite apart from white coat syndrome the test should be taken sitting down for at least five minutes without distraction and with the cuff in the right position. Then middle one out of three. If your own meter was accurate then I would trust it over the readings in the Surgery.
White coat syndome, clinical hypertension, call it what you will is a very real phenomenon. I suffer from it and once presented 220/110 at my GP surgery. My GP accepted that although I did have a high BP at the time, white coat syndrome was elevating the readings taken at tge surgery. I was asked to take my home monitor in to be checked against the monitor my GP used. I now take my readings at home and submit my results annually by post.
The bizarre thing is that I am totally chilled out going to see my GP. A visit is not a stressful event at all. I ran my own business for over 25 years, regularly meeting people in many situations, some far far more stressful than a visit to the GP. I also don't get an increased BP when I go to the dentist.... work that one out! In hospital I was presenting elevated readings, but not as high as when I see my GP. There is no logic to it.
I have worked with the pharmacist at my GP practice to get my medication right for me. The experience has been very positive and far less confrontational than when dealing with my GP who seems to want me on the maximum dose of every medication. I hope you will have a similar experience.
Thanks, your first 2 paras mirror my experience very closely. I'm now waiting to see the pharmacist so hopefully things will pan out the same way for me as for you.
I too have white coat syndrome. Exactly like above. I now monitor my own blood pressure at home , only every month now. No one knows why it happens but best to not worry about it. It feels like a body betrayal because I’m not a stressful person, I’m comfortable visiting the surgery.
The surgery are ok accepting my home readings, even when I have a hiccup with my medication ( like if my body gets used to one type and I need to change). It is a bit worrying when you realise that your bp IS actually that high at the surgery though. Luckily for me a visit is only once/ twice a year .
If I am in a setting where a medical professional takes my BP it is always high. I don't know if it's white coat syndrome or just because I don't want to be there as I'm not aware of feeling anxious.I keep a record of my BP at home, I can be very forgetful about it but make sure I have a complete week every month. I am an old dear so write it in a notebook and take it with me. So far that has always been accepted as an accurate record of what my BP is doing.
Try taking slow, deep breaths for 5 minutes before taking a reading. I do this between 1st and 2nd readings and the difference can be up to 15 less for systolic pressure. I’m always higher in clinical settings, but readings at home are usually fine.
I'm the same with very high readings at the surgery yet 130/70 at home. My monitor says to have your arm level with your heart yet at the doctors it's always resting on a table much lower down. I have no noticeable anxiety or stress at the surgery apart from the drive to get there and I usually have to wait 15 to 20 minutes before I see anyone. I just had a new GP check my pulse manually and absolutely insist I had AF and made me wait almost an hour until a nurse was free to do an |ECG which of course only showed a couple of ectopics and no AF. She even refused to read my discharge letter from the hospital which, after 4 days monitoring showed it wasn't AF. The practice nurses seem to do far better at taking BP readings. My mother in law was put on BP tablets for over 30 years after just one high reading by a doctor. It was only after she started passing out in her 80s that the hospital took her off ALL medication and discovered she'd never had high BP at all. There's only one GP at our practice who, after a high reading, will ask me to take it at home for a week.
You can request a 24hour monitor. This is fitted and removed at the GP surgery. It will give a better indication of how your BP is influenced by activities, sleep etc.
My BP tends to rise in a clinic setting, but I'm anxious at the best of times. I'm currently completing another week's readings to take to my GP on Tuesday. Roughly same time each day, sitting still for 5 mins beforehand, no moving, sips of tea, etc.! After six days, the lowest systolic reading is 148 (/96), highest is 184 (/103). Diastolic is also variable, ranging from 82 to 103. I use a 2nd reading. Tomorrow, I'll try to work out an average.
Try not to stress too much: as Wanderinglady suggests, you can request a 24 hr/ambulatory monitor from your GP. This would provide a better indication of your BP over time, doing normal activities. 💓
In November I was having problems with fatigue and had a fraught journey by public transport to see my cardiologist. It should have taken 90 minutes, but, having got off a train, I waited for the half-hourly bus service to the hospital. The first bus couldn't get into the station forecourt because the entrance was blocked by a lorry, then I got on a bus going in the opposite direction. Getting off the correct bus, I wasn't completely sure that I was heading to the hospital. When I finally got there, I went to the toilet and pulled the emergency cord rather than the light cord (prompting a nurse to scurry to see if I was OK). After all that, my BP was "only" 155/85, which is not much higher than some readings I've taken at ease at home.
Just an update to my post about BP and stress. At 0645 today my BP was 162/70 - a high systolic reading for me. I had a stressful Big Shop (unable to find items I'd been asked to buy, and a painful foot) and returned home feeling a little bit low physically and mentally. At 0830 my BP was 139/69 - which for me is an ideal reading. (My TAVI surgeon isn't too bothered about a systolic reading in the 140s but might be concerned about a diastolic one that went over 90 very often.)
Last year I took BP readings twice a day for six months, and I suspected that when I was feeling rough my BP was low, and when I was feeling good (and being energetic) it was high.
I am approaching 74 and was first diagnosed with hypertension well over 20 years ago. For most of the time after I was diagnosed, I was on Lercanidipine and Candesartan, medication very similar to yours and my blood pressure was all over the place. Yet I came to no harm and was generally very well. At various times and because I had private medical health cover with my job, I saw heart and kidney specialists who made no change to the basic prescription. In recent years, I decided to do my own research and persuaded my GP and then his pharmacist to try me on different medication. There was some reluctance because a CCB (Amlodipine/ Lercanidipine) and an ARB (Irbesartan/ Candesartan) is the standard NICE approved treatment. After much trial and error, I am now on Nebivolol (a Betablocker) and Spironolactone (a Potassium Sparing diuretic) at very low doses. I measure my BP at home regularly (mainly out of interest). Most recently it averaged 131/77 over 6 readings, half taken in the morning and half taken at night. This is now pretty typical. I have no troublesome side effects and I rather like this cocktail. Nebivolol helps me to keep calm and helps with a non-Parkinson's hand tremor I have. As for Spironolactone, there is research to suggest that it helps to keep Prostate Cancer at bay - something of a concern to me because my brother died with it last year. The only downside is that you have to have regular blood tests which, in my case, have been fine. This cocktail may not suit everyone. Some people experience fatigue with Betablockers and some men develop enlarged breasts with Spironolactone. I'd encourage you to do some research and work with your GP's practice to find something which works best for you. I began the search for something that works for me by reading a book by Samuel J Mann, "Hypertension and You - old rugs, new drugs and the right drugs for your high blood pressure". Don't be put off by the fact that it was written by an American specialist. The medication is the same there as in the UK.
Many thanks for the detailed comments and book recommendation. I've ordered it today. I wondered for some time whether Amlodipine and Irbesartan are the best drugs for me.
One thing that slays me is that the "white coat" is often asking me questions while taking my BP. Talking raises your BP so I don't answer them, hoping they will stop!
That reminds me, the last check I had done, the clinician wanted me to hold my arm horizontally in mid-air with no support. I thought you were supposed to relax the arm during the procedure. Also, while he did it 3 times, for systolic, it was all done by allowing the cuff to partially release the pressure, repumping and then repeating twice more. However, I thought the idea was to allow so long between each measurement. At home, I allow a minute between each measurement as recommended by various websites.
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