high blood pressure

[Tomich1949]

Hi, everyone,

I am having high blood pressure readings each night, pretty normal during the day. I am on Ibrutinib and was wondering if anyone else has this problem?

also palpitations are frequent.

Kind regards to everyone.

Viv

[LeoPa]

Ibrutinib can cause these kind of problems. Let your CLL and heart specialist know about them.

[Tomich1949 in reply to LeoPa]

Thank you all for your help. I have been referred to cardiologist who will hopefully sort it out. In NZ Ibrutinib is only option for me and I am grateful for it. Best wishes to you all. Such a helpful group.

[Lenny123 in reply to LeoPa]

My hypertension, on Ibrutanib has been harder to control. i have elected to take Metoprolol and Hydrochlorothiazide. This is not usually first line and does have some drawbacks, eg. both are mildly Diabetogenic. My thoughts have to do with also having occasional Atrial Fibrillation, hoping that Metoprolol will help with that. Also do lifestyle, minimal Sodium, increased Pottassium. minimal animal products. Exercise. Really trying to keep list of medications down and not interacting.

Started with 50 mg og Metoprolol, stepped up to 50 mg. twice daily on advice of my Cardiologist. Very pleased with better control.

Another issue is what is optimal BP. The American academy of Family practitioners favor a higher pressure(? 135/80). The SPRINT trial suggests 120/80 as ideal, based on optimal risk of Hypertension complications. My cardiologist wants 120/70. Bear in mind that traditional Hypertension is 140/90.

Not complex enough? Well the SPRINT trial took 3 BP samples, a minute or so apart. No talking, feet on ground, arm at heart level. And done 5 minutes after you sat down. Most doctors offices do not adhere to this, out of being rushed, or ignorance.

And BP fluctuates all day long and one must be careful to use a good quality device. Have never got good answer to how many measurements during day make you qualify as well controlled or not.

Now the "Coup de grace". Essential hypertension is due to 3 factors; the vigor of heart contractions, the amount of blood in the system and the resistance or"tightness" of the arteries. so the selection of medicine is ideally based on which factors you, personally have.

But no one checks that except for one group, who get astonishingly good outcomes. Weird.

I have clipped and pasted the reference re this really easy, proven, but underutilised way to control blood pressure:

Publish date: November 20, 2023

These factors summarize why it works:

Senior management belief, commitment, and leadership

Informed buy-in from clinicians and patients

A test that determines root causes of too much fluid, too strong pump action, or too tight pipes, and their proportionality

An AI tool that matches those three pathophysiologic factors and 35 other clinical factors with the best drug or drugs (of many, not just a few) and dosages

Persistent clinician-patient follow-up

Refusal to accept failure

Since this approach is so successful, why is its use not everywhere?

It is not as if nobody noticed, even if you and many organizations have not. The American Medical Group Association recognized the program’s success by giving its top award to PriMed in 2015.

Klepper and Rodis wrote about this approach for managing multiple chronic conditions in 2021. Here’s a background article and an explainer, Clinical use of impedance cardiography for hemodynamic assessment of early cardiovascular disease and management of hypertension.

I found one pragmatic controlled clinical trial of impedance cardiography with a decision-support system from Beijing that did demonstrate clinical and statistical significance.

Frankly, we do need more rigorous, unbiased, large, controlled clinical trials assessing the MedsEngine and NICaS approach to managing blood pressure to facilitate a massive switch from the old and established (but failing) approach to a starkly better way.

Almost no one ever “completes a database.” All decision makers must act based upon the best data to which they have access. Data are often incomplete. The difference between success and mediocrity is often the ability of an individual or system to decide when enough information is enough and act accordingly.

Cost-effectiveness studies in three countries (United Kingdom, United States, and China) confirm sharply lower lifelong costs when blood pressure is well controlled. Of course.

For the American medical-industrial complex, lowered costs for managing common serious diseases may be an undesired rather than a good thing. In money-driven medicine, lower costs to the payer and purchaser translate to less revenue for the providers. Imagine all of those invasive and noninvasive diagnostic and therapeutic procedures forgone by prevention of hypertension. Is it possible that such an underlying truth is the real reason why American medicine is habitually unsuccessful at controlling blood pressure?

Right now, if my blood pressure were not well controlled (it is), I would find my way to Cincinnati, to give PriMed physicians, MediSync, and MedsEngine a crack at prolonging my useful life.

Dr. Lundberg is editor in chief of Cancer Commons. He disclosed no relevant conflicts of interest.

A version of this article first appeared on Medscape.com. method of management.

[LeoPa in reply to Lenny123]

There is no such thing as essential hypertension. It's a myth. Hypertension is either caused by incorrect dietary preferences or in some cases by taking pills that might cause it, or a combination of both. Sodium is not the cause of hypertension in any case. Given that you are composed of 70% salt water, salt is essential and has to be replenished in adequate amounts. I am not on any pills yet, I consume almost exclusively animal products and eat a load of salt everyday. And my blood pressure is on the very low side. Sometimes 103/65. How is that for proof that most of the conventional advice regarding limited salt consumption and avoiding animal foods to help lower blood pressure is totally wrong?

[Lenny123 in reply to LeoPa]

Well, it is said that essential hupertension means we know essentially nothing about what causes it! Some truth in that. The real point is, that it is simple, pump pressure, vascular volume and arterial resistance.

We are wildly different and generalizations are just that. So, we know there is a diurnal rythm to Cortisol, Adrenaline and so on. So ideally each of us, should check our BP frequently and adjust accordingly. No doc can, will ever do that, wonderful and very worthwhile opportunity.

[LeoPa in reply to Lenny123]

Any doctor that uses the term essential hypertension and does not know what is causing it should lose his license in my opinion. I am not a doctor and I exactly know what causes it. All this information is available for free on the net. The only thing needed is a willingness to learn and kicking preconceived biases to the curb. That is what I did 12 years ago when I had borderline high blood pressure and refused to take a statin. I went straight for the jugular. And fixed the underlying problem causing my so-called essential hypertension while my GP had no idea how to do it.

[LeoPa in reply to Lenny123]

I forgot. I have a new GP now 😄

[LeoPa in reply to Lenny123]

This is my blood pressure currently and I am in the middle of my daily exercise routine so it is a bit higher than normal.

Color photo.

[hhk50]

Absolutely. Ibrutinib can raise your blood pressure and can cause atrial fibrillation. I take 25mg of Metoprolol (a beta blocker) every day to bring my BP back into normal range. Talk to your CLL doctor about this.

[mrsjsmith]

Viv,

BP is normally higher in the evening ( well mine is ). I try to do readings each week and I do 3 in the morning with a minute gap between and then do an average and the same in the evening. If you are still concerned then speak to your consultant and get an ecg and echocardiogram, which is something you should have been offered because you are on Ibrutinib.

Colette

[narl]

Call your doctor and tell them. Ibrutinib is bad about raising your blood pressure and causing a fib. I was glad to get off of it. Much Better drugs now. I don't understand why they are still giving it to people.

[mrsjsmith in reply to narl]

Because Viv is in NZ and has been on Ibrutinib for several years and unlike the US other countries don’t have the opportunity to switch drugs. It’s only recently in the U.K. that other options have been approved.

Colette

[Skyshark in reply to mrsjsmith]

In the UK switching between cBTKi's is only allowed for intolerance and not "just because".

[mrsjsmith in reply to Skyshark]

Yes I know that I was replying narl who seems to believe it’s the norm.