Borderline Hypertendion

It is surprising how little attention seem to be given to that now. I once mentioned it to a nurse taking my BP and got a blank look.

Bob, Excellent info regarding calculating MAP!  I have a question.  I do have a somewhat slow Pulse.  Cardiologist not concerned as I have a very Strong Beat.  I've had ALL the Tests as they determined I had an "Inverted T Wave" and wanted to check everything before they put me to sleep to remove my Gall Bladder.  Cardiologist unconcerned regarding my Heart Health even with a Pulse in the 50's and the Inverted T Wave.  He thinks "Possibly" as I was a Distance Runner in my 20's, 30's, and 40's with a Resting Pulse of 37 I may be just be still enjoying the benefits of that - although He admits that's not normally the case of someone who is now 70.  Cardiovascular Benefits aren't normally retained 20 years after stopping Running.  My question is "Can I calculate my MAP even though you distinctly stated it doesn't apply if one is Bradycardic - which technically I am.

Thanks in advance and Take Care!  Ernie 

Thanks for the information Bob that has put my mine at ease a bit.  Pasted and copied it for future reference.

Hi Ernie,

Good question.

?I deliberately put limits on the MAP equation because it is the simplest formula for cardiologists to use to work out your aortic blood pressure and even then it is only an estimate (although it's much better than using your brachial pressures in isolation).

?It's important that you do not use the formula if you are bradycardic or tachycardic because your aortic pulsatile waveform changes so much it makes the formula even less accurate. 

?In your case with a strong heartbeat, this compensates for the extended time between your heartbeats and your MAP will remain normal. This is why your cardiologist is not concerned.

?As far as your inverted T-wave is concerned it may be an unusual finding but it is quite possible to have a structurally normal heart with this condition that your cardiologist is not concerned about.

?The most important person during your operation will be your anaesthetist whose job will be to make sure your body organs are perfused with arterial blood circulating with an oxygen level not less than 95%.

?We now have very accurate instrumentation for that thanks to the pulse oximeter.

You don't have any worries - you are in safe hands.

?Regards

?Bob

 

Bob,

?Thank you taking the time to reply.  Years ago after being prescribed Azithromycin 3 Times within about 6 Weeks for a Persistent Sinus infection, I developed a Long QT.  It wasn't known then - or known by many - that this Med "could" possibly cause this to happen.  Also, in reflecting. I don't know why after two attempts - or even why initially - this med was prescribed vs. something like Augmentin to begin with. Long QT IS of concern to an Anesthesiologist before putting one to sleep.  Interestingly this condition went away about 5 - 6 years later - but the Inverted T Wave sort of "Replaced" it.  In fairness to those who prescribed the Azithromycin, We were traveling at the time and this was Three different Facilities - including one Nurse in a "Doc in a Box" at a Pharmacy.  When We returned home and I went to my ENT, He cleared it up promptly.  And the others did their best for a Patient "Passing Through"!  BTW, one of the reasons you may perceive I seem to be "Put to Sleep" somewhat frequently, I have Colonoscopies performed more frequently than most as I have a predisposition to Polyps - and about every other Procedure, at least one is "Pre-Cancerous".  A Family thing and my C/R Surgeon prefers we stay on top of this situation.  I agree!  Two "Inconvenient Days" every 2 - 4 Years much better than a serious illness! Been doing this since my 40's.  But that's for a different Forum, I suppose!

?Thanks again!

Hey Bob,

You're clearly a useful guy to have on a site like this. Do you mind if I pick your brains about high Pulse Pressure, "skipped beats" and the connection, if any, between them?

I'm 73, BMI 24.5, lifelong non-smoker, no taste for sugar, excessive salt or junk foods (though I drink a bit too much wine with my evening meal), walk an average of 45 mins per day, do a 20-min home aerobics programme 4-5 times per week.

I originally joined this site after I got myself a home BP monitor a few years back and found I was recording a consistently high Pulse Pressure (difference between systolic and diastolic) which I understand can be an indicator of CV problems. Typical home readings would be like yesterday's - 135/65. This, as usual, was an average of three readings taken in a 5-minute period. Also as usual, the systolic was very close and the diastolic identical in each case. That's a PP of 70, whereas I believe it's not supposed to be above 40. (I note, however, that it gives a MAP of 88 according to your formula, which seems to be fine.)

When my doctor takes my BP - with a professional sphyg - the systolic is usually about the same or slightly higher, but the diastolic is often in the 85-90 range. Only once did he record an odd 160/50 in his office. He took it again five minutes later, got a more normal 140/70, and told me he doesn't subscribe to Pulse Pressure theory anyway.

Someone on here mentioned "skipped beats" (which I know aren't really skipped) as a frequent cause of inaccuracy in home monitors, as opposed to the professional kind. Might this explain the discrepancy?

I've had the skipped beats thing at least since my 20s, possibly my teens. Sometimes it can get quite severe, with as many as one skip in every three or four beats. My average resting pulse is high 60s - up from high 40s ten years back, when my hypothyroidism was still going untreated.

When skipped beats are very frequent, it can make me feel quite ill for a couple of minutes, with what I can only describe as a visceral sense of foreboding. By that I mean I don't feel any fear - I've had this thing for at least 50 years now and it's never done me any harm - but it's as if my body is afraid. (Sorry if that doesn't make sense.) On these occasions I develop a small productive cough - not unlike the cough I get when my asthma is playing up, though I don't feel breathless. I occasionally develop a moment or two of tunnel vision and have fainted twice in my life during these episodes (once around age 40 and the other at 62).

I've never seen a cardiologist, for the simple reason I have no idea how to produce these "attacks" so have never been able to demonstrate them to a doctor - until this last summer.

I went to see my GP on a very hot, humid day. He has no a/c, and the sweat was literally dripping off my chin as I sat in his waiting room. I was strongly aware of getting a lot of skipped beats. I said nothing about this when I was called in, but he found my BP was 110/80. (I haven't recorded a systolic that low for at least 40 years.) He must have noticed something odd about my pulse too, as I timed him taking it for two full minutes, which he's never done before. He said nothing about this and neither did I. He's a good, honest man and I didn't want to put him on the spot in any way. However, I'm due to see him again in the New Year, and I'll ask him about it then, when the pressure is off. He's meticulous with his records, so I'm sure will have noted this episode.

Your view of all this would be much appreciated - on the understanding that I'm not using you as a substitute for my doctor of course.

https://patient.info/forums/discuss/pulse-pressure-and-bp-625563?page=0#2973158

?I've had a discussion about pulse pressure with Danisha at this Patient link.

?Danisha has been experiencing health problems for some time and has had a wide variety of tests which have all been clear but during our dialogue she has been seriously worried about her pulse pressure.

?If you have a look, you can see what we said and I had to tell her that doctors don't usually bother about pulse pressure. It is relevant to some extent because it is the pressure difference (systolic minus the diastolic) and is thought to be more relevant at certain ages than just systolic or diastolic either alone or together.

?The MAP calculation I have shown in my replies is that which some automatic blood pressure machines do work out for you but there are probably many health professionals who don't understand what it's for.

?I can add shed some further light on BP measurements later but you might find what I said to Danisha in the meantime.

Regards

?Bob

>high Pulse Pressure, "skipped beats" and the connection, if any, between them?

?Yes there is a connection.

In the attached image from my pulse oximeter there are three wasveforms.

Top one shows my blood oxygen level at 98%

?Middle one is my heart rate at 62 beats per second

and the

?Bottom one is the blood flow in my fingertip which is direct representation of my blood pressure and is known as a photoplesthymograph,

?You should see that the BP peaks are not the same and after the third beat of the triple set there is a longer duration than the previous two.

This is very similar to a missed beat and puts the BP up much higher for the next cycle of beats. This distort the readings on blood pressure monitor.

 

>photoplesthymograph

?Whoa there cowboy, let's see what this is!  Is it BP?  Wish it was but I don't even see a Y-axis.

?The curve shows the longer duration, and also a shorter duration preceding it.  Both those peaks look a tad lower than the surrounding good beats, too.  And if these are from your finger, on the periphery, the actual beat was probably a tenth of a second ago past by the time this reading is available.  All interesting stuff!  And this all counts as non-invasive, you can wear the little finger-thing all day, if you're so inclined, right?  And I might, if it also gave even a fair estimate of BP.  Of course if you swing your hand, you're liable to throw off the readings, but this can be filtered and such.

Thanks!

You have to work out the blood pressure related Y-axis from the BPM figure.  

?In this image which displays a trigeminy heartbeat sequence, the peaks on the X-axis relate to the systolic BP and the troughs to the diastolic. There's no X-axis scale either because the display is auto-ranging - it can be established however by taking a simultaneous brachial measurement.

The BP trace wave height (trough to peak) directly relates to BP pulse pressure which is a relative measure and not an absolute one (wrt atmospheric).

To some extent the PRbpm measure is inaccurate because the beat intervals (known as R-R) are not the same.

?This on screen real-time pulse oximeter display makes more sense when seen on the computer.

?There is a wrist version of my pulse oximeter with a finger probe which gives a more compact display.

Internet slow - may have break off unexpectedly.

?Having explained what the pulse oximeter does it should be interesting to note that the plethysmograph waveform is directly related to your instantaneous blood pressure so you can see your BP going up and down in real time.

?When you see the image I sent earlier and also included below you can see that any automated sphygnometer trying to measure my BP in this state is going to report erroneous BP readings because neither my short term BP measures nor my pulse rate would be accurate. 

?As you say, because the probe is on the finger it can record for 24 hrs (on most recording Pulse Oximeters). When USB connected afterwards to a computer my recording oximeter allows detailed analysis of critical events which because the device is light sensitive are best monitored overnight which is better because you are still, it's dark and you aren't waving your arms around (hopefully).

?I've also added an image below showing an overnight recording of my own critical events recorded on my CMS50E. 

How this recording should be interpreted needs another reply which I really need to explain in more detail. 

?I think though you're on the right lines about the power of this device which has much greater diagnostic power than a pair of BP values.

?I'm not the only one to have used this device to show that there is a medical issue that needs

addressing.

 

You too Ernie! I hope you find some seasonal cheer on the Prostate boards.

That's Funny, Lily!  Thanks for the laugh!  Nothing like being a Male and visiting one's Urologist!

Actually I think you'll find being a female and visiting one's gynaecologist isn't entirely dissimilar! Commiserations anyway. And at least you can laugh about it. Sounds like your wife is a lucky lady.

I must look out for you on the prostate Forum as that was the one that first took me here.

Billy Connolly does a couple of good stories on that.

Thank You, Lily.  My wife and I have been Blessed.  I met her when she was 11 -12.  We're not actually sure.  I took her out 3 days after she turned 15.  I'm two years older.  A Year later, we were engaged. and as soon as she graduated at 17, we married.  Have two Sons - 48 and 44.  Oldest lives near us and has always been a Professional Musician.  We met He and our DIL tonight to hear some "Good Old Blues".  Several of their Friends came up and He introduced us as His Parents.  They always ask - "How long have y'all Been Married"?  I have Standard Reply - "5 Wonderful Years! (50 Altogether"!)  Wife just Rolls Her Eyes!  LOL!  She's heard ALL MY JOKES!  She's my Life - And I would do it All Over Again!

God Bless from S.C.!

Thanks for your kind words Ernie and despite the conversations getting a bit heated, I have found some very helpful and reassuring comments on here which has made me feel a whole lot better.  I wont say what might be the forbidden phrase just in case (I don't know what they greyed out posts said) so Happy Holidays to you and yours and a very Happy Health New Year.

I wouldn't worry about saying Merry Christmas, Happy Hanuka or whatever Daisi.

I have a strong suspicion it would have been the expression B-- P----a that got henpen taken down. It's got me into trouble several times, but not when presented in this form (well not till now anyway!) as the electronic moder8or doesn't seem to be very sensitive. Quite understandable really - I guess someone has to sponsor this wonderful site and I can guess which kind of industry it might be. I'm sure you can figure it out. First word is big, btw, which should be OK when standalone.

It's not run by Big Pharma.

https://patient.info/about-us

If only my GP's surgery had a competent person running their computer system I could get a lot more benefit from their GP software as patients at other practices do.

https://patient.info/patient-access

 

Hi Derek,

That GP booking app they're offering looks good. Doesn't help me, of course, but nice to see someone is doing something about the dire booking system. I remember having to jump through hoops to get appointments for my mother in the 90s/noughties, and I don't suppose it's any better now.

My GP actually works on the old system - like the UK back in the 50s! No appointments, you just take your turn in the waiting room. I think he must be one of the few in this country still doing it. Downside is the possibility of a long wait, though I've got to know which days and times are best. By timing it right I can get away with a one-hour max wait, and I use the time to catch up on my reading.

This is entirely outweighed by the upside: without the pressure of sticking to appointment times, he gives each patient as long as they need. (Also like the 50s in the UK.) I've never had less than 15 mins, and it's gone on as long as 40 mins sometimes - usually because he wants to try out his English on me!

On my last visit, I asked him how old he was. 58 it turns out. Well, he'll see me through to my early 80s I suppose, maybe longer as I don't think they have a mandatory retirement age here. It'll be tough if I ever have to switch back to a "normal", modern GP!

It is good where it is implemented. Prior to our local surgery changing over the EMIS system. I could book appointments , ask for prescriptions and see my health and test result records. Now if I have an appointment with a nurse in the future for even a Flu jab I can't make an online appointment with the doctor. I can now only ask for what are down as repeat prescriptions. Others that I only need occasionally there is no way to ask for and the medical/test records are not available. I E-mailed the practice manager and she said that is how the system is for all practices in the area.

I contacted EMIS and they say that the practice can choose the options they want and if they need help it is available. I relayed that back about three months ago pointed out the more patients can do online the less calls and visits they will have to deal with and was told it will be looked at.

I raised the question on this and another Forum  and it seems that it varies fro practice to practice.

   

Just one reason why I'm never coming back!

Still, seems to me every country gets the health service it deserves. The British pay very little (via taxes, social security etc.), complain about the poor availability but almost riot if any brave politician suggests that those who can afford it might pay a little more.

The Belgians, on the other hand, pay on average three times as much for their health service, via various routes, mainly because there's a ridiculous over-supply with very short or non-existent waiting lists in most specialities. They complain like mad about the mounting costs, but won't countenance any UK-style rationalisation, which would keep costs down.

When I was offered an appointment for a routine bone-density scan on the same morning the GP gave me the request form, I remarked to a neighbour that this was absurd. What was also crazy was that there were at least six medical centres within 10 minutes' walk where I could have got it done. I told her we needed a bit of British common sense on this one. I said I'd be perfectly happy to wait a month or so for this non-urgent examination, and go to a major teaching hospital in town, a short bus ride away, rather than having it immediately available on my doorstep. She was appalled - said Belgians would never agree to give up the across-the-board instant availability of their health services.

The ideal health service for both countries would be somewhere mid-Channel - slightly higher costs for you, leading to more capacity; and slightly less capacity for us, leading to lower costs. Unfortunately neither nationality will ever accept those options. Nowt so queer as folk, as they say...

I just did a long reply to that and stopped to do something else and not it has gone. c'est la vie.

If you stop for a moment there is no way to save it. Sometimes to avoid that I do it in Word and then copy it to here.

Here various age limits are applied to bone density scans, breast screening, cervical smears, stool testing kits and many others.

We have walk in mobile breast screening units that appear in supermarket or station car parks for a few weeks at a time. Last time my wife asked when it was at the Asda one and they had no patients they said she was too old. If she really wanted it she would need to phone a number in the County town. She did and they said that she would have to travel to the next town to get it done by appointment and suggested that she would not want to do that. She said that she did and they gave her an appointment for one in the Sainsbury's car park there:-)