Death by hypertension. not on bp medication

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Hi all, I wonder if anybody could help.

My father passed away from Hypertensive heart disease. The coroner told us it was natural causes and that we would have been aware of this with the bp medication he would of been taking. The only thing is he was never prescribed bp medication. We have had his medical notes and we are not sure if he should have been prescribed medication.


He was 67 and smoked and drank also. His bmi was 22 so weight was not an issue. his heart was twice the weight and size.


his readings were


Date                     Systolic                Diastolic


7th Nov 1994                     140                       90


19th Nov 2004                  163                       94


10th Jan 2007                    140                       80


1st Mar 2011                     144                       82

2ND READING    142                       82

3RD READING     139                       86


11th Jan 2016                    139                       78


24th Mar 2016                  149                       87


23rd Aug 2016                   152                       83


7th Sep 2016                      134                       89

2ND READING    140                       80


10th Mar 2017                  155                       90


 are these reading high enough to of been prescribed medication? any help would be fantastic

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  • Posted

    Although there is no defined level for medication to be given, the usual guide is once it goes above 140/90 it begins to get 'discussed' but varies with a lot of factors, as BP usually rises with age, what is acceptable in an older person, would not be acceptable in a young person.

    In my experience (and I could fill the entire page with my regular visits to consultants and stays in hospital), when BP medication is given, there is never any discussion over conditions, just that the BP is too high and medication is required.

    I have been to a coroner's before as support/friend, never as a relative and I have found them to be pretty good, honest and helpful. However, it would seem that they are not so au fait with the medical profession who do little to tell their patients about all the things that are wrong with them.

    Obviously the smoking did not help his heart, but the description of size and weight of the heart, leads to believe that he consumed more than the average intake of alcohol. Hypertensive heart disease is one particular disease, it is a description of a group of disorders. Not always a fan of Wiki, but in this case, it does give a quite short uncomplicated description. If you Google 'Hypertensive heart disease' you will see a few websites describing it. Avoid the normally good NHS one, as it goes to individual types rather than describing across the board disorders.

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    • Posted

      Thank you for your respose.

      I will read on the wiki.

      Yes he did drink alot, everynight. and smoked probably 30 a day.  I was unaware this would cause the heart to go so big? There is medical history with his mother having angina too which is in the medical records.

      He recently last year started having to take injections for lack of white blood cells. 

      The basic question my mother keeps asking is 'why wasn't he on bp medication' but i know it's not that simple.

      Thankyou for your help.


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  • Posted

    james81679...I am not a physician, & not many on these forums are physicians. The worst reading I see in your list is the 164/90. Both the systolic(upper) & diastolic (lower) numbers are a little high.

    I'm somewhat confused as to 'why' a coroner would have said that it's because of his bp medication, yet he wasn't on any bp meds. I would think the Coronor would be thinking he was, given the numbers. Given your father's age, the fact that he smoked & those numbers...I would have thought the Dr. would have prescribed medication..but the question that comes to mind is...would your Father have taken the meds?..Would he have tossed out the prescriptions.

    Some people get it into their heads that they don't need the meds, or they'll lower the numbers on their walking, watching diet etc. 

    The 134/90 is a good number. Here in Canada, it's quite acceptable for a person of his age to have a reading of 140/90..but not higher. Even at that reading, they would be monitored, or should be.

    I have also noticed the readings are years apart. Yet, with the start of Jan. 11/2016, they are a few months apart. Then they go from Mar/2016 to Aug./2016...

    I don't know what you're hoping to find with all of this information..but if you were told your father died from hypertensive disease, perhaps a meeting with his Dr. would be in order, then you can ask if indeed prescriptions for meds were given & was your Father monitored.

    Good luck!

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    • Posted

      Hi there, thank you for your reply.

      We have all his gp notes and there are no notes on him having medication for blood pressure.  He did recently last year start having to take injecitons for lack of white blood cells and maybe this was a sign?

      The readings in the notes from 2004 to 2017 are exactly as i wrote. there are no other reading.

      The last readingon march 10 was his reading from A/E when he took him self down with concern over a swollen thumb which looked badly infected and hed had a cyst removed fro there a few years prior. It looked like it had come back. he died on the 12 a few days after this visit. we thought it was sepsis from the thumb but when the coroner told us it was natural causes from hypertension. it baffled us all as he was not on any meds for it. She also went on to saw the swelling on the thumb was an 'indication' that thing were no right. 

      I have organised a meeting with the g.p to get some answers.

      Again thank you for your response. 

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    • Posted

      'She also went on to say the swelling on the thumb was an 'indication' that thing were not right.'

      Interesting, I don't think coroners are allowed to speculate, but they do pass comment on things. Maybe there was something more she saw in the report. You can go and view it for free or for a fee obtain a copy.

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  • Posted

    Hi James,

    First of all, my condolences on the death of your father.

    I'm reading the second sentence of your second para to mean that the coroner assumed you would have known he had high BP because he'd been put on medication for it (which was another assumption he was making).

    However, none of those readings (including the later ones) are particularly high for a man your father's age according to modern medical thinking. I'm 73 and my BP is normally about 145/85 and has more than once registered 160/90 in my doctor's office, but he hasn't put me on medication. He has, however, told me he wants to keep a close watch on it and will recommend a low dose of medication if it consistently goes any higher. I live in Belgium, which may or may not be significant.

    I suspect the coroner may be working on an older assumption - i.e. that the only acceptable level of BP is 120/80. This view is still held by some doctors but it's rapidly falling out of favour these days, particularly for patients over the age of 50 or so, where more flexibility is thought to be desirable.

    So the answer to your question is: it depends how modern an outlook his doctor had. I'm afraid there are no absolutes, no one "right" way to do anything, in medicine as in general life. My personal answer, informed by my reading on the subject (I'm a former nurse, albeit from way back) and my own doctor's attitude would be: no, these readings were not high enough for him to have automatically been prescribed medication.

    There remains the question of why hypertensive heart disease was given as the cause of death. I'm wondering whether it was the result of an autopsy or just the opinion of the doctor signing the certificate. In my experience, doctors can be quite imprecise about causes of death. Two examples (both from the UK): my grandmother died of a massive stroke, but her cause of death was given simply as hypertension (which almost certainly would have led to the stroke of course); and my father died of a pulmonary embolism with his cause of death given as carcinoma of the lung (though again, cause and effect).

    As RHGB (hello again!) has said, there would have been other factors that wouldn't have helped his health. Even light smoking can have a serious effect on cardiovascular health, especially in susceptible individuals, ditto heavy drinking.

    I hope the answers here will give you closure, and above all that you're not feeling any guilt about not following up more closely on your father's health. It really doesn't sound to me as if his doctor was at fault in any way.

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    • Posted

      Thank you for your response.

      It was the autopsy report that put the death as hypertension due to the heart being twice the size and weight. 

      he was on gabapentin, folic acid and hydroxocobalamin for b12 deficiency also. whether these are signs of mutation of heart is something i have no idea on.  i am making an apointment to see g.p to dicsuss. Thank you for your help.

      I understand all you say. Its my mother that isnt so understanding! thank you.

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    • Posted

      'gabapentin, folic acid and hydroxocobalamin for b12 deficiency also' - hydroxocobalamin being injectable b12

      Whilst I am not a doctor, these all point to something more like alcohol neuropathy - peripheral neuropathy (polpneuropathy in the US).

      I am struggling to see that they in anyway would be used for HBP.

      I would be asking the GP why he was given these and why there appears to be nothing in the notes as to what for. Doctors are about as easy to nail down as blancmange.

      [Hello again Lilly, hope you are well]

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    • Posted

      This new information about the massively enlarged heart has me thinking pulmonary arterial hypertension, which a doctor might have recorded as "hypertensive heart disease", though that's not strictly a correct classification. As I've already said, doctors can be a bit cavalier when filling in death certificates, at least when there are no suspicious circumstances. (And, as RHGB has said, "about as easy to nail down as blancmange".)

      Perhaps you should google pulmonary arterial hypertension, as well as hypertensive heart disease. There are a lot of accessible, patient-orientated sites out there. PAH isn't hypertension as we normally know it - the kind that can be picked up on a BP machine. Broadly speaking, it's due to back-pressure in the arterial system that pumps blood from the heart to the lungs, to be reoxygenated. (In case you were wondering about arteries normally carrying oxygenated blood and veins carrying de-oxygenated blood, it works the other way round in the cardio-pulmonary vascular system.)

      The pressure can build up due to a number of reasons, among them narrowed arteries in the lungs, chronic lung congestion (e.g. COPD) or liver damage causing general back-pressure to the whole system. If your father was smoking 30 a day he would probably have had at least borderline COPD by the age of 67, smoking notoriously causes narrowing of the arteries too, and - as RHGB has pointed out - your father was almost certainly suffering the effects of excessive alcohol consumption, which may well have damaged his liver. This would suggest three possible disposing factors for pulmonary arterial hypertension.

      I would suggest exploring this line with your father's doctor. Although his normal arterial blood pressure wasn't high enough to ring alarm bells, I would imagine he would have had symptoms of congestive heart failure (breathlessness, swollen ankles etc.) which should have been investigated.

      All that being said - and I realise this won't be much comfort to your mother - I'm afraid his chosen lifestyle could have led to an early death from one cause or another in any case. We all decide on our own risks. My father didn't drink a lot but he smoked at least 50 a day from the age of 15. He also died at age 67, though it was lung cancer that took him. And Joanna in her post has told us a similar sad story.

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  • Posted

    Hi James,

    firstly can I say how sorry I am for your loss.  I know this doesn't help you answer your question but my husband died about 5 years ago aged 60, he also smoked  heavily and had done all his life and drank, alot!! He started on beer and then gradually ended up drinking spirits.  The point I would like to make is that he actually had low blood pressure but died of heart failure, again I am not a dr but the smoking and drinking must have affected his organs (not just heart) I assume.

    All the best.


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