Isolated systolic hypertension: Should I take Amlodipine?

Thanks a lot Pam for mentioning this, I am due for an updated blood test and will arrange this shortly. I have been on a very low sodium regime for many years and I have a healthy diet with no alcohol or very fatty foods.

Regards

Martin

Thanks a lot misswoosie for your good advice. No, I haven't had any risk management studies done on 10-year risks, but I can see that a study like this could provide a further incentive to reduce my systolic BP without further delay!

It seems that taking medication on a "trial and error" basis is the only way of finding out whether the benefits of reducing high systolic pressure outweigh the inevitable side effects of a drug like Amlodipine which has a list of likely problems that includes just about everything you wouldn't want to happen to you!

I don't know what the minimum diastolic pressure is that a patient is expected to cope with, but I guess if it goes below, say 50, then it's time to come off a drug like Amlodipine? There doesn't seem to be a lot written about this aspect of the problem when a patient who already has a diastolic pressure of say, 60, is put on to medication to reduce systolic pressure. I don't want to end up treating low blood pressure (for diastolic pressure) at the same time as I am treating high blood pressure (for systolic pressure).

At the moment, when my BP is checked, the readings can vary so widely, even within a 10-minute period, that one minute you think everything's not too bad and the next minute you think you've got less than a dog's life left!

Regards

Martin

 

Martin, have you had a 24-hour study done? This can be helpful in cases like yours, where your BP varies throughout the day.

Thanks Lily for asking whether I've had a 24-hour BP study done. I thought about this carefully, but because my average BP over the last 8 years has consistently been on the high side, I think this fact has now been established with some certainty and so a 24-hour study probably wouldn't add much to our knowledge of my condition.

Regards

Martin

 

Hello nzmartin, I've only just picked up on this thread but I can hardly believe that you haven't had a risk assessment from your GP! You can do them yourself on line, Qrisk 2. A risk of over 10% and you most likely will be offered a statin so be prepared!

Thanks, that's interesting, does Qrisk2 deal with isolated systolic hypertension, which probably has different risk factors to "normal" hypertension? In other words, is the diastolic pressure also taken into account?

Regards

Martin

Hi Martin. No it doesn't, and not sure about it's validation, ie whether it actually does what it says it does,especially without taking into account diastolic pressure.

This one does,but it's from the USA .

http://www.cvriskcalculator.com/

This one from Edinburgh is based on the Framingham Heart study and Joint British Societies risk calculators 

http://cvrisk.mvm.ed.ac.uk/calculator/framingham.htm

Here's a link to more information from the Joint Societies

Look at the 2 lots of graphs. First are for non diabetic, second for diabetics.

I think it might be valuable, because ,unless you clockwatch (which knowing a little about you I think you very well might!LOL) you just go about your usual business and it takes the BP whilst your active, at rest, standing, sitting, asleep etc etc.Even if it's been established that you have high BP with one off recordings, a 24 hr recording will show how much the diastolic and pulse pressure fluctuate. It might help to ease your concerns and anxiety also.

There is an article on our site about CVD risk assessment that may be relevant here. It has back ground and links to various tools inc QRisk/Framingham.

https://patient.info/doctor/cardiovascular-risk-assessment

Regards,

Alan

Hmm... It is true that the US version takes diastolic into account, which I think is good. However, it gives less general information about comparative risk than QRISK2. It also informed me that I should be on a moder8 to high intensity statin, even though my total cholesterol/HDL is only 2.9. I think my statin-averse GP would have something to say about that!

The Edinburgh one was a bit too technical for me.

The 2016 QRISK2, on the other hand, was very encouraging, giving me a relative risk of heart attack or stroke of 0.9 (i.e. slightly below average for my age). Out of interest, I tried the 2015 model too, which gave me a marginally lower score, but with the same relative risk. Maybe ClinRisk will do a further upgrade in 2017 to come into line with current thinking on pulse pressure...

I don't think one should obsess too much about the details of these assessments, as they only give an overall indication. I'd reiterate to Martin, by all means try one or more assessment tools, but accept a low dose (low as possible) of medication and see how it goes from there. You've nothing to lose by giving medication a try.

I agree completely.

Thanks very much Lily and Miss Woosie for this information. It seems that getting older isn't a good thing to do if you want to keep your 10-year risk assessments nice and low, so I agree that one shouldn't obsess too much over these assessments as life is full of risks!

Regards

Martin

Yes, I was thinking that as I was going through the test. It doesn't factor in the risks of going under a bus, does it?

No, there are all sorts of everyday risks that can't be factored in! But I was interested to find out from the USA cvriskcalculator whether isolated systolic hypertension (ISH) is factored in as a greater risk than when the pulse pressure is lower. So I compared the 10-year risk where BP is 150/90 (pulse pressure 60) with that when BP is 150/50 (pulse pressure 100).

For age 70, using the same cholesterol figures (140 and 45) the risk is calculated as 20.5% for both BP situations and at age 79 the risk is calculated as 37.4% for both BP situations. So, although the risk nearly doubles because of the increase in age (ouch!), it doesn't appear that the increase in pulse pressure makes any difference in the examples I chose above.

I tried one or two other situations and differences in pulse pressure don't seem to increase the risk calculation. Therefore, I may be wrong in assuming that the higher the pulse pressure the higher the risk, but I think some research has suggested that pulse pressure is an important risk factor to take into account?

Regards

Martin

That's interesting, Martin. So they're asking the right questions about systolic vs. diastolic, but not actually taking the answers into acount. I confess I didn't try it out with different situations, as I lost all faith in it from the moment it told me I should be on statins in spite of my 2.9 ratio.

I honestly don't know how important PP is. In my days as a nurse we were taught that the diastolic value was by far the more important of the two. A raised systolic was usually dismissed as nervousness on the part of the patient, provided the diastolic was no higher than 80. I only started hearing about the importance of PP a few years ago, and what I have read about the mechanism behind the dangers of raised PP certainly makes sense to me.

Incidentally, my PP has been marginally but consistently down on most readings for the past month or so! Apart from when I take it immediately after aerobic exercise (which briefly raises PP in everyone) I'm now getting average at-rest values in the region of 130/65, which is a significant improvement for me. I realise a PP of 65 is still not ideal, but am reassured by the wise words of Misswoosie, whose nursing experience is much more current than mine, that this is acceptable with a systolic of only 130 at age 72.

Not quite sure what I did to achieve this, as I was trying several things at the same time! I increased my intake of MgO from 375mg to 562.5mg at least six months ago. (It doesn't give me diarrhoea and I have unusually good renal function for my age, according to my GP.) Over the past 4-6 weeks - the same time-frame as the reduction in PP - I've added in a 15g allowance of 99% cocoa chocolate every day and have been more assiduous in practising the short cardio workout promoted by that British TV doctor whose name I'm forbidden to mention here on pain of deletion.

I'm going to keep up the exercise programme but my money is actually on the minute daily dose of chocolate! If I take my BP an hour or so after eating it, it's always down to around 110/60. And there's no danger I'll overdose on it, of course. Apart from the high price - €3.35 for just 100g - have you ever tasted 99% chocolate? Not hard to convince myself it's medicinal...

Thanks for your post Lily, I'm very impressed with your BP management and that you have been able to avoid going on medication. In my case, I realise that there are benefits of trying a low dose of Amlodopine, but several articles advise care in doing this. For example, in an article by Ehud Grossman titled "Blood Pressure: The Lower the Better" it says this:

Aggressive BP lowering may be even more deleterious in elderly patients with isolated systolic hypertension. Lowering SBP will also lower diastolic BP to a level that may jeopardize coronary blood flow and increase coronary heart events. In the active treatment group of the Systolic Hypertension of the Elderly Program (SHEP) trial, a decrease of 5 mmHg in diastolic BP increased the risk for stroke by 14%, for coronary heart disease by 8%, and for CV disease by 11% ...

So the measurement / management of diastolic pressure is just as important, if not more important, than the measurement of systolic pressure (IMHO)! And carrying on life and forgettng about BP in between GP visits is also good advice. I think I will leave all BP measurements to my GP as my measurements aren't consistent enough to form a proper opinion.

Regards

Martin