Low diastolic pressure

Hello Sorry I might have not worded my orginal post correctly at the time. Whilst my systolic pressure had been in 140s my diastolic the same I should have said stayed the same in the 60s.  Having cleared that up now 1 year later I have moved house and of course gp.  I have been taken off amlodipine because of severe ankle swelling.  I am now take a bendroflurazide a water tablet.  I also suffer white coat syndrome being a long time anxiety sufferer.  My last reading at the gp was 140/70 and he was satisfied with this as he is aware of the white coat problem.  I am taking readings at home having purchased a new bp monitor.  The readings do seem higher on this monitor whether it was because the old one wasn't working correctly.  My gp has told me to buy a new one every 12 months.  The last few readings have ranged from 141/73 to 128/68.  Todays was 132/70. 

Hi Mike, I am a male in my seventies and I am very interested in this discussion because, prior to recently going on to 5mg per day of amlodipine, my BP averaged 170/70. This situation of a high systolic pressure and a low diastolic pressure is referred to as “isolated systolic hypertension” (ISH).

Recent home readings of my BP (after taking 5mg of amlodipine for 2 months) show that my BP (when lying down) has now dropped to an average of 141 / 58.

In a recent article about ISH on the “Mayoclinic” web site, it is suggested that, in people with ISH, BP treatment may lower diastolic pressure too much, potentially increasing the risk of a heart attack or stroke and that your doctor may recommend that your diastolic pressure not be reduced to less than 70mm in trying to reach your targeted systolic pressure. Apparently, this is because it’s the diastolic blood pressure that supplies blood to the heart-feeding arteries and if it’s too low, you can get dizzy and fall over when standing up after being in bed or sitting in a chair.

So, my question is whether you would regard a BP of about 140/60 to be satisfactory for a man in his seventies, or would it be advisable to aim for an even lower systolic pressure of 120mm or 130mm? My concern in taking a second BP drug to help reduce the systolic pressure further is that it’s likely that my diastolic pressure could fall as low as 50mm. Do you think that a diastolic pressure of say 50mm or 55mm is too low for an elderly adult?

Regards

Martin

Hi Martin...Trying to understand bp can be very confusing. Years ago, the medical professin was concerned with the bottom number..then as years went by, they realised that it wasn't just the bottom number that mattered so much, it was the top one as well. Usually in elderly people, doctors don't increase bp medication very much especially if the patient is already on 3-4 medications for bp control. Increasing the medication could increase the side effects, making the patient's life a little miserable. 140/80 is ok here in Canada for an elderly patient. If I were you, I'd be very inclined to keep strict track of the readings...& report them to the doctor. My bp lately is averaging 128/64..or sometimes it is 134/65. Bear in mind, that I take a Beta Blocker along with some other bp controlling meds. I am not a doctor Martin, but will help you as best I can..but I do encourage you to discuss this matter with your doctor. After all he/she is the qualified one.

Thanks very much Mike for your helpful reply. Yes, it seems that systolic pressure is now regarded as more important than diastolic pressure. You mention that 140/80 is regarded as ok in Canada for an elderly patient and it’s great that your BP is well below that level.

If my BP was 140/80 then I would be quite happy to take a second drug to try and reduce it to say 120/70. But, a patient with isolated systolic hypertension (ISH) is likely to have a reading of 140/60 rather than 140/80 and some research has suggested that a diastolic pressure of 60mm is already too low!

I agree that it’s necessary to keep a strict track of readings done at home as a guide to my doctor and myself. At present, I am doing readings once a week and I think this is probably often enough to get a pattern of what is going on.

I think that some doctors are perhaps not as concerned as I am about a low diastolic pressure and I got some very good advice about ISH earlier this year in this thread:

https://patient.info/forums/discuss/isolated-systolic-hypertension-should-i-take-amlodipine--524891

Regards

Martin

nxmartin..do your self a big favour. Don't be doing so much research on the internet. You never know for sure if the site is accurate in what they're telling you.While the Mayo Clinic is one of the best medical centres in the world, what the guidelines are for various countries can be very different. The best person to get the information from is your doctor. 

Take my advice...don't rely on the internet. How well I know. You can get yourself very wound up over nothing because of what you read. You can very easily misinterpret what is said. Who knows?..it may be possible to lower your Systolic bp without the Diastolic becoming lower than it is. A Diastolic reading of below 80 certainly is not anything to panic about. 

You say you're checking your BP once per week. Why not try a few times..say Mon/Wed/Fri. Don't just settle for the 1st reading the machine gives you. Take at least 3 readings consecutively, then average them out. OR if you have a machine that takes 3 readings automatically, then gives you the average, that's even better..but in this case...take just 1 reading..throw it away because it's likely too high..then take the 3 readings automatically.

You could also take your readings 2x daily for the 3 times, e.g. take your reading Monday morning...then Monday afternoon...same for the other days. 

Please let me know how you get on.

Thanks very much Mike for your post. I agree that too much reliance on internet can be a dangerous thing, particularly when articles are not sourced back to the original research material! However, I have found one good article about isolated systolic hypertension (ISH) titled  Diastolic blood pressure control: How low is too low – ref 480720. This article gives research references and suggests that when diastolic BP hovers around 56-60mm Hg in a person who has ISH, care is needed not to lower it any further. So, because my diastolic BP is now averaging around 60, I am going to watch this situation quite closely. Thanks for your tips about taking BP readings, my machine does average the last 3 readings and I always take at least 3 readings.

Regards

Martin

Hi Martin...I've trained myself very carefully not to spend so much time on the internet researching things that I'm not qualified to diagnose. While it's good to be proactive; it's not good to diagnose, because you can THINK the same thing is going on with you, when it isn't. 

I saw my Dr. yesterday; & my bp reading was 140/80...not good,but not that bad either..his exact wording. If he thought it should be lower, he would have increased my meds, but he didn't. He of course took into consideration the fact that I'd been a little stressed over the past few days, I do have a mild case of "white coat syndrome", & the fact that I'd driven over 1 1/2 hrs to see him. I did however, provide him with some readings that I'd taken at home, & he was very pleased with them. 

Again, when taking your bp..take a single reading first..then toss it away..Continue to take 3 readings consecutively (by your machine), & let your machine provide you with the average of those readings. Note those readings along with your pulse rate, if your machine provides a pulse rate. 

I can't stress it again strongly enough Martin, that if you're concerned about the Diastolic readings, you truly should consult your doctor.

Hi Mike, I think your BP reading of 140/80 is better than mine, which since going on amlodipine, is now close to 140/60. This is because your diastolic reading is higher than mine and your pulse pressure is less than mine. I am in close and regular consultation with my Doctor and I think my research on the topic of my high BP has helped me to have much more informed discussions with him than would have been the case if I wasn’t interested in the literature on this topic.

Incidentally, there has been some very interesting comprehensive recent research completed on low diastolic pressure as reported on the Johns Hopkins Medicine site (release date 1 September 2016). It is reported that 11,000 Americans participated in a federally funded study. The researchers now have more evidence that driving diastolic blood pressure too low is associated with damage to heart tissue. There is a page on the site titled, Doctors: Beware of Low Diastolic Blood Pressure When Treating Hypertension. It was reported that some 3,728 people with a diastolic blood pressure between 60 and 69 millimeters of mercury were 52 percent more likely to have heart damage as measured by the high-sensitivity troponin test, with some 120 people in this range showing elevated troponin levels. People with a diastolic blood pressure range from 70 to 99 millimeters of mercury showed no greater risk of troponin-associated heart damage.

This research seems to confirm the view that it is most desirable to keep diastolic blood pressure above 70.

nxmartin..do yourself a HUGE favour, Buddy...stop with the research!

You'll drive yourself crazy. Yes, by all means be an informed patient, but you are not a Dr. If the Dr. feels the diastolic number is too low, it's up to him/her to do something about it. 

The difference between you & I is the fact that I not only take Coversyl HD, but also 1mg Doxazosin, & 50mg Atenolol. Atenolol is a beta blocker, which slows the heart, & therefore also lowers the pulse rate.

If the diastolic number is high, that means the force of the blood flow through the arteries is strong.

If one's diastolic were to go over say, 85..they would have their antennas up so high it would make your head spin. At 99, they'd be very worried. 

So please, I mean this with a good heart...stop with the research. You'll get to the point that every time you take your bp readings, you'll be wondering what the lower number will be. Chillax my friend!

Scroll up and read my reply of over a year ago to Jane243 about my diastolic.

Thanks Mike, because this thread is about low diastolic blood pressure (DBP) and is easily found on Google by people who are interested in this topic, I thought it may have been helpful to others to refer in my last posting to a recent major authoritative study on DBP, which is published in the JACC Vol 68, Issue 16, October 2016. In a nutshell, this research says that, when deciding on how to treat systolic blood pressure, it may be prudent to ensure that diastolic blood pressure levels do not fall below 70 mm Hg, and particularly not below 60 mm Hg.

Researching and publishing articles in scholarly journals has always been a strong interest of mine and I am quite used to doing it (without stress) on all sorts of topics, not just medical ones!

Because I have isolated systolic hypertension (ISH) the topic of low DBP is perhaps a little more relevant to my situation where, before treatment for ISH, my DBP was already quite low at around 70 mm Hg. I realise that ISH is not as common as “normal” high blood pressure, but I hope my research may perhaps be of help in the future to some other people who have this condition.

All the best

Martin

Hi Martin..I understand your point, & also appreciate that you're trying to help others, but many on here don't understand all the technicalities.

Thanks again.