Blood Pressure Medicine & Your Medical

Geico266

Geico266

Touchdown! Greaser!
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Geico
After reading the governement findings concerning blood pressure and CVD's ( cardio vascular dieases ) posted by Dr. Gary http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf. I am thinking seriously about talking to my DR. about starting BP meds.... But which ones are "legal" and no issue for the FAA medical?

Anyone taking meds now with a 3rd class medical? Any issues?

Side effects of BP meds?

Seriously, please read this report..... http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf It is an eye opener and a very fast read once you get by the credits and forwards, ;)

Thanks again to Dr. Bruce & Dr. Gary for your information and concern. Denial is not a river in Africa. :redface:
 
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I would be very surprised if any side-effect free BP meds are going to raise alarms at the FAA. I imagine they will want a letter from your doctor specifying symptom history, treatment, dose, side effects and remediation of said. Obviously our local AMEs will know far more than I.
 
Geico266 said:
After reading the governement findings concerning blood pressure and CVD's ( cardio vascular dieases ) posted by Dr. Gary http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf. I am thinking seriously about talking to my DR. about starting BP meds.... But which ones are "legal" and no issue for the FAA medical?

Anyone taking meds now with a 3rd class medical? Any issues?

Side effects of BP meds?

Seriously, please read this report..... http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf It is an eye opener and a very fast read once you get by the credits and forwards, ;)

Thanks again to Dr. Bruce & Dr. Gary for your information and concern. Denial is not a river in Africa. :redface:
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List of accepted meds here:

http://www.leftseat.com/medcat1.htm
 
steingar said:
I would be very surprised if any side-effect free BP meds are going to raise alarms at the FAA. I imagine they will want a letter from your doctor specifying symptom history, treatment, dose, side effects and remediation of said. Obviously our local AMEs will know far more than I.
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The side effects of most currently used antihypertensive drugs are minimal if any. Severe allergic reactions or severe side effects are rare. I tend to favor ACE inhibitors like lisinopril and might add a low dose diuretic like 12.5 mg hydrochlorothiazide if needed. Some people will get an annoying dry cough on ACE inhibitors and can be switched to an ARB (angiotensin receptor blocker).
 
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Gary F said:
Those who have had high or borderline BP readings in the past should consider getting a decent quality home BP cuff, something similar to one of these: http://www.omronhealthcare.com/home-products/blood-pressure-monitors/
I think the arm cuff devices are better than the wrist devices. Have the accuracy verified by taking the machine with you to doctor's visits.
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The upper end unit ( in the above link) is the one I bought. $ 80 at Walmart. It has an A/C adapter and keeps track of reading and averages them for up to 8 weeks, then drops the oldest week. It also averages and stores readings taken in the morning and night. .... Very cool and easy to use. Has A&B setting for 2 people.

I took it into the ME's office and verified the reading was accurate.
 
Hypertension meds and the third class medical are no big deal. Doc Bruce has posted the requirements many times. Perhaps they should be stickied to make'em easy to find. I very much appreciated the Doc sharing his knowledge. I imagine my AME also appreciated it since he could issue on the spot instead of having to review the documentation after the exam and issue then.

From a patient's point of view the common meds (lisinopril, the diuretics) are cheap but maybe not be so side-effect free. Lisinopril gave me a cough, the diuretics gave me lower back pain and ED. Losartan is cheap but didn't work by itself for me. Addition of a low dose of a beta blocker works very well for me. As you might imagine, working through many possible drugs takes awhile and can be frustrating. Hang in there.
 
There are only a few "no-no" antihypertensives:

alpha methy dopa ("aldomet")
Reserpine
Guanethidine
Clonidine

The first three are on the $4.00 Walmart Rx list. They are NOT bargains.
 
bbchien said:
There are only a few "no-no" antihypertensives:

alpha methy dopa ("aldomet")
Reserpine
Guanethidine
Clonidine

The first three are on the $4.00 Walmart Rx list. They are NOT bargains.
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So is clonidine which is often used as a 3rd or 4th drug for those with very difficult to control hypertension. I haven't seen the others used for many years. The good news is that the $4 list contains a lot of useful and FAA approved medications including 3 ACE inhibitors and some ACE-I HCTZ combinations.
 
I was verifying my medications (Benazepril,Amlodipine, Hydrochlorothiazide) and looking around a bit I found this little piece of humor on http://www.avweb.com/news/aeromed/181932-1.html

Why Is Hypertension So Dangerous?

Untreated, hypertension can lead to serious health consequences, including death. Of course, death disqualifies you for the issuance of a medical certificate. In fact, your AME is authorized to make this determination without calling Oklahoma City.
Click to expand...
 
Gary F said:
The side effects of most currently used antihypertensive drugs are minimal if any. Severe allergic reactions or severe side effects are rare. I tend to favor ACE inhibitors like lisinopril and might add a low dose diuretic like 12.5 mg hydrochlorothiazide if needed. Some people will get an annoying dry cough on ACE inhibitors and can be switched to an ARB (angiotensin receptor blocker).
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Typically true. However, both Leslie and I reacted badly to Lisinopril, with different (unusual) side effects. In her case, it resulted in multiple ER visits and exploratory surgery before they identified the cause as a side effect. With any medication, be aware that there is a risk of side effects.
 
Gary F said:
The side effects of most currently used antihypertensive drugs are minimal if any. Severe allergic reactions or severe side effects are rare. I tend to favor ACE inhibitors like lisinopril and might add a low dose diuretic like 12.5 mg hydrochlorothiazide if needed. Some people will get an annoying dry cough on ACE inhibitors and can be switched to an ARB (angiotensin receptor blocker).
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Do I recall correctly that there is a warning not to consume grapefruit while taking medication like lisonopril? If that's correct, educate me on the "why this is"...
 
AggieMike88 said:
Do I recall correctly that there is a warning not to consume grapefruit while taking medication like lisonopril? If that's correct, educate me on the "why this is"...
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Something in grapefruit juice can inhibit an enzyme that is involved in the metabolism of certain medications. Unless you consume a lot of grapefruit at one time or drink it regularly it probably won't be an issue with a few exceptions. I don't believe that lisinopril or ACE inhibitors are affected but calcium channel blockers and certain cholesterol medications are. Ask your pharmacist if you have concerns.
Here is a list: http://www.cmaj.ca/content/suppl/2012/11/26/cmaj.120951.DC1/grape-bailey-1-at.pdf
 
Just a counterpoint. I understand that medical practice improves over time, but I wonder if this intensive focus on BP isn't tied to Pharma's desire to have most all of the population over 40 on daily BP meds? It's hard not to consider the massive market and profit motive involved. Wasn't the old rule of 100 plus your age as normal? Now we are seeing 115/75 as normal?

http://www.disabled-world.com/health/cardiovascular/hypertension/bp-100-plus-age.php

BTW- I just finished a 7 mile hike that started at 10,120' and at the high point reached 13,000'. Didn't even use supplemental O2, like I would have if I was sitting motionless in an aircraft.:wink2: I guess I should be glad I didn't stoke out with a BP of 130/85 and a BMI of 30.
 
Alexb2000 said:
Just a counterpoint. I understand that medical practice improves over time, but I wonder if this intensive focus on BP isn't tied to Pharma's desire to have most all of the population over 40 on daily BP meds? It's hard not to consider the massive market and profit motive involved. Wasn't the old rule of 100 plus your age as normal? Now we are seeing 115/75 as normal?

http://www.disabled-world.com/health/cardiovascular/hypertension/bp-100-plus-age.php

BTW- I just finished a 7 mile hike that started at 10,120' and at the high point reached 13,000'. Didn't even use supplemental O2, like I would have if I was sitting motionless in an aircraft.:wink2: I guess I should be glad I didn't stoke out with a BP of 130/85 and a BMI of 30.
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Did you read this? http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
There are 81 references that show the science behind the recommendations and the committee members are familiar with many more studies. I don't claim that medical science is perfect but there is a great body of accumulated data. Big pharma is less of an issue since many if not most patients can be treated with inexpensive generic medications. I'm glad that you enjoyed your hike but it really doesn't prove anything. In the old days they thought hypertension was a beneficial physiologic adaptation to push blood through clogged arteries. Stroke and heart attacks were more common before hypertension was treated as aggressively as we do now. We normally don't lower BP to the ideal 115/70 as implied in your post. I've never hear of "Disabled World" am not impressed with the article referenced in your post and it did not contain a single reference to any scientific study. It's your body, do whatever you think is best and good luck.
 
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There is no conspiracy. Folks live longer than they did in the bygone age. Out of my grandparents half died in their forties of cardiovascular illness likely brought on by hypertension.

High BP was fine in an age when life expectancy was 40. But now that it's 80, things are different. So like the doc said, you can choose whether you spend the last decade of your life in the chair or tooling around. Or you can choose whether the during the last decade of your life you age will start with an 8 or 9 rather than a 6 or 7.

And not everyone over 40 is hypertensive. I have discovered my own BP issues to be directly linked to my use of allopurinol to abate my gout. A reduction in dose reduced my BP and I will reduce my dose further. Don't seem to be able to do without it, unfortunately.
 
Talk to your doctor, GEICO. I have been on BP meds for several Class III cycles. The first time, I had to jump through hoops. Now, I just put down "previously reported/no change" and get my Class III on the way out of the AME's office. Better to get your BP under control than take chances. I'm pretty sure it would be difficult to get your Class III after a stroke or something like that :).
 
Gary F said:
Did you read this? http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
There are 81 references that show the science behind the recommendations and the committee members are familiar with many more studies. I don't claim that medical science is perfect but there is a great body of accumulated data. Big pharma is less of an issue since many if not most patients can be treated with inexpensive generic medications. I'm glad that you enjoyed your hike but it really doesn't prove anything. In the old days they thought hypertension was a beneficial physiologic adaptation to push blood through clogged arteries. Stroke and heart attacks were more common before hypertension was treated as aggressively as we do now. We normally don't lower BP to the ideal 115/70 as implied in your post. I've never hear of "Disabled World" am not impressed with the article referenced in your post and it did not contain a single reference to any scientific study. It's your body, do whatever you think is best and good luck.
Click to expand...

If you look at my post I'm asking questions, signified by the "?". I'm not a physician, so I don't really know. However, there must be some profit motive as evidenced by the link. This is quite a list for a segment with no financial motive:

http://www.nhlbi.nih.gov/hbp/treat/bpd_list.htm

I also know that according to modern medicine I am a pre-hypertensive, obese male. Not qualities that sound very healthy to me or indicative of someone capable of physical activity, yet here we are. While I am always working to improve, the notion that everyone should be rail thin, herbal tea drinking, vegan, metro-sexual type to be called "healthy" seems a little over the top.

As to the validity of my comments, look at this article. It does raise some questions about the process by which standards are set:

http://seattletimes.com/html/health/sick1.html
 
Gary F said:
Did you read this? http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
There are 81 references that show the science...I've never hear of "Disabled World" am not impressed with the article referenced in your post and it did not contain a single reference to any scientific study.
Click to expand...

I find it enlightening to look behind the home page and follow the money to determine what biases may be slanting what I'm reading.

From DisbledWorld.com's "About" page:

Our web site information comes from in house writers, press releases, educational institutes and worldwide government organizations...Unless noted otherwise, contributors should not be considered as health professionals, although they might have an extensive experience in certain areas.
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From DisbledWorld.com's "Products" page:

The Disabled World Health and Disability Store features a wide range of medical, health and disability products for children and adults as well as carers of the disabled.
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So, it's a sales portal for things we need when we're disabled? By, say, cardiovascular disease?

Sure, big pharma wants us all on as many meds as they can sell us, but DisabledWorld.com may be a poor candidate to throw the first stone.
 
Alexb2000 said:
If you look at my post I'm asking questions, signified by the "?". I'm not a physician, so I don't really know. However, there must be some profit motive as evidenced by the link. This is quite a list for a segment with no financial motive:

http://www.nhlbi.nih.gov/hbp/treat/bpd_list.htm

I also know that according to modern medicine I am a pre-hypertensive, obese male. Not qualities that sound very healthy to me or indicative of someone capable of physical activity, yet here we are. While I am always working to improve, the notion that everyone should be rail thin, herbal tea drinking, vegan, metro-sexual type to be called "healthy" seems a little over the top.

As to the validity of my comments, look at this article. It does raise some questions about the process by which standards are set:

http://seattletimes.com/html/health/sick1.html
Click to expand...
An article in Seattle Times? You gotta do better than that to convince me. I deal with many of the consequences of not managing risk effectively and have a pretty good idea of what works and what doesn't.

Overweight people tend to have a higher incidence of glucose intolerance and metabolic syndrome so obesity is a problem.

I believe that competent adults should be able to chose their medical providers and accept or reject treatment options. It looks like the government will eventually engage in coercion to force people to submit to lifestyles changes and medical treatment. You should be worried more about that than my opinion.
 
somorris said:
Talk to your doctor, GEICO. ........... Now, I just I'm pretty sure it would be difficult to get your Class III after a stroke or something like that :).
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:rofl:

Now that is a great point. :yes:

I'm calling my DR. and making an appointment.
 
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Alexb2000 said:
Just a counterpoint. I understand that medical practice improves over time, but I wonder if this intensive focus on BP isn't tied to Pharma's desire to have most all of the population over 40 on daily BP meds? It's hard not to consider the massive market and profit motive involved. Wasn't the old rule of 100 plus your age as normal? Now we are seeing 115/75 as normal?

http://www.disabled-world.com/health/cardiovascular/hypertension/bp-100-plus-age.php

BTW- I just finished a 7 mile hike that started at 10,120' and at the high point reached 13,000'. Didn't even use supplemental O2, like I would have if I was sitting motionless in an aircraft.:wink2: I guess I should be glad I didn't stoke out with a BP of 130/85 and a BMI of 30.
Click to expand...
We have failed to teach the scientific method.
Do what you wish.
You will feel great until you don't at which time it's irreversible.

..........sigh.........
 
As a counterpoint to all this, my untreated BP is rarely over 140/90, but I was concerned enough with frequent readings in the 130s/85 that I wanted to get it under better control. I'm not even close to overweight, exercise regularly, and use salt sparingly. So the only thing left was medication. My problem was that it seems very few doctors will treat pre-hypertension with medication. I finally found a cardiologist willing to prescribe, and after trial and error we found a cocktail that seems to work. But at my last checkup he told me that the evidence for hypertension as a risk factor for coronary disease is very weak, unlike for cerebrovascular disease, where he says the evidence is pretty solid. What say the docs here?
 
azure said:
As a counterpoint to all this, my untreated BP is rarely over 140/90, but I was concerned enough with frequent readings in the 130s/85 that I wanted to get it under better control. I'm not even close to overweight, exercise regularly, and use salt sparingly. So the only thing left was medication. My problem was that it seems very few doctors will treat pre-hypertension with medication. I finally found a cardiologist willing to prescribe, and after trial and error we found a cocktail that seems to work. But at my last checkup he told me that the evidence for hypertension as a risk factor for coronary disease is very weak, unlike for cerebrovascular disease, where he says the evidence is pretty solid. What say the docs here?
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I suspect he meant that there is little evidence that pre-hypertension is a risk factor for coronary artery disease. Full blown hypertension is a risk factor but even if you exclude coronary artery disease hypertension is a definite risk factor for congestive heart failure and other problems including atrial fibrillation. I've read over 10,000 echocardiograms and I'm convinced that hypertension is bad for the heart, especially when it gets really high (stage 2 or higher).
 
bbchien said:
We have failed to teach the scientific method.
Do what you wish.
You will feel great until you don't at which time it's irreversible.

..........sigh.........
Click to expand...

You mean the scientific method that says, question everything? That's all I'm doing is asking some questions. Since we have had a major change in the last decade as to the standards for BP at the same time big Pharma has taken an interest beyond simple diuretics it does beg some questions.

It's not like "science" hasn't been swayed by money in the past. For example:

http://content.time.com/time/photogallery/0,29307,1848212_1777633,00.html

Now that just seems like a funny little trivia point, then in a nation where roughly half the population smoked it was comforting to know that doctors and scientist endorsed smoking even if anecdotal evidence said otherwise.
 
Alexb2000 said:
You mean the scientific method that says, question everything? That's all I'm doing is asking some questions. Since we have had a major change in the last decade as to the standards for BP at the same time big Pharma has taken an interest beyond simple diuretics it does beg some questions.

It's not like "science" hasn't been swayed by money in the past. For example:

http://content.time.com/time/photogallery/0,29307,1848212_1777633,00.html

Now that just seems like a funny little trivia point, then in a nation where roughly half the population smoked it was comforting to know that doctors and scientist endorsed smoking even if anecdotal evidence said otherwise.
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Great. Don't take meds and starve those greedy companies. Take the advice of a long deceased physician and smoke Camels (do they even make them anymore?) http://www.youtube.com/watch?v=X0tWONdhyO0
Just between you and me I think that recommendation is a little dated.
 
Like I say, we failed to teach the scientific method. Lisinopril is now a $4 WalMart med. The key is not only asking the question, but KNOWING WHAT QUESTION TO ASK.
 
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Alexb2000 said:
You mean the scientific method that says, question everything?
Click to expand...

There's a lot more to it than that

It certainly doesn't say that you can never draw any valid conclusions.

It's not like "science" hasn't been swayed by money in the past. For example:

http://content.time.com/time/photogallery/0,29307,1848212_1777633,00.html

Now that just seems like a funny little trivia point, then in a nation where roughly half the population smoked it was comforting to know that doctors and scientist endorsed smoking even if anecdotal evidence said otherwise.
Click to expand...

People sometimes use the fact that scientists have been wrong in the past to imply that scientists are wrong now. Certainly no discipline is perfect, but it's important to recognize that the state of scientific knowledge advances over time.
 
Palmpilot said:
There's a lot more to it than that

It certainly doesn't say that you can never draw any valid conclusions.

People sometimes use the fact that scientists have been wrong in the past to imply that scientists are wrong now. Certainly no discipline is perfect, but it's important to recognize that the state of scientific knowledge advances over time.
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OK, I guess I'll bite again.

I actually do know the scientific process, but that really wasn't what I was challenging. I am questioning the input of big industry with regard to sudden changes in medical standards that conveniently define large blocks of the population as unhealthy enough to warrant daily medication.

Earlier comments suggested that there could be no profit motive for BP related drugs because they are $4 at Walmart.

Quick Google searches say.... well that isn't the whole story.

Here are some links to information that makes my point:

In 2004 alone Pfizer reported Norvasc revenue at $3.8B their second most profitable drug. This is a big number and it would be incredibly naive to think that there isn't any influence with those kinds of numbers.

http://www.forbes.com/2004/02/26/cx_mh_0226pfizerpatent.html

We all know there was a law suit that challenged Pfizers patent and generics hit the market around 2006ish.

BUT.... let's wind the tape back a little and see what studies prior to that time period defined the "new" blood pressure standards that put so much of the population into the chronic management category.

2003 One of many articles defining optimal BP as 115/75

http://www.ncbi.nlm.nih.gov/pubmed/12698067

2003 WHO guidlines for management of hypertension

http://www.ncbi.nlm.nih.gov/pubmed/14597836?dopt=Abstract

1999 WHO/ISH hypertension guidelines changed

http://www.who.int/bulletin/archives/77(3)293.pdf

Etc. I won't fill the thread will more references, but it does seem convenient that those kinds of studies supported years of massive profits.

Common sense says that losing weight, exercising, eating right, and the resultant decrease in BP is good for someones health and longevity. No one is questioning that (at least I don't think so). I am just questioning the method that we push medicine forward: Pharma funds research through directed grants, research concludes that millions are at risk for X (big surprise), Pharma produces a drug to manage X, Pharma posts big profit numbers.... rinse and repeat.

Last point:

Look at this POA thread. Here we have a guy that weights 146lbs., runs marathons, eats an almost perfect diet, and is concerned about a 131/75BP. Most of us wish/dream we were as healthy as this individual (I do), yet modern medicine has defined him as at risk and he is concerned about it. Perfect example of what I am talking about.

http://www.pilotsofamerica.com/forum/showthread.php?t=62587&highlight=blood+pressure
 
Alex, I think there is some validity to your point. I have seen many times where big business convinces government the "codes" need to be changed to incorporate their product. ( non -health related) So I can imagine it is true for the health industry. :yes:

Each of us must weight the risk / benefit of taking meds.
 
Geico266 said:
Alex, I think there is some validity to your point. I have seen many times where big business convinces government the "codes" need to be changed to incorporate their product. ( non -health related) So I can imagine it is true for the health industry. :yes:

Each of us must weight the risk / benefit of taking meds.
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I do listen to trusted medical people. Having said that I have a real problem excepting anything just because the government says it is so. More often than not it is what a lobbyist says is so.

An example near and dear to my wallet. Convince a legislator that the parts per billion of any contaminant in the water is too high and walla everybody in the state has to build a new water plant. My share is $500 a year for that decision.

I am convinced that with the money that flows through Washington and even State and local governments that it would be nothing for a few million dollars to show up in a Swiss bank account to buy a vote or even for someone to "disappear" when a several Billion dollar contract is on the line.

200 years and the more things change the more they stay the same.
Our country is now taking so steady a course as to show by what road it will pass to destruction, to wit: by consolidation of power first, and then corruption, its necessary consequence. -Thomas Jefferson
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Standards and recommendations change based on the results of more recent studies. Based on observational studies we know that those with BP 115/75 or less have a lower risk for many vascular and cardiac complications than people with higher BP. Previously BP was treated more aggressively until studies showed that it was not helpful to push under 140/90 for non-diabetics and 130/80 for diabetics.

The heart works continually and high blood pressure has very deleterious effects on heart muscle. The wall thickness and stiffness of the left ventricle (pumping chamber) increases and can result in heart failure. Blood vessels are also damaged by hypertension. I see this all the time and have observed the correlation between BP and cardiovascular health. Smoking is really, really bad and so is diabetes. A diabetic smoker with poorly controlled hypertension is begging for big trouble.

This is only my opinion. I agree with the current recommendations here: http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
I don't care if the rest of you take advice from The Mother Earth News, or your grandma, or anybody else. It's your health and each of you can do whatever you think is best and we'll see how it works out in the end. Why do I feel like I'm back in the SZ?
 
I give up, Gary. Everybody knows better than the doc.
You feel great until you don't.

And this grousing about big pharma......for $4.00 a month?
Sigh.

:(
 
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bbchien said:
I give up, Gary. Everybody knows better than the doc.
You feel great until you don't.

And this grousing about big pharma......for $4.00 a month?
Sigh.

:(
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Or $10 for three months (90) of a combination antihypertensive like Lisinopril/HCTZ 20/25 cut in half. That's a whopping $0.055 per day.
 
bbchien said:
And this grousing about big pharma......for $4.00 a month?
Sigh.

:(
Click to expand...

Dr. Bruce your opinion obviously can't be trusted we know all the doctors get all those huge kick backs from the pharma companies to peddle their products. :rofl::lol::goofy:
 
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