Blood Pressure

[JohnWF]

I typed this earlier but it 'disappeared' so I hope this won't be a duplicate.

I take my BP daily at same time of day, average three readings taken one minute apart. Over past 10 days BP was average of 131/75 - typical of the past four months.

I use absolutely no salt, don't buy any food with lots of sodium in it, eat little red meat, eat lots of vegetables, drink low sodium V-8 daily, use supplements like magnesium, garlic, hawthorn berries, folic acid, have a BMI of 22, do slow breathing exercises for 15-min daily, take dark chocolate daily, use no sugary foods (except the chocolate) Age is early 80s.

What could you suggest I add to try to get BP down to 120/xx ?

 

[bbchien]

Lose weight. I know, you didn't want to hear that because it is not easy.
Run a mile in 7:00 daily. I know, you didn't want to hear that because it is not easy.
sigh.
Both have scientific merit.

 

[JohnWF]

Well, I have run many marathons, did a 50-miler once, and am at 146-lbs so I can't really loose much more weight or I will look like a toothpick.
A 7-minute mile is something I was never able to do ... if you're blessed with a lot of fast twitch muscle fibers you might be able to do a 4 min mile, but we're stuck with what nature gave us. I averaged 150-miles per month for years and never could do a 7 minute mile.

I should have been more careful in selecting my parents I guess.

I do agree that exercise and weight loss is a valid general recommendation, but that can only go so far.

John

 

[Jim Logajan]

Just curious to know how you calibrated whatever you are using to measure BP. It appears to give consistent results, but are the absolute readings reasonably correct?

 

[Brad Z]

Let's be honest though...131/75 for someone in their 80s is not exactly terrible.

 

[Gary F]

I typed this earlier but it 'disappeared' so I hope this won't be a duplicate.

I take my BP daily at same time of day, average three readings taken one minute apart. Over past 10 days BP was average of 131/75 - typical of the past four months.

I use absolutely no salt, don't buy any food with lots of sodium in it, eat little red meat, eat lots of vegetables, drink low sodium V-8 daily, use supplements like magnesium, garlic, hawthorn berries, folic acid, have a BMI of 22, do slow breathing exercises for 15-min daily, take dark chocolate daily, use no sugary foods (except the chocolate) Age is early 80s.

What could you suggest I add to try to get BP down to 120/xx ?

Let's be honest though...131/75 for someone in their 80s is not exactly terrible.

Congratulations, it's actually very good for age. At your age I would not try to run but walk briskly for 30 to 60 minutes at least 5 days a week.

 

[douglas393]

Congratulations, it's actually very good for age. At your age I would not try to run but walk briskly for 30 to 60 minutes at least 5 days a week.

or swim, or bike ride.

 

[Gary F]

or swim, or bike ride.

Agree, I advise my patients to walk briskly or equivalent exercise. Wear a helmet if you bike.

 

[JohnWF]

Thanks, gentlemen. I think I will get out the mountain bike and try that for a while...
I do fly about 3x each week but that doesn't help much except to please the mind...

I used that mountain bike to do the "Ride the Rockies" bike tour a few years ago...around 400 miles total with 80 mile max leg...lots of passes that really taxed me....on one long pass uphill ride I noticed a 'sag wagon' keeping a close eye on me, expecting a new patient I suppose...they didn't get one!

Thanks again for the suggestions. In a few months I'll post results.

JOhn

 

[Gary F]

Thanks, gentlemen. I think I will get out the mountain bike and try that for a while...
I do fly about 3x each week but that doesn't help much except to please the mind...

I used that mountain bike to do the "Ride the Rockies" bike tour a few years ago...around 400 miles total with 80 mile max leg...lots of passes that really taxed me....on one long pass uphill ride I noticed a 'sag wagon' keeping a close eye on me, expecting a new patient I suppose...they didn't get one!

Thanks again for the suggestions. In a few months I'll post results.

JOhn

Amazing. If you are really in your 80s I would like to know what you eat for breakfast and please tell me you have a shot of Bourbon daily.

 

[Piloto]

I started going out with my wife weekly to the mall. After two hours the only thing that lost weight was my wallet.

 

[JohnWF]

This is for GaryF

For breakfast I have 3-oz orange juice, 1/2 grapefruit, whole banana, two pieces of whole wheat toast with a bit of jelly, and a cup of
CAYANNE PEPPER tea. That last helps the BP but takes a while to get used to.

 

[Gary F]

This is for GaryF

For breakfast I have 3-oz orange juice, 1/2 grapefruit, whole banana, two pieces of whole wheat toast with a bit of jelly, and a cup of
CAYANNE PEPPER tea. That last helps the BP but takes a while to get used to.

Worth a try. Can't argue with success.

 

[dtuuri]

What could you suggest I add to try to get BP down to 120/xx ?

For breakfast I have 3-oz orange juice, 1/2 grapefruit, whole banana, two pieces of whole wheat toast with a bit of jelly, and a cup of CAYANNE PEPPER tea. That last helps the BP but takes a while to get used to.

I'd give up the tea. Some random quotes from this article:

"Capsaicin, one of the major active components of cayenne pepper pills..."

"Capsaicin, a sympathomimetic agent, may be implicated in the initiation of coronary vasospasm and acute myocardial infarction in the absence of substance abuse, particularly in previously healthy teenagers and young adults. We suggest that this product, which may increase the risk of life-threatening cardiovascular events, be closely supervised and controlled by relevant institutions worldwide."

"Hachiya et al. [12] reported that capsaicin enhances adrenal medullary adrenaline secretion in humans, which transiently elevates the blood pressure and heart rate."​

dtuuri

 

[Art VanDelay]

Only way to bring that systolic number down is MORE sex !

 

[asgcpa]

Congrats. I want to be alive in my early 80s. It sounds like you are doing great.

 

[Gary F]

Congrats. I want to be alive in my early 80s. It sounds like you are doing great.

Not only alive but active, flying and with good BP (for age) to boot.

 

[steingar]

Damn, I'll have whatever he's having.

 

[tinerj]

A banana split every day at DQ works for me.

 

[comanchepilot]

Guys, and even Doc - did you read? The entire post? BMI of 22. NOT OVERWEIGHT. May have muscle mass issues in their early 80''s which I dare say is likely older than I shall get - c'mon - READ the F'ing post all the way through.

I'm assuming that he can still run - and walk - and maybe even cycle - but cycling needs to be stationary - give any thought to what happens to 80 year old bones when you fall off?

A wily old GP told me once that hypertension seems to be caused when the arteries lose their elasticity - which makes them harder - and thus less supple and increases the pressure inside - he also told me that is it also a sign that they are getting narrower. . . same flow, less volume = higher pressure.

John is early 80's - having a diastolic pressure under 80 is marvelous for his age -

I also had another wily old AME once tell me that pressure under 80 diastolic at any age is target. The hight end systolic pressure can get to 140 before anyone sees any real problems as long as the diastolic is under 80.

Most of our seasoned citizens have problems with the diastolic not systolic

John, maybe its finally time for an ACE inhibitor . . .relax those arteries . . .

 

[bbchien]

Guys, and even Doc - did you read? The entire post? BMI of 22. NOT OVERWEIGHT. .

No, I was post #2. I can't patrol these strings every night....sigh.

The other perspective: if the OP is 80, BP in his range is unlikely to do much damage in 20 years. How long does a person think he can fly? Is it time to buy radial tires?

How much area is under the "hypertension-time" curve?

What's the morbidity from an ACE inhibitor vs benefit?
This needs your family doc.....

 

[comanchepilot]

No, I was post #2. I can't patrol these strings every night....sigh.

The other perspective: if the OP is 80, BP in his range is unlikely to do much damage in 20 years. How long does a person think he can fly? Is it time to buy radial tires?

How much area is under the "hypertension-time" curve?

What's the morbidity from an ACE inhibitor vs benefit?
This needs your family doc.....

Sorry for dumping on ya' Doc - its the end of a busy day here and I came to try to relax . . . . guess I should I take my own BP . . .

 

[Gary F]

Guys, and even Doc - did you read? The entire post? BMI of 22. NOT OVERWEIGHT. May have muscle mass issues in their early 80''s which I dare say is likely older than I shall get - c'mon - READ the F'ing post all the way through.

Hey, we're not running a free online medical clinic, just giving out some general information so pilots can consider and discuss these issues more intelligently with their personal physician.

I'm assuming that he can still run - and walk - and maybe even cycle - but cycling needs to be stationary - give any thought to what happens to 80 year old bones when you fall off?

Probably no worse than if I fall off my Harley Davidson Super Glide at 60 mph. I guess the safest thing to do would be to check into a nursing home and sit on a couch to watch TV all day long. I congratulate the OP for being active at his age. There is risk walking out of your house every day and the OP wants to enjoy life. I hope I am as active and still flying at his age.

A wily old GP told me once that hypertension seems to be caused when the arteries lose their elasticity - which makes them harder - and thus less supple and increases the pressure inside - he also told me that is it also a sign that they are getting narrower. . . same flow, less volume = higher pressure.

A bit of an oversimplification but probably good enough for this forum.

John is early 80's - having a diastolic pressure under 80 is marvelous for his age -

I also had another wily old AME once tell me that pressure under 80 diastolic at any age is target. The hight end systolic pressure can get to 140 before anyone sees any real problems as long as the diastolic is under 80.

Most of our seasoned citizens have problems with the diastolic not systolic

John, maybe its finally time for an ACE inhibitor . . .relax those arteries.

I like ACE inhibitors and use them a lot but probably have a different perspective on geriatric medicine than you do, probably a lot closer to Dr. Bruce's opinion on this subject.
Here is a general medical recommendation for treating hypertension in the elderly:
"Generally, antihypertensive therapy appears to be clinically beneficial in geriatric patients. Target blood pressure values of <140-150/90 mm Hg and <140/90 mm Hg can be used as a general guideline for octogenarians (80-89 yrs) and septuagenarians (70-79 yrs) respectively". http://www.ncbi.nlm.nih.gov/pubmed/22573500

 

[Geico266]

Only way to bring that systolic number down is MORE sex !

I'm in!

 

[Lucky]

I'm in!

That's all that matters.

 

[Geico266]

Not only alive but active, flying and with good BP (for age) to boot.

I can only hope I am so lucky!

Good for you! Keep it up man!

Speaking of keeping it up, how is your sex life?

 

[Concorde]

Only way to bring that systolic number down is MORE sex !

Good advice even if it doesn't help the bp .

 

[comanchepilot]

So Gary, why is it ok to 'accept' higher BP's in those over 70? No other choice?

 

[steingar]

So Gary, why is it ok to 'accept' higher BP's in those over 70? No other choice?

What's "normal" for a 40 year old may not be for a octogenarian and likewise.

 

[Gary F]

So Gary, why is it ok to 'accept' higher BP's in those over 70? No other choice?

Several reasons but in general the risk/benefit changes of medical therapy changes as we age. Medications are metabolized differently in elderly patients and the risk for side effects increases significantly including the possibility of orthostatic hypotension which can result in falls.

Here is the full text from the paper which explains in greater detail. http://www.smw.ch/content/smw-2012-13574/

"Although it had been shown that a target BP <140/90 mm Hg significantly reduces cardiovascular risk in middle-aged patients, only one single study was conducted in elderly patients (65–85 years) applying this target and showed no clinical benefit"

"It is known that orthostatic hypotension (supine-to-standing BP drop of >20 or >10 mm Hg for SBP and DBP respectively) is known to occur more frequently (5–30%) in the elderly (patients >65 years) [33]. With regards to this condition the ESH-ESC 2009 [6] mentions an increased risk in the elderly on anti-HT therapy"

 

[comanchepilot]

I know about the hypotension issues - and the slowed clearance issues - you give the first dose to people in the office - and then measure the BP and have someone there to grab them if they faint. Then adjust the dose -

Hey Docs - keep in mind that the cost of a 50mg doze is often the same as the 25mg pill - so prescribe the higher dose for patients and have them cut the pill in half - thereby immediately saving them 50% on their medical cost.

I asked my doc to give me 1000mg of metformin - he asked why - and I said the 1000mg pill is scored halfway down and breaks in half easily - a 1 year mail order supply becomes a 2 year supply for exactly the same price . . .

 

[Gary F]

I know about the hypotension issues - and the slowed clearance issues - you give the first dose to people in the office - and then measure the BP and have someone there to grab them if they faint. Then adjust the dose -

Hey Docs - keep in mind that the cost of a 50mg doze is often the same as the 25mg pill - so prescribe the higher dose for patients and have them cut the pill in half - thereby immediately saving them 50% on their medical cost.

I asked my doc to give me 1000mg of metformin - he asked why - and I said the 1000mg pill is scored halfway down and breaks in half easily - a 1 year mail order supply becomes a 2 year supply for exactly the same price . . .

Long story short, the data does not support aggressive pharmacologic management of hypertension in the elderly that may be appropriate in younger individuals.

Conscientious physicians consider the patient's ability to afford medications and tricks to reduce costs. Many large chain pharmacies have $4/month ($10/3 months) list of prescriptions and cutting pills in half is no secret.

 

[bbchien]

I know about the hypotension issues - and the slowed clearance issues - you give the first dose to people in the office - and then measure the BP and have someone there to grab them if they faint. Then adjust the dose -

Hey Docs - keep in mind that the cost of a 50mg doze is often the same as the 25mg pill - so prescribe the higher dose for patients and have them cut the pill in half - thereby immediately saving them 50% on their medical cost.

I asked my doc to give me 1000mg of metformin - he asked why - and I said the 1000mg pill is scored halfway down and breaks in half easily - a 1 year mail order supply becomes a 2 year supply for exactly the same price . . .

Keep up the way you're going, Joe, and you won't need no steenkin metformin pretty soon......