Class 3 medical question-blood pressure

[Guest2018]

Good evening. I have taken up flying lessons after a 40 year hiatus. I am 56, in good health overall. I went to the dermatologist for a check up a couple weeks ago. Left work, rushing to get there, and not enjoying the sitting naked waiting for the Doctor. When the nurse took my blood pressure it was super high. Like 175/100. I take my blood pressure several times a week and it averages about 135/85. This morning it was 124/76. It is randomly high, close to the 155/95. I worry that if it is high when I go for my medical it will be an issue. Any advice is appreciated.

 

[kyleb]

Go to your regular doctor, have him or her treat you for high blood pressure and get it under control. Then, have the doctor provide you a note explaining that you are being treated for BP and your condition is managed and stable.

 

[Lachlan]

The BP machines that people use at home are often error prone and tend to read low. 175/100 is not awesome, and you need to have that checked out immediately! No need to bleed inside your head and have to learn how to eat with a spoon while your speech is limited to three garbled words. You're getting into a range where the long term effects of untreated high BP can cause a great deal of damage, some of which is irreversible. Take care of your body and worry about flying once you're healthy.

 

[rk911]

faa max average while sitting for all classes is 155/95.

https://www.faa.gov/about/office_or...am/ame/guide/app_process/exam_tech/item55/et/

 

[Fearless Tower]

The BP machines that people use at home are often error prone and tend to read low. 175/100 is not awesome, and you need to have that checked out immediately! No need to bleed inside your head and have to learn how to eat with a spoon while your speech is limited to three garbled words. You're getting into a range where the long term effects of untreated high BP can cause a great deal of damage, some of which is irreversible. Take care of your body and worry about flying once you're healthy.

Yes they are inaccurate, but I have seen and heard of far more of the digital home blood pressure monitors read high, not low.

Even the ones many doctors and dentists use can be inaccurate.

For the OP: are you getting the high BP readings on digital/automatic cuffs, or manual readings with a cuff and stethoscope?

If you are getting high readings on digital monitors, but normal when a doc or nurse checks it manually, I wouldn’t worry about it. But if you are getting high readings manually, you best get it treated.

I went into my Dentist just a week ago and the digital monitor showed 160/85. They were all freaking out and I asked them to check me manually and I was 125/80. I was 120/75 at my aviation medical a couple weeks before that.

Not all technology is helpful.

 

[Guest2018]

This was a one off result and was measured with a machine not as good as the one I have at home. Pressure is normally not high but is from time to time. I don't take any meds and don't want to start down that path.

 

[Guest2018]

Yes they are inaccurate, but I have seen and heard of far more of the digital home blood pressure monitors read high, not low.

Even the ones many doctors and dentists use can be inaccurate.

For the OP: are you getting the high BP readings on digital/automatic cuffs, or manual readings with a cuff and stethoscope?

If you are getting high readings on digital monitors, but normal when a doc or nurse checks it manually, I wouldn’t worry about it. But if you are getting high readings manually, you best get it treated.

I went into my Dentist just a week ago and the digital monitor showed 160/85. They were all freaking out and I asked them to check me manually and I was 125/80. I was 120/75 at my aviation medical a couple weeks before that.

Not all technology is helpful.

This was an automatic machine, lower model that the one I own. I have not had a reading for about a year with a stethoscope but it has never been high.

 

[Lachlan]

Yes they are inaccurate, but I have seen and heard of far more of the digital home blood pressure monitors read high, not low.

Even the ones many doctors and dentists use can be inaccurate.

For the OP: are you getting the high BP readings on digital/automatic cuffs, or manual readings with a cuff and stethoscope?

If you are getting high readings on digital monitors, but normal when a doc or nurse checks it manually, I wouldn’t worry about it. But if you are getting high readings manually, you best get it treated.

I went into my Dentist just a week ago and the digital monitor showed 160/85. They were all freaking out and I asked them to check me manually and I was 125/80. I was 120/75 at my aviation medical a couple weeks before that.

Not all technology is helpful.

Try this: next time you need to have your BP manually checked, have two or more people check it without telling each other what they got until they're all done. Surprise! (And no, not the good kind.) Most people have a very hard time getting all touchy/feely with someone by taking a manual BP and telling them that they got a concerning reading. If the machine did it then there aren't any feelings to deal with, it's the technology that did it. When someone has to put their skills on the line they don't want to deliver bad news. Add to that the fact that a manual BP is entirely based on interpretation by the person taking it and you have a huge source of error. Best BP practice is to monitor it over time and look for consistent readings. Outliers need to be investigated accordingly.

 

[bbchien]

Here is everything you should NOT do:

Deny you have hypertension
Have a hemorragic brain infarct like Eisenhower did.

 

[James331]

I’d go get someone with half a brain to take a couple manual readings and see if there really is a problem vs at home digital BP cuff / LPN user error first.

 

[Guest2018]

My reading this morning, 124/85. Last night, 142/82. Is this truly a cause for overall concern? I don't want to portray denial, I am surprised at the extreme answers. The super high reading was followed by a 124/78 when I got home that evening.

 

[Fearless Tower]

Best BP practice is to monitor it over time and look for consistent readings. Outliers need to be investigated accordingly.

Don’t disagree with that at all. Just pointing out that the digital ones are notoriously inaccurate.

 

[Greg Bockelman]

My reading this morning, 124/85. Last night, 142/82. Is this truly a cause for overall concern? I don't want to portray denial, I am surprised at the extreme answers. The super high reading was followed by a 124/78 when I got home that evening.

See the post 2 above yours from Doc Bruce. To put it in plain language, get it checked by a qualified medical professional. Preferably several times on different days at different times. You can’t really guarantee the accuracy of those self serve machines.

And to be frank, you sort of ARE portraying denial.

 

[sarangan]

Good evening. I have taken up flying lessons after a 40 year hiatus. I am 56, in good health overall. I went to the dermatologist for a check up a couple weeks ago. Left work, rushing to get there, and not enjoying the sitting naked waiting for the Doctor. When the nurse took my blood pressure it was super high. Like 175/100. I take my blood pressure several times a week and it averages about 135/85. This morning it was 124/76. It is randomly high, close to the 155/95. I worry that if it is high when I go for my medical it will be an issue. Any advice is appreciated.

Infections and inflammation can significantly elevate blood pressure. You may not have any outward signs. I had such an episode. A week later it went back to normal by itself.

 

[Fearless Tower]

Most people have a very hard time getting all touchy/feely with someone by taking a manual BP and telling them that they got a concerning reading.

Disagree with that. In my experience most medical folks are looking for something to treat, not admit that the digital equipment they paid a lot of money for doesn’t work.

All I’m saying is that based on the scientific research out there on digital cuffs, I’d trust multiple manual readings from trained medical personnel over what the robot says.

 

[wsuffa]

I'm in the "check it again" school. It needs to be under control and you need to be sure that you are not hypertensive, but you also need to make sure that the diagnosis is right. I have had 2 different nurses manually check mine 5 minutes apart and get readings as much as 20 points different. I have also seen medical personnel try to do routine blood pressure checks through clothing.

So, yes, go for another reading or three. Make sure the MD or staff does it right. If you do have hypertension, get it treated.

 

[Skip Miller]

The width of the cuff makes a difference, too. The standard cuff will read higher than a wide cuff for large individuals. Not necessarily fat individuals (but yes them too) but large individuals. If this is you, ask for a wide cuff.

-Skip

 

[timwinters]

And to be frank...

Hi, Frank!

 

[PaulS]

My reading this morning, 124/85. Last night, 142/82. Is this truly a cause for overall concern? I don't want to portray denial, I am surprised at the extreme answers. The super high reading was followed by a 124/78 when I got home that evening.

Blood pressure meds are no big deal, contrary to the horror stories you read on the internet. I have been on them for a long time now, with numbers like yours when I started. Just take what the doc orders if you go on them and forget about them, really. Much better than a stroke or heart attack. Get yourself to a doctor and do what he says.

 

[timwinters]

Two things are great at lowering blood pressure.

1. Giving blood.

2. Having a beer.

The first contributes to society, the second to the economy!

 

[AggieMike88]

Blood pressure meds are no big deal, contrary to the horror stories you read on the internet. I have been on them for a long time now, with numbers like yours when I started. Just take what the doc orders if you go on them and forget about them, really. Much better than a stroke or heart attack. Get yourself to a doctor and do what he says.

Agree with all of this, especially what I highlighted.

Control of hypertension is easy to do. Neglecting it is something that will cause long term and serious problems.

A Doctor Bruce-ism very much applies to Guest2018 and this thread

"Health First, Fly Later"​

 

[azure]

Agree with the "check it again, and again" crowd... however, to be blunt, even your "lower" readings are really acceptable only as an upper limit. I had readings like that for years, and occasionally higher when in strange doctors' offices ("white coat hypertension"), but rarely more than 140/90. I didn't like what I was seeing, even though I was nearly always below the level usually deemed hypertensive. Dr. Bruce has written a number of times that end-organ damage from elevated pressure in your plumbing is a function of the area under the curve, the curve being a plot of BP vs time. (So you can still be doing damage to yourself with only slightly elevated readings, if they are consistent and stay that way for long enough.) And if my BP rose to borderline levels in stressful situations like being in doctors' offices, it was likely that it was nearly as high, if not higher, during the day when I was teaching and getting ready for lectures and labs.

So I asked to be put on meds. It was challenging to get anyone to listen because the conventional wisdom is only to treat when it's really high, and they see MUCH higher pressures than mine. But I was persistent, and in the end I prevailed. It turned out I was fairly resistant to diuretics alone and wound up on a combo of two meds, a diuretic and a calcium channel blocker, to keep my BP consistently under control. It is almost always in the 110-ish/70 range now when checked by the nurse at my PCP's office. Even so, under times of very elevated stress (such as sometimes in the AME's office), it can get back up into the hypertensive range. But I'm confident after many repeated checks that it is under control 99% of the time, so my "area under the curve" is favorable as far as my long term health is concerned.

As others have said, BP meds are a yawn as far as your 3rd class is concerned, as long as you're only on the common, non-central-acting ones (most diuretics, beta blockers, CCBs, ACE inhibitors) and if you need more than one, that you don't need more than three at once. It's a CACI, I believe (a Condition that AME Can Issue).

 

[wsuffa]

I'll add that you should make sure to work with your doc to find the optimal combo for you. Some can cause significant side effects - including increasing cholesterol or a1c levels - which will then require more pills for treatment. So you're looking for the balance between effective and side effects (toxicity).

Some docs will want to stop at "that works, let's give you pills for the other things), while others will work with you to find the best solution. Get treated, but work to do so in the best manner.

 

[inspectorpacket]

I have been to Doc Bruce and he is spot on. What I recognized on my journey to getting my BP under control was the following truisms:

1. Your primary care physician is nearly useless and will just toss you on some meds until you complain about the side effects.
2. Get yourself a good cardiologist, and explain that you are going for the class 3 medical and what your goals are, if they understand and are willing to hep you along the way you have a good doc. Otherwise find a new one. I have a great reference here in Atlanta if anyone needs it.
3. Use a program to input your diet, I use MyFitnessPal. The goal here is to observe how much damn salt you are taking in daily. I can lower my readings just by a few simple changes, in essence I can see the cause and effect of what I eat on my BP nearly real time.
4. take readings at home at the same time 3x per week. Even if the machine is wrong, it will be consistently wrong and you are looking for the trend. I use the omron and it is damn close to what the Dr gets.

Today, I am happy to say that if my blood pressure goes up, it is because I made the choice, for example: to have a bowl of French Onion soup with that Filet Mignon. Manage it accordingly and you will feel better.