Stage 1 Hypertension

spiderweb

spiderweb

Final Approach
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Ben
Getting ready for Class 3 Medical. Reading my blood pressures, average is about 140/90.

Notes:

--I am vegetarian, but not vegan.
--I run five miles a day, 5-6 days a week, maintaining 9 minute miles (I know, it's slow)
--I love salt, unfortunately
--Family history is that everyone has very high BP, like 180/110
--Believe the reason my BP is not this high is due to exercise and vegetarianism

Questions:

--What would be "too high" for the AME?
--What happens if he thinks it is too high?
--Would becoming completely vegan help?

Thanks, in advance!
 
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One additional note: after exercise, my BP is FAR lower, in the order of 120/70
 
bbchien said:
Ben, the scientific goal is systolic at 130, diastolic at or below 80.
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Hmm. Not that far away. Would the vegan thing help, or should I run longer?

I do, of course, want to pass my medical; but I'd also like to avoid medicine if I don't really need it. . . .
 
Dang laptop posted my first line before I knew it.

Hypertensive damage is irreversible and is an area under the time curve phenomenon. From what you wrote, you have 4 times the 30 year risk of a stroke than a normal.I f you are near the 150/90 limits, you have more risk even that that.

The Federal Limit is 150 and 90, but we accept 155 and 95. However, if that is "white coat syndrome" the MRFIT trial showed us that the mortality and morbidity of the "white coaters" was the same as the uncontrolled group. We suspect unless you run 24/7 that running is just the same thing.

Add to that, I usually advise airmen that their best chance for the onetime normal EKG required for the first hypertensive issuance, is when you are younger.

Do NOT spend your 60s, 70s, and 80s, like Rose Kennedy, Stroked out in a wheelchair watching your grandkids rip you off. Work on it now. Lisinopril is a GREAT first choice and if it creates a cough, Cozaar (losartan) is now generic.
 
bbchien said:
Dang laptop posted my first line before I knew it.

Hypertensive damage is irreversible and is an area under the time curve phenomenon. From what you wrote, you have 4 times the 30 year risk of a stroke than a normal.I f you are near the 150/90 limits, you have more risk even that that.

The Federal Limit is 150 and 90, but we accept 155 and 95. However, if that is "white coat syndrome" the MRFIT trial showed us that the mortality and morbidity of the "white coaters" was the same as the uncontrolled group. We suspect unless you run 24/7 that running is just the same thing.

Add to that, I usually advise airmen that their best chance for the onetime normal EKG required for the first hypertensive issuance, is when you are younger.

Do NOT spend your 60s, 70s, and 80s, like Rose Kennedy, Stroked out in a wheelchair watching your grandkids rip you off. Work on it now. Lisinopril is a GREAT first choice and if it creates a cough, Cozaar (losartan) is now generic.
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Thank you, Dr. Bruce. If, say, I goto the AME next week and read 135/90, and he just grants me a medical, should I ask for a prescription? Does that create more paperwork?

And if, for some reason I read 150/100 and that prevents me from a medical, what happens next?

I'm in good shape, and have lots of energy. My non-vegetarian family are way worse off than I am, and are all on meds. :(

Thanks, as always, for your time!
 
No. if he's the same guy, separate the Aviation medical from the Flight physcial, as once you are on the meds, you will be down 14 days until he is comfortable that you are "well controlled, no side effects, and not being followed for CAD". Serum Creatinine, Fasting glucose, and a lipid profile are mandatory.

Of course, you can take that period "down" while August recess is still in force.....or during some nasty winter month in which you don't fly anyway. But I think you proabbly need to do this.
 
bbchien said:
No. if he's the same guy, separate the Aviation medical from the Flight physcial, as once you are on the meds, you will be down 14 days until he is comfortable that you are "well controlled, no side effects, and not being followed for CAD". Serum Creatinine, Fasting glucose, and a lipid profile are mandatory.

Of course, you can take that period "down" while August recess is still in force.....or during some nasty winter month in which you don't fly anyway. But I think you proabbly need to do this.
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Sure. I fly mostly because I love to fly--only about 25% for my music stuff. A two-week downtime (or even much more) is not significant for me as long as I am healthy and eventually get my medical!

But I do want to know your opinion on becoming a vegan. I have been a vegetarian for 22 years, but have many friends, including a heart surgeon, who are vegan. I'll have to be more careful about food choices, of course, but I do have the time to be smart about that. Do you know if that would help more than a few points, or so? (I am on the traditional Chinese/Taiwanese Buddhist vegetarian tract which is, essentially, an ovo-latco diet.)

Thanks again, Dr. Bruce, for your continual, selfless advice on this and many other aviation webboards!
 
Salt is bad for hypertension and processed foods contain a lot of salt.

I started paying attention and recently discovered that there was a lot of sodium in bread...

I never add any salt to my food ( except eggs...)
 
spiderweb said:
But I do want to know your opinion on becoming a vegan. I have been a vegetarian for 22 years, but have many friends, including a heart surgeon, who are vegan.
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I realize that your question was directed at Dr. Bruce and I don't know anything about the vegetarian/vegan lifestyle, but let me relate a few things that I've read and observed. I'll note up front that I have no medical training and what follows in no way constitutes medical advice.

In my 20's and 30's, my blood pressure was always "borderline". Back then, doctors didn't pay much attention to systolic numbers, but my diastolic was always around 90. When I reached my 40's, aging caught up with me and I went on medication. I've also always had a weight problem, so I've tried many diets with varying success.

About 4 years ago, I changed physicians and the new doc' recommended that I keep a daily blood pressure log. I bought a blood pressure "machine" with a memory and once a week I enter the numbers in an excel spreadsheet complete with graph(yes - I am a geek). The neat thing about this is that I can recognize trends and make associations with my behavior's effect on blood pressure.

Around two years ago, I became aware of the writings of Gary Taubes. I was never a believer in "low carb" diets, but I bought one of his books and read it completely before making any changes. Finishing the book, I decided to give it a try and also picked up an Atkins diet book.

I noticed a few things immediately. If I am "good" - 25 to 50 "net" grams(you subtract dietary fiber from total carbohydrates) of carb's a day, I will lose weight and my blood pressure will settle in a nice range around 130/70. If I'm not "good", my blood pressure jumps up to around 140/80. My weight can also jump 3 - 5 lbs in one day - obvious fluid retention; I notice edema around my ankles. A few days of being "good" and the extra weight/fluid drops right off and my blood pressure settles back into the lower range.

I've always had a sweet tooth and love chocolate. When I'm good, I typically have no cravings at all.

One last thing that I noticed. I have availed myself of both the "little blue pill" and testosterone therapy in the past. Since going low carb, I have used neither in over a year and frankly haven't needed them.

Taubes maintains that the human body is a much more complex system than modern science seems to give it credit for. This system is driven by hormones and insulin is one of the more powerful ones. Controlling the glycemic reaction seems to be most of the battle.

While low carb diets are often associated with meat. The Atkins book has sections on vegan/vegetarian modifications.

Whatever action you take, I highly recommend keeping a daily blood pressure log.

Good luck!
 
Blood pressure meds are readily available that are on FAAs acceptable list.
The goal should be 120/80, 120/70 is even better.
High blood pressure is not necessarily caused by clogged arteries. It could be caused by needing to push blood through too much excess human flesh -- every pound of fat has 200 miles of capillaries.
Exercise, eat right, limit salt.
Limiting salt intake is the most difficult item because it is in so many foods.
Some foods (chocolate!) have far less salt than others deemed good for you.
 
Unfortunately I love the taste of salty food. But I've found that a product called NO SALT satisfies my salt cravings. It is pure potassium chloride but to me, tastes exactly like sodium chloride (salt).

The fringe benefit is I don't have to eat bananas to get my potassium. Of course, consult your doc before doing this. I do not use table salt at all and also avoid other sources of sodium such as processed foods. I read a lot of food labels.


No-Salt.jpg
 
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Papa Foxtrot said:
Whatever action you take, I highly recommend keeping a daily blood pressure log.

Good luck!
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Related, for the past 2 weeks I've recommitted to eating better when my home A1C test showed me a number I wasn't happy with.

The big change was that I started using a food diary app on my iDevices (LoseIt!) that keeps track of what I am eating and the nutritional data.

Prior to starting, I very much admit to eating too much of the wrong things.

With the food diary, I am much more aware of what I am eating and when, and keeping better track of both calories and carbs. And now 2 weeks in, I'm 6 lbs lighter and that was with minimal exercise. I'm now encouraged to add additional exercise and keep up a healthy reduction rate. Goal is to see my toes on the scale without bending over and do that by Thanksgiving.

Add me to the list of folks that say keeping a log, journal, diary of what you are eating and exercising as well as number statistics (BP, and blood sugar if you're diabetic) can help keep you honest as you make the positive lifestyle changes.

For BP Tracking, I'm going tonight to pick up one of these iHealth devices (click the image to get to their page). I'll use and track my BP and then compare with my doctor's info to see how accurate. But at least it will provide me with some eventual trending information like Papa Foxtrot mentions.

 
Just wanted to update anyone who is interested on what I've done.

In the past week and a half, I changed from vegetarian to nearly vegan. I discovered, to my horror, that I had been eating almost a brick of cheese a day! That stopped.

Next, I started eating a lot more green leafy veggies, beans, and nuts (often all in the same salad, lol).

I've lowered carbs, and those I eat I try to limit to complex or those in fruits and indigestible fiber.

Haven't changed my exercising habits which are pretty good.

I started taking magnesium supplements, as I found when magnesium and potassium are in balance, salt becomes much less of an issue. (I even read the original studies, being the good researcher that I am!)

I've also been taking a BP log.

RESULTS:

In just one week, I have gone down ten points on systolic, and seven points on diastolic.

The diet certainly is NOT for everyone, but it works fine for me. I will keep this up and keep you posted!

spiderweb said:
Getting ready for Class 3 Medical. Reading my blood pressures, average is about 140/90.

Notes:

--I am vegetarian, but not vegan.
--I run five miles a day, 5-6 days a week, maintaining 9 minute miles (I know, it's slow)
--I love salt, unfortunately
--Family history is that everyone has very high BP, like 180/110
--Believe the reason my BP is not this high is due to exercise and vegetarianism

Questions:

--What would be "too high" for the AME?
--What happens if he thinks it is too high?
--Would becoming completely vegan help?

Thanks, in advance!
Click to expand...
 
Papa Foxtrot said:
35mg/tsp(1% DV) - pretty minimal.
Click to expand...


Where as a teaspoon of Tabasco will do 4 or 5 eggs for me, stuff goes a pretty fair way. I'm glad I don't have hypertensive or even 'white coat' issues, Every time I get checked it's 106-112 / 48-62, good thing I smoke, drink, cavort, and lead a generally hedonistic life style or I might live forever...:hairraise::rofl:
 
spiderweb said:
Just wanted to update anyone who is interested on what I've done.

In the past week and a half, I changed from vegetarian to nearly vegan. I discovered, to my horror, that I had been eating almost a brick of cheese a day! That stopped.
Click to expand...

That's good. A vegetarian can stillest plenty of fat, which is not at all good for you.

spiderweb said:
Next, I started eating a lot more green leafy veggies, beans, and nuts (often all in the same salad, lol).

I've lowered carbs, and those I eat I try to limit to complex or those in fruits and indigestible fiber.
Click to expand...

I'd go easy on the nuts, they're expensive and full of fat. Complex carbs are good, whole grain even better.

spiderweb said:
Haven't changed my exercising habits which are pretty good.
Click to expand...

They sound a damn sight better than mine.

spiderweb said:
I started taking magnesium supplements, as I found when magnesium and potassium are in balance, salt becomes much less of an issue. (I even read the original studies, being the good researcher that I am!)

I've also been taking a BP log.

RESULTS:

In just one week, I have gone down ten points on systolic, and seven points on diastolic.

The diet certainly is NOT for everyone, but it works fine for me. I will keep this up and keep you posted!
Click to expand...

It is for us. We eat mostly complex carbs in while grains. Protein mostly comes from legumes, though we enjoy the occasional seafood meal. We eat salads, but we're partial to cooked food, of which we get plenty. Good stuff.

Be interested in what's happening to your weight, as that could explain some of what's happening to your BP. Adipose tissue (fat) has a rich blood supply, that many more vessels through which blood has to be pumped.
 
spiderweb said:
Just wanted to update anyone who is interested on what I've done.

In the past week and a half, I changed from vegetarian to nearly vegan. I discovered, to my horror, that I had been eating almost a brick of cheese a day! That stopped.

Next, I started eating a lot more green leafy veggies, beans, and nuts (often all in the same salad, lol).

I've lowered carbs, and those I eat I try to limit to complex or those in fruits and indigestible fiber.

Haven't changed my exercising habits which are pretty good.

I started taking magnesium supplements, as I found when magnesium and potassium are in balance, salt becomes much less of an issue. (I even read the original studies, being the good researcher that I am!)

I've also been taking a BP log.

RESULTS:

In just one week, I have gone down ten points on systolic, and seven points on diastolic.

The diet certainly is NOT for everyone, but it works fine for me. I will keep this up and keep you posted!
Click to expand...

The problem with what you did is that you don't know what had what effect and caused the result. :dunno:
 
Having just updated my Class III, here's a story and a question.
Went to FAA doc and he did a preliminary BP check and told me mine was too high to start the medical. Charged me $125. I went to my regular physician and he put me on a BP med which lowered my BP. I'm 57, in good shape but with heredity working against me (parents have high BP). I went back to the FAA guy a month later, passed the BP and the medical. The doc charged me $125 for the physical and $500 more to write a waiver, after I went to another doc to get an EKG and blood work (I guess the FAA requires that once medication is started to lower BP).

Question - Does this seem like extortion/highway robbery - to pay $750 that includes $125 for an office visit to get BP checked, $125 for FAA physical and $500 to write a waiver letter?
 
Jaker7 said:
Question - Does this seem like extortion/highway robbery - to pay $750 that includes $125 for an office visit to get BP checked, $125 for FAA physical and $500 to write a waiver letter?
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Yeah, my AME wouldn't have charged double on the exam fee and any statement letters to the MCA he had to write me cost 10% of that, and he is the only doctor on the east coast of the US certified by the UK MCA.
 
Jaker7 said:
Question - Does this seem like extortion/highway robbery - to pay $750 that includes $125 for an office visit to get BP checked, $125 for FAA physical and $500 to write a waiver letter?
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1.) The guy started out fine; he must have checked you over before you filled out the FAA form. This saved you a denial, I think. Good.

2.) I'm not familiar with the term "waiver letter". For controlled hypertension FAA requires a statement, usually from the treating doc, saying your bp is under good control - as well as an EKG and some blood work. You don't have a waiver. Perhaps the AME wrote the letter instead. I've never been charged an extra cent for this (I'm on bp meds myself). Charging you another $125.00 isn't unreasonable. Five Benjamins for a letter is outrageous.

Assuming your medical comes through review okay, you've got a year to find a new doc (FAA will want an EKG annually, at least in my case).
 
bbchien said:
Add to that, I usually advise airmen that their best chance for the onetime normal EKG required for the first hypertensive issuance, is when you are younger.
.
Click to expand...

Dr. Bruce, are you suggesting that it's better to be diagnosed with hypertension earlier in life then later and get the younger EKG or can a five year old EKG be submitted with the first hypertension diagnosis and treatment to the FAA?

Thanks for your advice.

Lisa
 
steingar said:
That's good. A vegetarian can stillest plenty of fat, which is not at all good for you.



I'd go easy on the nuts, they're expensive and full of fat. Complex carbs are good, whole grain even better.



They sound a damn sight better than mine.



It is for us. We eat mostly complex carbs in while grains. Protein mostly comes from legumes, though we enjoy the occasional seafood meal. We eat salads, but we're partial to cooked food, of which we get plenty. Good stuff.

Be interested in what's happening to your weight, as that could explain some of what's happening to your BP. Adipose tissue (fat) has a rich blood supply, that many more vessels through which blood has to be pumped.
Click to expand...

Thanks for the advice! I am 6' tall, ectomorph, and before exercise, I weighed 185 lbs. I now weigh 170, and am looking to go down to 155.
 
Henning said:
The problem with what you did is that you don't know what had what effect and caused the result. :dunno:
Click to expand...

I realized that, haha! So, I have to keep on doing what I'm doing, and continue not do do what I did before, since the aggregate of those actions and non-actions are working!
 
Jaker7 said:
Question - Does this seem like extortion/highway robbery - to pay $750 that includes $125 for an office visit to get BP checked, $125 for FAA physical and $500 to write a waiver letter?
Click to expand...

May be higher than some, lower than others. In general, the whole thing was cheaper than an ambulance ride to an ER when you went "pop" in your brain, so I'd say, count your blessings and go fly. ;)
 
mslisaj said:
Dr. Bruce, are you suggesting that it's better to be diagnosed with hypertension earlier in life then later and get the younger EKG or can a five year old EKG be submitted with the first hypertension diagnosis and treatment to the FAA?

Thanks for your advice.

Lisa
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The EKG has to be current, e.g, 90 days or fewer old. However, they generally let it go to 180 or so, and then they wince and won't accept it.

It is generally better to send the one and only EKG in when you are younger- it has a higher chance of not having a bundle branch block on it, and therefore requiring the Stress treadmill +/- Nuke (if it's a left bundle).

Jaker7 said:
Question - Does this seem like extortion/highway robbery - to pay $750 that includes $125 for an office visit to get BP checked, $125 for FAA physical and $500 to write a waiver letter?
Click to expand...
Yes, that's exorbitant. I usually run $100 for handling the whole thing and $90 for the exam. HTN isn't even a special issuance for crying out loud....

But ask Henning about Aussie medicals.....(!)
 
spiderweb said:
I realized that, haha! So, I have to keep on doing what I'm doing, and continue not do do what I did before, since the aggregate of those actions and non-actions are working!
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That's not good methodology as you may have to modify one or more of those in the future so it's good to know what did what. Personally since you apparently have a genetic and salt issue, I would have used the chemical combination that helps with your salt issue independently first, although you can now eliminate it and see the result. When you see the result of that you can judge its effect and subtract that from the total effect. Next you can continue by modifying other individual aspects of diet and exercise and figure out what they are worth. Once you know the value of each component, you can further modify those components to see the efficacy of those modifications. Since strict diet regimes which deny desires and even requirements are difficult to maintain over the long term, you can experiment with a more moderate diet and find out what things effect you most.
 
There are a few things that a person may be able to do to lower blood pressure than take medications. I am not advocating that anybody toss their meds but if your BP is creeping up and you are getting close to needing medication you might want to think about these things.

Obviously weight loss and regular aerobic exercise are a good place to start.

The ratio of potassium to sodium consumed might have an affect. If you have healthy kidneys and are not taking medications that affect the potassium level consider substituting potassium for sodium in the diet.

Two nutrients, sodium and potassium, likely work together to affect blood pressure and heart disease risk, according to a new study http://www.nih.gov/researchmatters/january2009/01262009hypertension.htm

Consumption of dark chocolate might be beneficial. I eat 2 squares of 85% or 90% chocolate each day.

A new study shows that eating dark chocolate decreases blood pressure and improves insulin sensitivity in healthy people. Impaired insulin sensitivity is a major risk factor for diabetes and reduces the body's ability to process blood sugar (glucose) effectively. http://www.webmd.com/hypertension-h...50311/dark-chocolate-may-lower-blood-pressure

I also recommend strictly limiting sugar and simple carbs to keep insulin levels naturally low.
 
Gary F said:
There are a few things that a person may be able to do to lower blood pressure than take medications. I am not advocating that anybody toss their meds but if your BP is creeping up and you are getting close to needing medication you might want to think about these things.

Obviously weight loss and regular aerobic exercise are a good place to start.

The ratio of potassium to sodium consumed might have an affect. If you have healthy kidneys and are not taking medications that affect the potassium level consider substituting potassium for sodium in the diet.

Two nutrients, sodium and potassium, likely work together to affect blood pressure and heart disease risk, according to a new study http://www.nih.gov/researchmatters/january2009/01262009hypertension.htm

Consumption of dark chocolate might be beneficial. I eat 2 squares of 85% or 90% chocolate each day.

A new study shows that eating dark chocolate decreases blood pressure and improves insulin sensitivity in healthy people. Impaired insulin sensitivity is a major risk factor for diabetes and reduces the body's ability to process blood sugar (glucose) effectively. http://www.webmd.com/hypertension-h...50311/dark-chocolate-may-lower-blood-pressure

I also recommend strictly limiting sugar and simple carbs to keep insulin levels naturally low.
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Forgot to say thanks for this! So, thanks, Gary!
 
UPDATE:

Mostly vegan diet,
Getting RDA of Magnesium, Calcium and Potassium--mostly from food, but also from supplements
No caffeine, minimal alcohol

I'm just getting over "vegan flu" which has taken 2.5 weeks.

BUT, BP is now down to an average of 135/85 (down from 150/105) with NO medication!
 
Salt and anything with salt will tend to raise the blood pressure. Your spread is good and your pressure is really not that bad.
 
Hawkarrow said:
Salt and anything with salt will tend to raise the blood pressure. Your spread is good and your pressure is really not that bad.
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There are different types of salt and not all are bad. Sodium salts can contribute to hypertension and potassium salts may be beneficial. People on certain medications or those with kidney problems may not be able to regulate potassium levels properly so not everybody can switch to a potassium containing salt substitute.
 
Gary F said:
There are different types of salt and not all are bad. Sodium salts can contribute to hypertension and potassium salts may be beneficial. People on certain medications or those with kidney problems may not be able to regulate potassium levels properly so not everybody can switch to a potassium containing salt substitute.
Click to expand...

Thanks Gary. One thing that I've enjoyed about this is learning a little bit about how big a role vitamins and minerals play in blood pressure, and learning about how the body handles carbs.
 
spiderweb said:
Thanks Gary. One thing that I've enjoyed about this is learning a little bit about how big a role vitamins and minerals play in blood pressure, and learning about how the body handles carbs.
Click to expand...
I'm not against carbs, just over consumption of simple carbs especially sugars. I avoid sugar anything made from refined grains. Whole grains and non-starchy vegetables are fine in appropriate amounts. I also switched from table salt to Morton Lite salt which is 50% sodium chloride and 50% potassium chloride. When I got used to that I switched to French's NoSalt which is 100% potassium chloride. As I mentioned earlier this is only safe if you have normal kidney function and are not taking medications which interfere with potassium excretion.
 
Gary F said:
I'm not against carbs, just over consumption of simple carbs especially sugars. I avoid sugar anything made from refined grains. Whole grains and non-starchy vegetables are fine in appropriate amounts. I also switched from table salt to Morton Lite salt which is 50% sodium chloride and 50% potassium chloride. When I got used to that I switched to French's NoSalt which is 100% potassium chloride. As I mentioned earlier this is only safe if you have normal kidney function and are not taking medications which interfere with potassium excretion.
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RE: salt

Since tracking food intake with a food diary app Lose It!, I'm flabbergasted in just how much sodium I had been taking in before I made a positive switch. Looking at various sources for nutrition details on restaurant and quick food joints, it's so easy to go over the RDA in sodium intake. And in many cases, in one meal.

Like many of you, I'm changing gears on this in interest for better long term health. It is a bit of a change and a challenge to alter the habits, but it's do able and for the right reasons.
 
Now averaging 135/80. If I measure in the morning when I just get up, I have gotten as low as 121/75, but that's sorta cheating.
 
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