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Running and high blood pressure (Read 166 times)

    Another comment on variability of blood pressure measurement: The difference between 120/80 and 117/78 is just statistical noise, particularly when being measured manually by someone without a ton of experience.  Manually taking an accurate blood pressure is not an easy skill.  You are listening for a very faint sound, the sound of valves in a blood vessel opening and closing, among all the ambient noise in the room and the sounds that are made by the slightest movement of the stethoscope (the cheapest stethoscope available in many cases) against the skin.  And the needle bounces with each heartbeat, which can muddy the reading another 5 points if you aren't paying close attention. I worked two years as a nurses' aide, taking thousands of blood pressures during that time.  At the end of that stint, I still wouldn't have guaranteed my accuracy as being closer than 5-10 points either way.

     

    The good news is that a few points isn't what matters.  For screening purposes, if you're in the ballpark of 110/70 - 120/80, you pass.  If you're not, higher or lower, it should always be redone by a more experienced nurse/DR/etc. to make sure the measurement was accurate.

     

     

    As to the "Silent Killer" label...it's not called that because you have a silent painless death.  It's that high blood pressure often has no noticeable symptoms before the stroke that disables or kills you.

      granite_running, since your post is, IMO, the best of the thread, I'd like to address a followup question to you:  How does the accuracy of the automated sphygmomanometers compare with an experienced practitioner doing the stethoscope method?  I suppose there could be a big difference between the home units and the hospital units, too.

      Well at least someone here is making relevance to the subject.

      SillyC


        granite_running, since your post is, IMO, the best of the thread, I'd like to address a followup question to you:  How does the accuracy of the automated sphygmomanometers compare with an experienced practitioner doing the stethoscope method?  I suppose there could be a big difference between the home units and the hospital units, too.

         

        I'm curious too!  Can you tell us?

         

        I can't use the automated ones.  About 12 years ago, one malfunctioned on me and I got trapped in the cuff with it fully inflated.  This was painful and melodramatic as well (as the nurses struggled to get me out while I cried in pain), and left me with hematomas on my arm.  I couldn't really use the arm for about a week.  SOOOO....  I see one of those and I freak out a little bit.

           You are listening for a very faint sound, the sound of valves in a blood vessel opening and closing...

           

          Just to be completely anal, in normal conditions the sounds are from heart valves closing. Not valves in vessels.

            I have been running consistently for the past 7 years (ten marathons in that time). About a year ago, I started noticing my heart rate increasing a lot while I was running, which affected my running long distances. A few months ago my physician diagnosed me with high blood pressure and put me on a medication (hydrochlorot). I don't know if there is any correlation or not (high blood pressure and the medication), but my running for the past 6 to 9 months has been a struggle to say the least—my heart rate while running increases quickly, and therefore it is very difficult to run sustained long distances.

             

            Does anyone know if there are different blood pressure medications that might be better for runners or any other insight (i'm 51, 6', and weigh 175)?

             

            In case you're looking for more information before talking to your doctor, I suggest reviewing this article:

             

            http://www.medscape.com/viewarticle/747755_4

             

            You'll see a link to "table5" in the article...it's an excellent summary of the various classes of meds and their impact on endurance activities.

            DalTexRunner


               

              In case you're looking for more information before talking to your doctor, I suggest reviewing this article:

               

              http://www.medscape.com/viewarticle/747755_4

               

              You'll see a link to "table5" in the article...it's an excellent summary of the various classes of meds and their impact on endurance activities.

               

              Dr. Strangelove:  THANKS!

               

              This is an excellent article, and so is "Table 5."  Even though i wholeheartedly agree with the obvious suggestion of consulting again with my doctor, i think its important to be as well informed as possible.....and who's to say that a particular doctor is going to be 100% correct in his solution?  Therien lies the reason for my post.  Thank you for the article.

                 

                Just to be completely anal, in normal conditions the sounds are from heart valves closing. Not valves in vessels.

                 

                You are absolutely correct and I appreciate the correction.  My only excuse is I was typing from 15 year old memories on half a cup of coffee.

                  granite_running, since your post is, IMO, the best of the thread, I'd like to address a followup question to you:  How does the accuracy of the automated sphygmomanometers compare with an experienced practitioner doing the stethoscope method?  I suppose there could be a big difference between the home units and the hospital units, too.

                   

                  15+ years ago, the nurses I worked with considered the ones in a Dr.'s office or for home use to be fine for screening purposes, but would always manually double check an abnormal reading and/or have the machine do multiple readings to see if they were consistent.  Probably fair to say they considered the machines accuracy to be equivalent to mine, as an aide with 12 weeks training and minimal to moderate experience over time.  I got the impression the ones in the ER were better, but even in the limited time I spent job shadowing there, I saw nurses manually double check unexpected or unusual readings from the machines.

                   

                  It's been 15+ years since my aborted nursing career, so I really can't comment on today's technology, though I assume it has improved.  But even the older ones were accurate enough to be valuable for daily monitoring of someone with known hypertension.  You could compare it to a GPS watch.  It might not measure perfectly, but it's close enough that you can see trends or a significant deviation from normal.

                  cookiemonster


                  Connoisseur of Cookies

                     

                    You are absolutely correct and I appreciate the correction.  My only excuse is I was typing from 15 year old memories on half a cup of coffee.

                     

                    You are both incorrect.

                     

                    When auscultating a blood pressure manually the sound you're hearing is the turbulence of the blood flow through the artery as the pressure from the BP cuff is reduced.  You're not hearing valves in vessels or valves in the heart.

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                    "C" is for cookie.  That's good enough for me.

                       

                      You are both incorrect.

                       

                      When auscultating a blood pressure manually the sound you're hearing is the turbulence of the blood flow through the artery as the pressure from the BP cuff is reduced.  You're not hearing valves in vessels or valves in the heart.

                      In the arm! Never mind.

                      cookiemonster


                      Connoisseur of Cookies

                        granite_running, since your post is, IMO, the best of the thread, I'd like to address a followup question to you:  How does the accuracy of the automated sphygmomanometers compare with an experienced practitioner doing the stethoscope method?  I suppose there could be a big difference between the home units and the hospital units, too.

                         

                        Hospital or physician office based automatic blood pressure cuffs are pretty accurate as they are usually properly maintained and regularly calibrated.  Unless one is regularly calibrating his/her home machine accuracy is questionable.

                         

                        That being said there can be a difference of up to 10% between a regularly calibrated automatic cuff and a manual.

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                        "C" is for cookie.  That's good enough for me.

                        cookiemonster


                        Connoisseur of Cookies

                           

                          From UpToDate:

                           

                          FIRST HEART SOUND (S1) — The classic hypothesis for the genesis of the first heart sound (S1), for which there is much support, relates the high-frequency components of S1 to mitral and tricuspid valve closure; the first component of S1 is attributed to mitral valve closure and the second to closure of the tricuspid valve. A second hypothesis suggests that the principal high-frequency elements of S1 are related to movement and acceleration of blood in early systole, and are influenced by the peak rate of rise of left ventricular (LV) systolic pressure (dP/dt), which is a measure of contractility and ejection of blood into the root of the aorta.

                           

                          SECOND HEART SOUND (S2) — The genesis of the second heart sound (S2) consists of two components, aortic and pulmonary valve closure sounds, traditionally designated as A2 and P2. S2 occurs after the peak of the carotid pulse and coincides with its downslope. The onset of A2 occurs with the dicrotic notch of the aortic root pressure pulse.

                           

                           

                          Exactly.  Those are classic descriptions of heart sounds which is, in fact, the sound made of the closing of the valves during the beating of the heart.

                           

                          Heart sounds are not auscultated when taking a blood pressure unless you've got your stethoscope in the wrong place.

                           

                          Sounds auscultated for blood pressure are Korotkoff Sounds.  You can read about them here.

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                          "C" is for cookie.  That's good enough for me.

                            Yeah, thanks. I wasn't picturing the stethoscope on the arm as in a blood pressure check, just heart sounds generally. Thinking like a pathologist...I'll get back to my slides.


                            Latent Runner

                              Another comment on variability of blood pressure measurement: The difference between 120/80 and 117/78 is just statistical noise, particularly when being measured manually by someone without a ton of experience.

                               

                              Yeah, exactly what I was trying to illustrate; two BP readings two weeks apart, both following 6+ mile runs.  However, a day after the second reading I got a third, not following a run, of 147/95.  I don't know if this has any bearing on my fluctuating BP readings I've gotten over the years, but I do have a fairly slow heart beat.

                              Fat old man PRs:

                              • 1-mile (point to point, gravity assist): 5:50
                              • 2-mile: 13:49
                              • 5K (gravity assist last mile): 21:31
                              • 5-Mile: 37:24
                              • 10K (first 10K of my Half Marathon): 48:16
                              • 10-Mile (first 10 miles of my Half Marathon): 1:17:40
                              • Half Marathon: 1:42:13
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