Blood pressure slightly above normal? You may still be at increased risk of stroke (Read 1114 times)

I can generally be anywhere from sometimes about 117/65 to more often closer to 145/80 - it never seems to be consistant, which surprises me (I'm 65 YOA).  OTOH, my pulse rate is consistantly extremely low.  My GP always says "Watch your BP and let me know if it changes", so I periodically record it to keep track.  But so far, no meds.  Maybe I should have a more serious discussion with him about it on the next visit...I do consider my BP to be slightly or a little above normal in general. 

 

Back in 1992, Dr. Wollom, the Nephrologist that first treated me for high BP had been a researcher at published a book documenting stroke versus BP. He used scatter charts and when I looked at them (I used to be his last patient and we had long discussions abt the research) I mentally drew a curve thru the points and saw that so called "normal" BP of 140/90 was actually a 10-20% increase in risk over 120/80 and discussed it with him. I've argued with every Dr since them about BP and wanting to get it down. Interestingly it was in the early 2000's when Pre-Hypertension was defined by the Medical profession as between 120/80 and 140/90. I still disagree with that definition. Anything over 120/80 should result in action being taken to get it down, even drugs if need be. No Dr should be satisfied with anything over 120/80. 

 

I was able to mentally draw the curves because drawing curves thru raw data had been a task of mine in 1972 when I first got out of school. I was working on reducing propeller flight test data and had to draw curves thru crazy scatter chart data and other squiggly line data. Learned to extract patterns visually before laying the french curves on vellums to draw the lines. Today we'd feed the raw data into a computer and it would spit out the curves and smoothed design data in seconds...LOL

If you've worked with such data, then you know that scientists and engineers don't just eyeball and draw an abstract line that looks good through such data.  My four-year-old could do that.  To have any meaning such curves are determined by regression algorithms and, almost by definition, cannot be drawn by eyeball unless you are a mathematical savante.  They are not representing a pattern, but a mathematical relationship between data points.  So eyeballing this could add huge errors in interpretation.

Even if there is a 10-20% numerical increase in risk, what is the p-value?  Is it significant?  Do the confidence intervals overlap?  If the p-value is unknown as are the confidence intervals, how can you be so convinced that the numberical difference is real?

There are many reasons why even a small but real difference would not be medicated.  All drugs, including anti-hypertensives, have side effects.  One must weigh the likelihood and severity of side effects against the benefit of treatment.  If you must incur a 5% risk of serious adverse event by taking a drug to protect against a 2% chance of a difference serious medical problem, you would be better off not to treat!

However, if my BP were that high, I think it would be a sign to start evaluating what I was eating and doing with my exercise to make sure it remained a relatively minor increase, or went back into the "normal" range.

Thank you spaniel for saying what I was too lazy to say.

It's type or drink a beer, and I don't need the calories.  

My point to the Dr then was that "normal" of 140/90 seemed to have a higher risk than 120/80 and why weren't interventions of any kind discussed with patients, even lifestyle changes?  

I am not a doctor and have zero experience managing hypertension...I would need to solicit an opinion from my wife who has such experience...but it would seem rational to me to use pre-hypertension as a warning flag to begin taking some action.  There seems little downside to taking appropriate dietary and exercise steps. 

Perhaps some docs do not bother, because on average people are terrible patients and don't bother to take such advice until something major happens...or because they simply don't have time in the meat grinder assembly line that modern primary care has become? 

I don't know.

BTW I just read your sig line...congrats on your accomplishments and lifestyle changes.

MTA:  I do come in contact with a lot of information through my profession as to why docs sometimes don't have such discussions.  Often their experience with non-compliant patients can make them cynical as to the value of spending time on such things.  I recall my wife having a patient come into the ER with multiple problems...including worrisome high blood pressure. The patient was 9 years old and weighed 209 pounds.  All of the problems were obesity-related.  When she carefully approached the subject that perhaps the mother should look into ways to address the problems through diet and exercise, the woman started screaming and was incensed that my wife was accusing her daughter of being fat.  It led to a long drawn-out drama, including supervisor time, that likely led to other patients needing care having to wait longer.  It's sad but not irrational to weigh the value of approaching such discussions. 

This topic was widely covered in the lay press in the last month:

 http://www.nytimes.com/2011/10/11/health/research/11prognosis.html

http://www.cbsnews.com/8301-504763_162-20113066-10391704.html

http://www.cnn.com/2011/09/28/health/high-blood-pressure-stroke-risk/index.html

Thank you spaniel for saying what I was too lazy to say.

I've heard that laziness is frequently a result of undiagnosed TIAs that result from pre-hypertension. 

Spam will raise your blood pressure.