BP readings are strongly dependent on factors which AMEs don’t seem to bother with e.g.
Peter wrote:
BP readings are strongly dependent on factors which AMEs don’t seem to bother with e.g.
They’re also strongly dependent on the BP being taken at all. It is also known that the BP will be noticeably higher if taken by a doctor rather than a nurse. Last year my GP thought that my BP was too high for comfort, so he gave me an automatic BP meter to carry for 24 hrs. It showed a systolic pressure 15 units lower than what the doctor had measured…
At 63, I’m not yet on any medication. Fingers crossed…
I’ve found that none of the factors (well within reason) affect my BP much – back supported vs unsupported doesn’t seem to make a lot of difference for me.
One thing of note is we are trying to measure quite small changes, 1mmHg of blood pressure, to put it into terms pilots know well is only about 1.3 millibars, so the equipment has to be quite sensitive and it’s easy to swamp the signal with noise (e.g. you can easily understand how tensing up muscles can add another 10-20mmHg to the reading – hence the phenomenon of white coat hypertension).
Whenever I take it at home I always take a triple reading and take the average (automatic with the cuff I have). If the first and second readings are too far apart, I wait and take it again – generally if I sit for 5 minutes and take my BP, the first reading is the highest and the third the lowest, if they are only 10mmHg apart I don’t bother redoing it.
The other thing I notice I even get “white coat hypertension” when taking my own BP if I’ve not done it for a while. If I do it regularly, my BP will trend down over a fortnight a good 10mmHg. Unfortunately, none of these things are things you can do in an AME’s office, but if you’re marginal it helps if (a) you obviously look in decent shape and (b) if you can show what readings you’ve been taking at home and then perhaps the AME will wait a few minutes and take your BP again by which time hopefully it’s gone down a bit!
It was best when Dr. Pilling (the AME in the Isle of Man) was still alive – short journey to his office where he did it with an old fashioned mercury sphygmomanometer. Now I have to make a long and painful journey somewhere in the UK, doesn’t matter which AME I use, it’s going to be getting up early for a long complex journey with the stress of airline cancellations and delays (the airline dispatch rate from the Isle of Man is terrible at the moment)…either that or forking out for a hotel in Watford.
A quick point to add if drinking hibiscus tea.
Short term before your medical, avoid teas which use liquorice root as a sweetener, as this increases your blood pressure.
I recently had 4 cups of mint and liquorice tea in an afternoon, and the effect was noticeable. It’s subjective as I don’t check my blood pressure, but would describe it as similar to background stress or anxiety.
Peter wrote:
BP readings are strongly dependent on factors which AMEs don’t seem to bother with e.g. back supported? if back support not offered, sit very straight so torso is not working hard head upright, neck not bent slow deep breathing think of something like rabbits jumping around a field NOT talking don’t do a long drive to the AME but if unavoidable don’t see him right afterwards
Also some take your BP as the first thing once you walk in, which is not how it should be. You should have been sitting down for at least 5 mins.
During my “vaccations” I had an incident where due to over exertion I got a bit dizzy for a moment. As my MiL spends her days measuring her ever so up/down BP (and drives everyone crazy with it) she insisted to measure mine, which resulted in a 160/90 reading, quite alarming to me. 5 mins later, it was down to 133/85. Now back home, I am down to my usual 120/80 every time I take the measuring.
And another nice tidbit of information I got from a friendly doc: If you know you will be tested for blood sugar, avoid grapes like the plague for about 24 hours before. They can turn you from a perfectly normal value to something which your AME will insist on testing for weeks on end just to be sure… Despite my obvious overweight (even though that reduced by 8 kgs over the last month) I have never yet “qualified” for higher scrutiny, except for the one case when I had eaten grapes the night before: My morning bs was 6.2 instead of the usual 5.5 and caused a one month 3ple test per day and record keeping to get my medical back. I changed my AME after that experience.
Mooney_Driver wrote:
If you know you will be tested for blood sugar, avoid grapes like the plague for about 24 hours before. They can turn you from a perfectly normal value to something which your AME will insist on testing for weeks on end just to be sure…
Wow! My AMEs have never tested blood sugar but only sugar in my urine. You need to pretty far gone before anything shows up there.
Airborne_Again wrote:
Wow! My AMEs have never tested blood sugar but only sugar in my urine. You need to pretty far gone before anything shows up there.
Being done here standard if your BMI is over 30 I think. I’ve had it done ever since I came back to flying in 2009, twice it was not done as I did come later during the day.
Since that “grape” experience I own a self tester, which I use about 1ce a month to check if there is anything out of the extraordinary.
This week I had a 20 year old patient with a BP reading 220/140 mmHg. The thing about arterial hypertension is that you usually don’t feel any symptoms from it, and if you do it is usually an emergency (by definition the term “hypertensive emergency” means having an abnormally high BP reading with organ damage from hypertension which results in symptoms such as headache, dizziness, visual impairment etc.).
The fellow I mentioned had no symptoms and we only knew about his elevates BP because we measure it regularly in all of our postoperative patients. Also these are not values you would ever achieve through “white coat hypertension”, which is more in the area of perhaps 30 mmHg elevated, so say 140 to 160 mmHg systolic.
The repeated advice in this topic to measure BP at home and when relaxed is certainly valid, though there are many devices on the market which give widely incorrect readings compared to professional equipment. Devices measuring at the wrist are usually insufficient and upper arm cuffs should be prepared (which need to be of adequate size: Too small a cuff will result in an incorrectly higher value and vice versa).
My father, recently 80, has become obsessed with his blood pressure and is constantly measuring it and seeing his doctor to discuss a change of meds.
Whilst it’s sometimes a little on the high side, is there something to be said for just leaving well alone?
Graham wrote:
Whilst it’s sometimes a little on the high side, is there something to be said for just leaving well alone?
Absolutely there is, especially at his age. Arterial hypertension is mainly a problem over long timespans and especially when developed early in life and not properly controlled. Then it can significantly shorten your lifespan.
But if you already made it to 80, your remaining lifespan statistically is in the range of say 5 to 10 years, if you made it to 90 it is more like 2 to 5 years. At that age I would make quality of life the most important criterion for any medication. And BP medication can have a lot of side effects, including feeling tired/sleepy or – especially important for males – impotence. Obsessing about the BP can very well lead to elevated BP by itself. Several guidelines discuss higher thresholds for treating hypertension at advanced age, and personally I wouldn’t treat any systolic pressure below 150 mmHg or diastolic below 90 mmHg at that age.
