One thing to keep in mind is that the hypertensive readings were recently changed to a lower value. So, the ST BP guidelines article is out of date as it was written in 2015.



Edited to correct links.

Don't stress yourself out over it. I am pretty much in the same boat as you (well not a top AG athlete). I am also on Valsartan* (see below, kind of important, and infuriating), at half the dose. The only side effect I notice, because it has a diuretic aspect to it, is I pee a few more times a day than previously. Other than that... nothing.

I have noticed that during hard intervals (VO2 Max or FTP tests) on the bike I would get tunnel vision. But after being placed on the drug, that no longer happens. Coincidence, maybe... but I doubt it.

So my advice to you... don't worry about it. Take your med, do your workouts, live your life.



*Now, with that being said... Valsartan has been recalled due to trace amounts of a carcinogen being in it. At first, there were only a few manufacturers involved in the recall. Mine was on the list. So I called the PCP and he switched me to a different manufacturer. Well, the recall expanded in the last couple days and now the new manufacturer is on the list as I just got the robocall last night from my Pharmacy. YAY ME! So double check to make sure your med is OK. The manufacturer should be listed on the bottle, or just call the Pharmacy if they haven't already called you.


But as I said, carcinogens aside, don't worry about it. Though I did tell my wife if I die from Cancer she can sue the hell out of some corporation. ;)

We need dtoce's advice on this one. Will be very interested to hear what he has to say.
Are you still taking your BP medication now?

Yes. I'm still currently taking the BP med. Though I have not taken todays dose yet. I'll need to get in touch with my PCP, again, and have him write a new script so I can get the drug from a different manufacturer. Not to mention pay for it... again!

It's just a huge pain in the ass... the carcinogen stuff, not taking meds. But I digress...

https://www.fda.gov/downloads/Drugs/DrugSafety/UCM615703.pdf




List of the Valsartan manufacturers that ARE BEING RECALLED

Don't know if you know anything about this. I'm curious about the actual underlying cause of high blood pressure, and why exactly it's beneficial to take drugs to lower it.

Frankly, diagnosing half the population with a disorder in need of drug treatment, sounds like a scam.

...late to the party as I was on a run with my tri-club...and was just alerted via e-mail to this thread...

Yes, diovan/valsartan and diovan-hct/valsartan-hct have been recalled by the FDA due to the presence of NMDA. I think the first findings were from manufacturers in China and Europe had pulled it. One of my patients texted me about it then and we've been following this closely.

I was aware of the official recall on the day before, as I subscribe to the Cleveland Clinic IM daily briefs and like to hear about stuff before it hits the lay press and our office is flooded with calls...and get ready for telling the patients what to do. I'm not sure this was widely publicized directly to the MD's here in the US.

You must understand that if you are on the drug, it is for a good reason. The recall was because some batches contained minor amounts of impurities of an agent that might cause cancer. You do not need to see an oncologist. You need to find out if the drug you are on was recalled or not and if so, take a substitution that your physician recommends. It's not the drug, it's from contaminant in there with the drug, which is highly effective.

Anyone taking the drug should look on the bottom of the container which identifies the manufacturer and you can see if it's on the list above. Or call your pharmacy and ask.


To the OP:
It is essential that you discuss this with your own physician, of course. You will likely find that there are grey areas in medicine as well as things that are more black and white. And the lines move and what was thought to be true, proves to not be quite as true as we originally thought. I love cardiology as it is truly centered more on 'evidence based' medicine. You need to have trust in your doc and good communication, making sure you know what you are taking and why.

Recently the guidelines changed for goal treatment of hypertension and the new upper limit of normal is 130/80. This has created a lot of new 'at risk' people and I'm not quite sure if this is really a good thing or not. The 'silent killer', HTN, is known to put people across all age groups at risk, with increasing risk as you age. Additionally, the higher your BP is, the higher the risk of stroke is and optimal treatment certainly needs to be individualized.

http://www.heart.org/...cle.jsp#.W28Gb7gnZPY

Definition of hypertension
●The following definitions and staging system, which are based upon appropriately measured blood pressure (table 1), were suggested in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA) (see 'Definitions' above):

•Normal blood pressure – Systolic <120 mmHg and diastolic <80 mmHg
•Elevated blood pressure – Systolic 120 to 129 mmHg and diastolic <80 mmHg
•Hypertension:
-Stage 1 – Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
-Stage 2 – Systolic at least 140 mmHg or diastolic at least 90 mmHg

Additionally, some comments about 'hypertensive response to exercise' (defined as a peak systolic blood pressure ≥210 mmHg in men and ≥190 mmHg in women)

-these patients are more likely to develop hypertension
-it is not associated with increased risk of MI/SCD
-a delayed decline in BP during recovery may be an adverse prognostic finding

Finding a medication, if needed, that doesn't cause issues (side effects) and lowers risk is always the goal. Negative training performance would be considered an 'adverse' effect. There are lots of choices for your physician and you to discuss.

GL

So what was your pressure recently that made your doc put you on meds, still 140/80?

Mine has been around that for years. Sometimes if I sit for a few more minutes and relax in the chair, and doc takes a second reading, it'll be more like 135/80. So far she hasn't wanted to put me on meds....

how much does exercising shortly before (1-2 hours) checking ones BP change the results?

This morning I had a 2.5 hour ride averaging 217 watts with a few pushes and a 30 min TT within some easy riding (8:40-11:10) Average HR over the 2.5 hours was 133, 169 during the 30 min TT at 265 watts (I wasn't dying but some work in there). At noon I went in for a prescheduled health check (ticking some boxes for reward points for vitality insurance) and ticked a 191/148 with a HR of 86 (holy heart attack batman!!!). Person took the reading three times to verify.... 45 minutes later I had a fitness test which indicated a 124/84 with a HR of 76.

The first reading seems laughable, person was trying to get me to go to A&E immediately
The second seems high, but given a short bike ride from the first appointment (and earlier exercise) seems more 'reasonable'

Looking at my records most recent (actual GP run) test was in April with a 111/67, HR was 60 (done in the evening so no exercise near then). This is/was my typical result. In all my years of physicals and check ups my BP always been 'normal' and 'exactly where someone my age/whatever would want to be.' Never smoked, don't drink (a lot), eat decently, exercise more than enough and nothing about my lifestyle has changed in the last six months as to introduce any new stress and change results.

I'll likely set an appointment with the GP regardless just to confirm my heart isn't about to explode but figured I'd ask how BP test results are impacted by exercise.

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________________________________________________________
Taylor Rogers

2024: IM Hamburg

Have hardly even seen a diastolic of 148!!!
That is bound to be wrong. How were they taking it? Manually with a stethoscope or with an automatic machine? Diastolic can be very inaccurate if done on a machine. Even then, that systolic seems very high given what you have said of your previous levels.

They took it with an automatic (battery powered) machine. Unit was self branded (by the pharmacy) which also lends to my overall skepticism of the results. The second result was also from a battery powered unit but at least seemed to be a ‘real’ unit. Not really sure I even know what that means... just looked more professional... But either way, both results were/are way off typical.

Ill see what the doctor says when I go in this week but (assuming I return a Normal reading) just amazed at variability due to timing!

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Taylor Rogers

2024: IM Hamburg

Yep, that diastolic of 148 was a massive red flag to me. With oscillometric BP measuring devices the diastolic tends to be the most inaccurate number. I don't think I have ever seen a diastolic that high before, except in a few people who needed ICU/CCU admission for emergency control of BP. Many other things can also come into play re accuracy of the measurement, including appropriate cuff size.
Keep us up to date with how it all plays out.

Not in response to the OP, but does anyone else suffer from "white coat syndrome"?

A few times in the past doctors wanted to put me on BP medicine and I almost went with that recommendation. A number of years ago I decided to get a BP monitor for home and would typically get normal levels. In 2016 I suffered from an Ocular Migraine so I went in for a series of tests (was cleared and thought by an Optometrist to be a random event). My BP was elevated in the visit and was much higher than what I just tested at home. I showed my home readings to the doctor so she said that it may be white coat syndrome and to bring in my monitor on a follow up visit.

That morning I tested at home and it was in the upper range of normal. At the doctor's office it was very high as taken by the nurse. The doctor came in and tested with their monitor and then with my monitor. Both had the same high results so I got to see that my monitor was fairly decent. I am still a bit cautious because mine does go into the elevated range.

This morning it said elevated on the app as 123/74 and 49bpm. The previous test was 117/65 and 43bpm.

I am ignorant of what I should be doing, but if I don't have to be on a daily med I would prefer not to be on one and to know if it is a result of a nurse rushing through her checklist of things to do or me a bit tense in a doctor office visit.

Most of my doctor visits the nurses seem to rush through like they really don't give a crap. Like weighing you with all your clothing, heavy work shoes and a heavy winter coat because they said to leave it on and then you see they listed you as overweight is kind of a crappy service in my opinion. They seem to rush through the BP test. However, I recently got a colonoscopy and their monitoring equipment was far superior and the nurse was very thorough. I was tested normal there and I was really nervous because it was my first one.

Why did you need an echocardiogram at age 44 with a long history of training/racing? I am 49, am an emergency medicine doctor, and have never heard of just having a "routine" echocardiogram for someone fit and healthy with no cardiac history (and a normal exam, i.e. no murmur or concerning findings)... Also, increased blood pressure is the norm when exercising. This should not dictate needing to be on anti-hypertensives, ASAIK. If your resting BP is fine, I am struggling to see the need for you to be on meds. My 2 cents...

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Colorado Triathlon Company, CO2UT 2021, Crooked Gravel 2022, Steamboat Gravel 2022

I personally never order echo tests unless there is a need. Not sure of his exact circumstances as we are both in the 'armchairs playing quarterback' Doctor...but perhaps the EKG suggested LVH and the echo was done to see if more aggressive BP Rx was warranted-especially if there were BP issues with exercise, ie 'hypertensive response'. An 'increased BP response to exercise does not equate to a 'hypertensive response to exercise' for the record-one is normal, and one is not.

We do not know exactly went on between him and his doctor and what all of the test results were and what the physical exam was, so it's best that we leave it to his seeking answers there with his physician.

To the OP:
-from the other thread that I posted on regarding BP.


Current Guidelines regarding BP:
https://www.acc.org/...d-pressure-in-adults

Data Supplement showing Studies
http://jaccjacc.acc.org/...746528541.1532986808

FAQ's
https://www.cardiosmart.org/...746528541.1532986808

Population Risk-page 136, on why we treat BP
http://www.onlinejacc.org/...746528541.1532986808



D. Toce MD FACC

I have got to stop responding to these threads...

page 143 from the definitive statement on BP
this is the section on 'White Coat HTN', which may not be entirely benign..

http://www.onlinejacc.org/...746528541.1532986808

Thank you guys for all the replies and feedback.
Answering some of the questions regarding how and why I got here, a good friend of mine from many years, also a multisport athlete and a firefighter now, went through a routinely med check a few months ago and an arritmia was seen. He was advise to stop training immediately (was preparing IMLZ) and was sent home until further test were performed on him. He got somehow scared, and in one of the few conversations we had, we agreed that we were over 40 with many years of training, and these kind of things might happen as a result of younger wild sport adventures. So having young kids and a wife, I decided it was fine to be checked just in case.
After the "adverse result" during the treadmill test, my cardiodoc decided to put me a BP Holter (measures your BP during 24h, every 20 min during daytime, and 40 minutes at night). I did my training during that period and my normal day/night routine. The results showed average of 140/80-day and 117/60-night, BUT with a significant large standar deviation on the daytime result. The cardio doc had no doubt about it, I was hypertense. I showed the results to 2 friends both doctors but not cardiologist, and they were not that sure about it as I did not had any health issues and no heart nor kidneys damage. So I went to see a Professor at the university, MD and PhD in sport physiology. He told me about the new definition of HBP and a bunch of very interesting medical and academic stuff, and he recommended to go on with the treatment as I had maybe not very HBP, but with no room for improvement on lifestyle (no overweight, very little salt on diet, no smoke nor drink, exercise daily, work on shifts on a well recognized stressful job, etc.), he was pretty sure I was a firm candidate to develop HBP without a doubt . So here I am.

These days I've cheked my BP early in the morning, being in the 120/70-80.

Thanks again for the inputs.

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STRAVA INSTAGRAM

Update: Went into my GP today for a blood pressure check. Other than a short walk over to the practice I didn't exercise, just my typical morning routine (I don't drink Coffee early in the morning). Result was a 135/67. The 135 is high compared to my previous 111 (in April) but the 67 is the exact same at the same. The GP suggested another check in two weeks for the heck of it. However, overall the 135 is far more 'normal'. I'll evaluate the few things that might be increasing my level (ie salt and caffeine intake) but otherwise I'm doing everything I can be with exercise, eating healthy, managing stress, etc etc.

The only reason she could offer that might explain the high result was that perhaps the machine hadn't been calibrated. The exercise might have played some small part in the elevated reading but being 1.5 hours beforehand it shouldn't account for that sort of spike.

All in all, feeling much better (or at least normal).

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________________________________________________________
Taylor Rogers

2024: IM Hamburg

Makes me wonder if it was a scheme by the pharmaceutical companies to push drugs to a wider audience. (Yes, I'm a skeptic. I admire doctors but I avoid pills.)

I would ask for a manual check in that case. Yes, machines are very accurate. But, if there's a question on calibration, it should be checked again manually.

The initial test location (with the ridiculously high reading) was not equipped to do a manual test. And given they were basically serving as a high level clearing house for people to get a health check (as incentive only, no ramifications on insurance) I really wasn’t inclined to have them do it (or even really though to ask at the time).

The GP did a manual reading this morning with the 135/67 result. Well see what the reading is in two weeks time.

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Taylor Rogers

2024: IM Hamburg

I'm not a doctor but...are you married? There may be reasons aside from what is initially apparent... ;-)

I've had high BP for some time, and I noticed that my readings always seemed high in the Dr.'s office. I bought a little home monitor and started taking it when I wake up in the morning. With that data, I was able to demonstrate where it truly was trending.... and minimize the meds....

I feel like there should be some allowance for "white coat syndrome". Especially if you're made to wait an ungodly amount of time to be seen, or have to sit in a waiting room with people who are visibly more ill than you are, or anything else that may cause stress.

My PCP's office now walks me to the examination room, has me sit, chats with me about non-medical stuff for about 5 minutes, and then takes my BP. If it's out of normal for me, the doctor will take it again near the end of the exam after I've been sitting quietly for a while.

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Level II USAT Coach | Level 3 USAC Coach | NASM-CPT
Team Zoot | Tailwind Trailblazer
I can tell you why you're sick, I just can't write you an Rx