Hello All:
Background: I am 54 years old, well trained and lean with excellent LDL and HDL, but still have mild hypertension. Lisinopril 10 mg keeps my BP in the mid 130s over high 80s but sometimes higher. I did try two weeks without salt and that had no apparent effect.
So, question for docs and others genetically predisposed to hypertension: Are there meds that may target genetic hypertension rather than the bulk (pun intended) of individuals with lifestyle/diet/obesity related hypertension? Naturally, I will take any advice to my primary care doc to discuss changing meds.
Thanks,
Jim
the distinction you are trying to make does not really exist. hypertension is either primary (essential) or secondary (e.g. due to kidney impairment). 90% is primary eg in your case. there is no absolute proof that weight loss/low salt diet etc etc reduces your blood pressure. there are certainly studies that suggest that it helps but this is by no means proven beyond reasonable doubt. but getting back to your question, NOBODY KNOWS what causes blood pressure to go up and there is no conclusive evidence that obesity (for example) causes hypertension in a manner that is different from someone who is not obese. all the different meds work through different mechanisms, and you are pretty much on a good first line medication (assuming you are caucasian; yes it does depend on your race to a point).
as a side note you should try to get your blood pressure as low as possible without making you faint. conventional blood pressure targets are based on confidence intervals and normal distribution curves. we don’t actually know what the ideal blood pressure ought to be though it is generally accepted that the risk of fainting go up significantly when your systolic BP drops below 90.
BMBCh
Thanks for the feedback. Yes, this is what I was getting from my primary care doc but I was hoping he didn’t know everything, particularly about well trained individuals (since he rarely sees any).
I take your point about further reductions being beneficial. So perhaps it would be good to try a higher dose than 10 mg/day. I’ll ask about that.
Cheers,
Jim
I’m the same age as you and your first sentence could have been written by me. My doctor cut me a lot of slack and I tried everything I could find short of voodoo for several months: less salt in my diet than a freshwater fish, meditation, mamaki tea from the big island of Hawaii, etc. Now I’m on 10mg of Lisinopril…
When I retire, I’ll try again in case the lowered stress gets me over the hump. My doctor has seen cases (not many, but there is the existence proof) of people being able to go off of medication when they retire. I read a lot on the subject (as I suspect you have), and I never came across believeable evidence that hypertension due to genetic causes could be treated differently than that caused by lifestyle issues. Sorry…
there is no absolute proof that weight loss/low salt diet etc etc reduces your blood pressure.
only salt sensitive individuals which is an extremely low percentage of the population
there is no conclusive evidence that obesity (for example) causes hypertension.
**there is very good evidence to say lowering weight does lower blood pressure. iirc it is noted ~5mmhg for every 10lbs. **
all the different meds work through different mechanisms, and you are pretty much on a good first line medication (assuming you are caucasian; yes it does depend on your race to a point).
as a side note you should try to get your blood pressure as low as possible without making you faint. conventional blood pressure targets are based on confidence intervals and normal distribution curves.
according to numerous studies, lowering ones blood pressure to <120/80 is a good goal and does decrease risk many risks. however individuals can live very healthily with a systolic above 130. the recommendation of lowering blood pressure as low as possible is not a recommendation i have seen anywhere.
2013 pharmD candidate
Have you tried smoking weed?
What’s the highest your BP gets? Even mid 130’s isn’t terrible and it can depend on current hydration level as well. Everyone can handle different numbers just fine and there is no standard perfect BP for everyone in the world.
Hi Jim
Weight loss, a reduction in sodium intake, and cardiovascular activity are the cornerstones of ‘lifestyle’ intervention as a means of controlling HTN. When these efforts prove unsuccessful, medication is typically the next step. I hope these articles help…
http://hyper.ahajournals.org/content/47/2/296.abstract?ijkey=136cb8a37e66e8ee1a7319f491685d1dbdb56545&keytype2=tf_ipsecsha
http://content.onlinejacc.org/cgi/content/short/54/14/1336#BIB128
I’d suggest abiding by these recommendations (which it sounds like you’re doing), track your bp t/o the day, then see your doc. Incidentally, your doc’s recommendation regarding meds/class of meds may change a bit if you are frequently racing long course or in particularly hot/humid conditions (with the potential to exacerbate volume depletion)…be certain to mention if applicable…
BTW…at the end of the day we can’t escape all of our genetic predispositions but you should be proud to be 54, lean, well-trained, and have a normal lipid panel…good luck…
Hes mid 130s with a medication which still would be considered prehypertensive even if he wasnt taking the medication. So it still is high.
Yeah I know it’s prehypertensive but as long as it doesn’t increase I’m just saying…nothing to worry about. Never heard of problems from a systolic in 130’s.
Plant-based diet. See INTERMAP study from 2006 concluding that “egetable protein intake was inversely related to blood pressure”:
http://archinte.ama-assn.org/cgi/reprint/166/1/79.pdf
The “significant” difference the researchers found would not be enough to get you where you want to be–but that doesn’t mean a plant-based diet couldn’t take you there. Look at page 83 of the paper, where it says the largest inverse relationship was found in participants from the United States, and see what foods accounted for most of the intake of vegetable protein. The largest percentage came from breads, rolls, and biscuits; only a tiny percentage came from powerhouse foods like beans, nuts, and seeds. Who knows what would happen to BP if those percentages were reversed?
we can’t escape all of our genetic predispositions but you should be proud to be 54, lean, well-trained, and have a normal lipid panel…good luck…
Thanks for that. Yes, I do take pride in that but the blood pressure haunts me. My dad died of his third heart attack at age 50 and I want to leave no stone unturned with respect to my own health.
Cheers,
Jim
Plant-based diet.
Yes, but I’m already there. Thanks though.
Cheers,
Jim
How high were you untreated? You could always try a combo of two meds.
i would not consider a combo until he’s maxed out his lisinopril. most of the other alternatives really affect the way the body responds to exercise more than the ace inhibitors.
Thanks everyone. Seems the simple answer to my question was no, there is no specific med that is better for genetic rather than lifestyle (and indeed that question itself may be moot). So I reckon I’ll just carry on with my current routine with one exception. One person responded to me by email and suggest nitrate so I am going to look into incorporating high nitrate foods into my diet.
Cheers,
Jim