Diagnosis
Back before COVID 19 rendered most GP’s appointments video or email, I went to visit my doctor about a pain in my thumb (it turns out I’d broken it, but that’s not the subject of this story). My doctor said, “Since we haven’t seen you for four years, let’s check you over.”
So she took my blood pressure: 215/125.
That’s high. That’s really really high. It should be no more than 140/90 and ideally 120/80. So mine was approaching double normal. Anyway she smiled, made an appointment for me to see her the following week, and suggested that if, over the weekend, I had the chance to take my blood pressure I should do so.
As it happens it was that weekend that my Danish niece was moving to the UK to attend Canterbury Christchurch University, and we spent some of Saturday trying to find a bank that would open an account for her. We finally succeeded at Barclays (thank you Barclays).
Anyway, the Stroke Association had a stall in the branch and were taking blood pressure measurements. So I got mine taken. Eventually.
They’d been using their blood pressure machines all day so the batteries weren’t fully charged; trying to inflate the cuff to stop my blood flow exhausted the batteries on three of their machines. The fourth worked. On the form they give you, there are four boxes, and they tick one of them:
- Blood Pressure’s fine
- Blood Pressure’s slightly raised, make an appointment with your GP to follow up
- Blood Pressure’s significantly raised, consult your GP urgently
- Go to A&E IMMEDIATELY!
As you might guess, my form had the bottom one ticked. I declined the visit to A&E as I had the appointment for the following week.
Medication
My GP took blood samples and performed lots of tests. My weight (BMI slightly over 25, but she was happy with that), diet, blood samples, cholesterol, electrolytes, lung capacity and lots of other measures were all perfectly fine. I simply had exceptionally high blood pressure.
So we began “titration” otherwise known as adjusting the dose.
To maintain my blood pressure at a normal level I take three different drugs:
- Amlodipine – a calcium channel blocker – vasodilator
- Candesartan – an angiotensin II receptor blocker
- Bendroflumethiazide – a diuretic (water tablet – makes me pee a lot)
I will probably have to take these for the rest of my life. Luckily I live in the UK, and under our health system, since I’m over 60 years old, I get all of this medication free of charge. My GP explained these work well in combination, are effective, inexpensive and have few side effects (apart from the peeing).
I also check my blood pressure regularly.
She explained the best way to do that is to use a machine with an arm cuff and sit at rest, on an upright chair, such as a dining chair, with my feet on the floor and my legs uncrossed. I shouldn’t take the measurement if I need to pee as this may give a raised reading. I should then take three readings, discard the first one and average the other two.
Arm cuff blood pressure meter
She suggested that wrist blood pressure meters can be inaccurate.
Side effects
I was taking all my medication each morning, then sometimes finding myself light-headed in the evening when I stood up. I mentioned this to my GP who suggested that I split the medication, so I now take Candesartan and the diuretic in the morning, and Amlodipine at night. That solved the problem.
Adherence
Adherence is the medical term for how well I stick to taking my prescribed medication each day. I’m pretty good. I rarely fail to take the medication.
However on days when I’ll be travelling for much of the day (not that often any more), I deliberately skip the diuretic. My pharmacist went apoplectic when I told him this, but I reckon that since my body was used to my blood pressure at 215/125, if it’s now normal but slightly raised for 24 hours I’m not going to come to any harm. And it avoids either my spending the whole journey looking for a loo, or having to carry extra clothes in case of an embarrassing accident.
Also, on the advice of a retired GP friend, I don’t take my morning medication before going for a morning cycle ride – his view was you want as high blood pressure as you can get when you’re vigorously exercising – I take it when I finish. Also I’ve discovered that my blood pressure can drop significantly when I finish exercise, particularly if the weather is very warm, and I don’t want it so low that I pass out.
Other medication
It’s a good idea to be aware how your medication works. The effect of the calcium channel blocker is to expand the blood vessels (vasodilation), this increases the volume of your blood vessels and, assuming the volume of blood they contain remains the same, reduce blood pressure.
There are some common anti-inflammatory medications, including Ibuprofen and Naproxen, which work by constricting the blood vessels. This reverses the effect of the vasodilator and so can increase blood pressure. I take them only very occasionally, and only when absolutely necessary. Again my pharmacist gets very agitated about this, but I think I know what I’m doing – it’s my body after all.
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