about my GP and blood pressure?

[bloodpressurerising]

About 4 months ago I went to see my GP regarding anxiety. It's something I'd seen others in the practice about previously who were quite dismissive -anyway, this one said I'd benefit from meds, and prescribed Citalopram. Ok, so far so good.

My bp was checked, and found to be high. I was asked to come back in a fortnight. It was still high them - appointment another fortnight later. GP said it was still high, but medicating me wasn't a good idea as I'm only in my early 40s and I'd have to be taking meds for the rest of my life if I started now.

I've done some reading myself, taken steps to improve my diet (cut out chocolate, snack foods etc) and limited my caffeine. GP advised me not to add salt to my cooking and meals - I never have!

So I then had a 24hour monitoring in Nov. Results we're ok, I didn't see a detailed breakdown but reading it over my GPs shoulder most of the time my bp was far lower than on any of my GP visits.

Despite this I was told to come back again in 4 weeks. Before my most recent visit (end of Dec) I had another health issue which resulted in me going to A&E. Where they of course took my BP and said it was entirely fine...

Back to my GP just before Xmas. Bp still high, come back in 4 weeks, GP says you really need to stop adding salt to your food (I don't!) and you need to lose weight (this is on going, can't lose it overnight) otherwise your BP won't go down.

Is this typical? For ref, on the BP test, ad at hospital, my bp was around 130/77. Last time at my GP it was 145/95.

I fully accept I'm overweight, I am trying to address that. I'm also starting to do more exercise (I had to stop this in Dec due to work/ home pressures). Going for repeated appts is quite difficult as I have to ask to leave work every time, which is not always convenient. I know my health is important but I just don't feel any progress is being made?

Yes it's been same GP throughout. GP says that white coat syndrome, anxiety etc only affects the top part of the reading, it's the bottom on mine which is consistently too high (when I'm at the surgery that is) and that's what GP is concerned about apparently.

That isn't true. Both readings go up a bit. It may not just be white coat hypertension but if the 24 hour readings are normal it is worth checking it at home.

I don't have one at home but I don't see what it will add
You'd know if your blood pressure was as bad as it seems to be at the doctor's. A double check. If the 24 hour check & hospital checks were ok, and then a series of home readings also prove to be fine then your doctor will know that the high readings are due to seeing him. You could even take your home monitor to the doctor's with you so that he can see your readings go up in his presence on that too (proving that it works fine)

Well my gp is saying that if the top part of the reading was high (which it has been when I've seen her) she could ignore that. But she can't ignore the lower part which is why I am asked to come back. And of she wouldn't accept the 24hr result, I'm not sure she'll accept a home bp test - though I will ask at my next appt.

And I am losing weight, but that is going to take months rather than weeks, I've cut out all sugary snacks and crisps, etc. I now am eating cereal and fruit for breakfast, a small roll or sandwich or soup for lunch, and my dinner, which is usually cooked from scratch (and Am eating that on a smaller plate to encourage portion control), I'm not sure what more I can do in terms of losing weight, other than increase my exercise which I'll be doing now Xmas is out of the way as I really didn't have time in Dec. I didn't find it helpful for my gp to say I should lose weight, I am, but as she's never weighed me she wouldn't know.

My BP is always high when I have it taken at the surgery, so much so that the nurse won't prescribe me the contraceptive pill, I have to see the GP who accepts the readings from my home monitor. Mine is a Boots one and cost about £20 but is definitely worth it.

I always always always have high blood pressure when my GP measures it, so I bought a blood pressure thingy and take my own in, just to avoid the fuss. My heart rate is always higher too. My Nan is the same.

They used to wait a couple of minutes and then try again, which just gave me a couple more minutes to somehow get even higher readings.

It sounds like classic white coat syndrome - the point of the 24 hour monitors is to show your BP under normal conditions. Those are the readings that should be taken into account.

I didn't find it helpful for my gp to say I should lose weight, I am, but as she's never weighed me she wouldn't know.

While this probably isn't going to be interpreted as helpful, if she thinks you still need to lower your BP, and she can see that you are still overweight, then telling you to lose weight is still a valid recommendation. It doesn't matter whether she has measured how much weight you've lost or not, it doesn't change the validity of the advice.

As a practice nurse we would medicate consistantly higher readings than 150/90. We don't put much faith by clinic readings though, home readings are key. Buy a machine (about £20) and record your BP at home three times a day at differing times of day for a week or so. Then show them your GP.

I wish my practice nurse was like you CPtart! Mine insisted on taking my blood pressure over and over again. Needless to say it went up and up, my arm was sore and I was getting more and more upset. In the end she agreed to lend me a BP monitor to try at home and when I got it home it didn't work!

What are the best medications? My BP is high - 180/110 on several occasions. Have been on Ramipril 5mg for a few months but no dramatic effect. BP recently 151/96 but a few days before 194/101! Home arm cuff monitor.

Also does anyone know if the wrist BP monitors are any good? Easier to use so thought I might try one.

GP's usually take two BP readings 5 -10 mins apart to get a more accurate reading. Most people are anxious on first going in to see the GP so BP is elevated. It's the second BP that should be recorded, as more accurate. This applies to both electronic or manual BP machines.

BP is also affected by the size of the cuff, how it is positioned and how snugly it fits around the arm. When using a manual BP the same applies however the dial or manometer should be level with your heart and not several feet up on the wall.

I was going to say check the BP cuff size as well - the arm circumference for the standard cuff is surprisingly small. Because the BP measurement involves inflating the balloon inside the cuff to squash the artery in your arm having the wrong size makes a difference. If you do get a home monitor, make sure you follow the instructions precisely when taking your BP - you need to have the measuring device at the same level as your heart otherwise the reading will be wrong.

I have high BP. I'm early 40s and my 24hour monitor showed it was stress related (normal during sleep). I've been on tablets for 2 years and have home monitor. It's been consistently good with meds.

I was really worried about taking tablets but I've been fine with no side effects.

@Jimijack your readings are really high. I would seriously think about meds. Much better than a stroke.

I know people don't think it will happen to them but it happened to my friend. She's same age as me. She survived the stroke but is having ongoing issues. She may now be epileptic.

OP you need to check out the salt content of your meals - cereal can be surprisingly high - and what are you having in your sandwich? I have high BP for 10 years it is controlled with medication but I still have to watch my diet.

5blue Ramipril could be doubled to 10mg but again, do several readings over a week to look at the average first. You should also have a blood test to check your kidneys before upping the dose.
Don't bother with a wrist monitor.

Thanks CPtart. Have GP appt next week so will discuss.

I guess the comment about weight, I'd gave preferred her to have maybe asked if I'm trying to lose weight rather than just tell me I need to lose weight. - because surely she must accept that having mentioned it the previous time 4 weeks earlier wasn't enough time for me to have lost more than maybe half a stone (which obviously wouldn't be visible).

I will ask about buying my own monitor, but I don't see how given that my GP is ignoring the results from the 24hr test, she'll favour any test I do at home over her own readings but I'll ask.

My BP readings are always pretty much identical - last time I went it was 145/95 first time, and 146/95 the second.

Re cereals, I either have bran flakes or porridge oats, both the ones I have are pretty low in salt. In a sandwich I generally have tuna or other fish, or some lean meat. I do feel I'm watching my diet as much as I can, especially as my gp is basing her comments that I eat too much salt on me adding it to my cooking or my late, neither of which I actually do.

I've got hypertension but the pills take it to a reasonable level.

However as to measurements that's a BIG variable.

Location, time of day, measurement system, home, hospital standing sitting lying down all vary a lot.

Most seemingly accurate is sitting and having it done Manually old fashioned method works well:)

OMRON are one of the best makes the one I have plugs up to the PC but these days i think they'll connect to your smartphone and mail it all to your GP;!)

I know this is an old thread, but I wanted to say that it really is possible to lower BP with weight loss. I lost 2st and came off the BP tablets I had been taking.

Could be white coat syndrome, could be wrong cuff and you could have hereditary high bp. Most high bp is idiopathic, no known cause. I think your GP is right to put you on meds. It’s still higher than it should be. High BP is serious and is the number 1 cause of heart disease. The muscles are overloaded, thicken up, then they don’t pump properly leading to a raft of issues which can be irreversible. Preventative measures are far better than the ambulance at the bottom of the cliff.