High blood pressure & GP advised I stop HRT suddenly - is this a good idea?

[bloominoreilly]

I had my annual HRT review today. I'm on 3 pumps of oestrogel daily & have Mirena IUD + I have vag pessary twice weekly. I had high blood pressure reading at the GP today so I'm going to take readings twice a day for a week then go back to see GP next Friday. She told me to just stop taking HRT now, but I'm worried about that - won't that be like falling off a cliff, aren't you supposed to taper? I've been on HRT since April 2022. Can anyone advise whether it's best to taper? I'm wondering if I should seek advice from a menopause expert - can anyone recommend any? Thanks!

i thought transdermal HRT was pretty low risk for high blood pressure (compared to oral). How high was your reading in Drs?

It seems a bit knee jerk to say stop after one reading in Drs office. I started transdermal HRT while medicated for high blood pressure and it was under control (no longer medicated after weight loss)

Absolutely no way should you suddenly stop after been on it years.
Just see what the home readings are to get a more accurate picture.

If BP persistently high then taper over a few weeks would surely be the better approach after advice from a GP who knows whay theyre talking about. Sudden return of unpleasant issues will have a negative effect on BP anyway.

How high was it?

Did the GP talk about lifestyle changes? That’s usually the first step in reducing BP. They normally advise you to reduce salt intake, eat more salad, vegetables and fruit, lose weight if you need to, increase your daily exercise and cut back on alcohol.

Thanks @Blanketpolicy that's what I've read too. It's good to hear that you're no longer medicated - well done! This morning I'd had 2 strong coffees & no breakfast before my early apt, so I'm gonna cut the coffee out & make a few other lifestyle changes but stay on the HRT - but go down to 2 pumps. I think you're right that it seems a bit knee jerk to tell me to just stop - but when a dr tells you to do something you worry about not doing it. I don't drink, smoke or eat salt & I've got good BMI, so I'm a bit flummoxed as to why I got a high reading, so I'm hoping cutting out coffee will help!

She didn't really ask me much about my lifestyle, thinking back - she asked me if I smoke (I don't), but not if I drink (I don't) . I've been exercising a lot lately, I eat fairly healthily - lots of veg, don't add salt to anything. I'm now gonna cut out coffee (jeez, my only vice!) & eat super-heathily & meditate etc (I am stressy), & see if I can get the reading down. I didn't just want to suddenly have to deal with sudden hormone drop on top of trying to bring in lifestyle changes!

Thanks - I will. It was 160/90

That’s quite high. Do you have a home bp device? I would take a few readings over next few days. Had you been rushing to the surgery? How is your weight.

would have thought they would give you an ecg rather than go off one reading.

I bet loads of people have one off readings like that at a healthcare setting, even if we don't feel stressed we tend not to be in a relaxed state and often talk as it's doing the recording which increases readings. Mine once was 145/90 and average home readings 115/70

I do - & I had been rushing a bit to the surgery. I will take action to be calm when I take home readings & see what happens. Thanks for the suggestion of the ECG - something I can ask about when I next see her

It is well known that 1 BP reading is not a trend. Absolutely no way would i be suddenly stopping based on that.
Measuring BP is notoriously difficult, white coat syndrome for starters!
I'd absolutely be looking at doing regular readings and evaluating over the next couple of days. Make sure you've sat down quietly for 5 mins before taking the reading and ensure you position the cuff correctly.

Definitely high BP is a serious thing but make sure that is what you have first !

I don't know if this applies, but I get higher readings than that in any medical setting, ye olde White Coat Syndrome. Would that apply to you OP?

Matter of fact I was getting a procedure done last week, my bp was 168/90. They weren't one bit concerned. Maybe they had my "normal" readings somewhere in my chart though. It did go down (not to normal though) on third try in the hospital and off they went to do the job.

I don't take HRT but I'd be very wary of stopping cold turkey like that, especially before doing at least a weeks averages first.

Thank you ☺️

Thank you - this is all very reassuring. So glad I posted!

I was advised by my to get myself a good quality bp machine as readings can vary acording to the quality of the machine ( minewas £24 off amazon but i should invest in a better one

I've got a Vital Track one - it sounded like a good one when I bought it a year or do ago (& then buried in a cupboard!)

@bloominoreilly Transdermal estrogen often lowers BP because it stop the arteries furring up.
There is no evidence it causes high BP.

Your GP sounds out of date because it's the older synthetic estrogen / tablet form that has a slightly higher BP risk (but still nowhere as risky as the Pill.)

Unless you were told to rest for 5-10 mins before your BP was taken, it's not an accurate reading.

You should take your BP at rest, not after eating a meal or having a hot drink/ alcohol and take the average of 3 readings taken 5 mins apart.

Coffee doesn't affect BP so you don't need to change that!
It can cause palpitations in some people if drunk to excess.

But just don't drink it just before you test your BP.

BP readings should be taken rested (often not the case in a GP's surgery because you've rushed to the appointment), relaxed (tend not to be when in front of a medical professional), with your back supported (fine with the bloods nurse who has a special chair, if it's the GP doing it they often don't), feet flat in the floor (that's where our practice's blood nurse's special chair fails - you'd have to be at least 6ft 5 for your feet to touch the floor), not within an hour after a meal, and not either dehydrated or desperate for a wee.

It's rare to get all those right at once. And it varies through the day as well.

If you want to improve it, it sounds as if you're doing the right things. I'd add checking you're hitting fibre targets, which also helps with hormone balance. And isometric exercises such as planks and wall squats, which improve blood vessel flexibility.

Definitely out of date GP…Transdermal estrogen is safe for women with risk of heart disease/high BP. My BP went sky high at menopause and I now take BP medication alongside my HRT and all is good!

Thanks - this is very helpful! My systolic is down to 135 this morning but diastolic 98 (!) But it wasn't in all the ideal circumstances (eg feet weren't flat on the floor) so I'll start trying to get that right from now on. Will up my fibre intake & get into the isometrics too!

Do you have a history of high BP?

Is your machine okay?

We have a Duronic- one of my family has to take their BP regularly.

I've never heard of feet flat on the floor to take BP but if you're sitting at a table with your arm rested at the same level as your heart, your feet should be on the floor anyway.
Make sure you're following the instructions for taking it. Easiest way is to sit at a table and if needed support your arm with a cushion because it should be roughly at the same level as your heart.

Make sure the lead is the right way up- ie on your forearm not under your arm.

You don't need to do squats etc. In fact with that reading (diastolic) you need to be careful. The best exercise is walking - as much as you can.

https://www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure

www.bhf.org.uk/informationsupport/risk-factors/high-blood-pressure#Reducing_high_blood_pressure

Thanks 😊

Make sure the lead is the right way up- ie on your forearm not under your arm.

Have I confused you? What I mean is the lead should be along the inner part of your arm,not the back of your arm where your elbow is.

You should also take 3 readings , 5 minutes apart. This is standard practice- because sometimes even at home there is a stress factor and your BP on the 3rd reading can be lower.

IF your BP is very high over the week your GP may want to put you on BP meds for a short while but there is no need to stop HRT at the same time.
The guidance is if BP is controlled, women can use HRT.
And it's only the tablet forms that have a slightly higher risk of blood clots.

OP, I’ve had exactly the same thing happen to me in the past month ie high blood pressure at an HRT check with a refusal to renew my prescription until my bp was verified by home checks for 7 days. I sent in 2 days of readings and was called into GP and started immediately on medication, along with a load of tests ordered, including ecg. The GP agreed I could continue HRT but failed to approve the prescription so I had to go back. I saw a different GP who really didn’t want to renew my HRT. A lot of the appointment was spent in silence whilst she was looking on her computer, presumably googling something, she didn’t have a clue about HRT and at one point suggested she change my current 25 oestrogen patch and 100 micronised progesterone tablet for combined patches. I assume she’d read something suggesting tablets are bad for bp.
Evidence indicates that the right level of oestrogen helps keep arteries supple, keeping bp normal. The same evidence exists for micronised ( but not synthetic) progesterone.
My theory is that that when my HRT was swapped about a year ago my oestrogen has been too low and that’s what caused a rise in bp.
Of course it might just be my age/ bad luck!

My gp had me stop my hrt as it increases blood pressure and mine was crazy high, about 220/110 and that was after significant weight loss. It’s more stable now and I’m on Sertraline for menopause symptoms and it’s working well to be fair.

What sort were you on?

Maybe consider another opinion from a different GP?

If you are prone to high BP, it's worth looking at it from all angles.

Using HRT within 10 years of the menopause reduces cardiovascular disease by up to 50% (according to research.)

If you can get the dose right it's far better than SSRIs for your long term health.

Long term use of SSRIs can cause loss of bone density - there is plenty of research on this - so it's definitely worth looking at again.