Ideal BP

Mxsmanic said:

Patrick Blanchard said:

I don't think that your doctor would believe you to be mentally ill if
you told her your carotid intima media thickness is abnormal and you
want to reverse the atherosclerosis that has already developed.

That would be like the city of Boston reducing water pressure by a third
because half of city's water supply leaks out through the network.
Beyond a certain point, this causes a lot more problems than it solves.
Protecting the carotid becomes a bit moot if the organ it serves is no
longer adequately perfused.

No, this is not what I am advocating.

CIMT allows individualization of atherosclerosis management. So in
reference to your example, I am advocating that someone go out to each leak
and fix it properly.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

Mxsmanic said:

Dr. Andrew B. Chung said:

The brain... however, this is self-correcting when someone faints and
the
head ends up at the same level as the heart.

Of course, after the car hits a tree, the brain and heart may be in
almost exactly the same position, splattered against the firewall.

We do not disagree that risks are involved with any treatment for
atherosclerosis, whether or not medications are taken.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

Mxsmanic said:

Patrick Blanchard said:

some meaningful references would be nice here....

You need references for this? Low BP --> (renal) hypoperfusion --> ARF

How low a blood pressure is required to result in acute renal failure, in
your experience?

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

Patrick Blanchard said:

How low a blood pressure is required to result in acute
renal failure, in your experience?

I don't treat ARF myself. However, I'd expect it to vary by individual.
The kidneys must be adequately perfused, but the pressure required to
accomplish that may depend on many things.

I've always felt that essential hypertension is an automatic
compensation mechanism, not a disorder in itself. By pushing it down
with medication, you only encourage the compensation mechanism to wind
up. There may be a _reason_ why BP has to be high for a specific
individual; the damage done by the high pressure is just an incidental
side effect. Find the reason why the pressure is being maintained at
such a high level, and you can fix it. Push down the pressure
artificially, and a body will just drive it back up, since it is
(presumably) needed for some reason.

If an aircraft in flight springs a leak in an actuator system, that
doesn't mean that you can lower the pressure in the system. Some level
of pressure is required to keep the actuators working, and if you lower
the pressure in order to slow or stop the leak, the actuators won't
work, which defeats your purpose. Same thing for blood pressure. If
you just push BP down blindly because it seems too high, you might just
make things worse.

It's kind of like giving someone lots of water because he has stopped
urinating. Maybe he is just dehydrated, in which case the water will
help. But if he is suffering from kidney failure and you pump him full
o'water because his urine output doesn't match your recommended numbers,
grief will ensue.

There's no such thing as BP that rises for no reason. Essential
hypertension is high blood pressure that is high for an _unknown_
reason, which isn't the same thing; and while pushing it down to a lower
level diminishes the known risks, you have no way of knowing what other
risks may be augmented in consequence.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Quoted message said:

Quoted message said:

In this country (UK) doctors do not believe anything and are not
encouraged
to send patients to hospitals. You as a Dr can refer yourself, I am
surprised that you are allowed to prescribe your own medications. After

I

Quoted message said:

Quoted message said:

had a negative angiogram two years ago the consultant said "This time we
will sort out your B.P. at the outpatients clinic"
When no appointment came through I spoke to my GP about it. He looked at
the
letter from the hospital after the angiogram and said he does not say
that
here. I phoned the consultants secretary and she said it is not on your
notes.
Stalemate.
Derek.

Derek, would you be willing to send me a copy of the angiogram report?
Also, why was the angiogram performed. Did you have any additional

studies?

Quoted message said:

Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

This may be a bit jumbled as I have copied bits from various old postings to
the N.G. :-)

This is British NHS where they do not willingly give patients their records.
At the time of the angiogram in November 2001 I asked for a copy of the CD
they recorded it on but was politely refused.
The initial report to my GP included: ETI + ve echo good LV function, mild
LVH. o mitral/aortic on echo, aortic calcification. Angiography: arteries
normal therefore false + ve ETT.
The angiogram was done after I had been sent to the chest pain clinic with
similar symptoms to ones that I had previously had. This time the young
doctor who checked the output from the stress test said that my condition
had deteriorated greatly from the previous year. I offered to bet him a
months wages
that my angiogram would be OK but he refused the bet.
The year before even with what we now know to be a false positive the
consultant was 98%certain that I did not have a serious problem and but
offered to do anangiogram, being a gambler I turned it down as I would
not bet on such an outsider. He also agreed that I did not have angina.
The background is I have suffered from digestive
problems for many years and I always put chest pains down to wind. After a
severe attack in 1992 when I was 57 (sweating, chest pain and pain in left
arm and jaw) my doctor panicked and I was admitted to hospital. I was
connected up to the
usual monitors. My BP was evidently normal at that time as it was not
mentioned or
treated. After a few days they gave me the stress test in a hot little room
and I did it without discomfort but with much sweating. I was told that my
heart was not getting enough oxygen and that I had angina. They prescribed
glycerol trinitrate which gave me a headache and I stopped taking it. Two
follow up visits to the hospital and they were satisfied that I did not need
medication but of my own bat I started taking a mini aspirin each day
(probably not helping my stomach) .
At least in 1999 I was fortunate to find that my BP was very high before any
harm befell me. Personally I do not understand why it was suddenly so high
as it had been checked on several occasions and been 'normal' except in the
previous September after a prostate biopsy when it was 180/80 which the
theatre nurse
put down to the stress of the occasion.
In February 1999 I went to my GP to get something
for my indigestion. I was waking up in the morning with acid reflux and
retching and choking. I was also having indigestion type pain/symptoms with
sweating and a pain in the left arm and my chest. The Dr took my BP which
was
210/110 and sent me to the Chest Pain Clinic right away. My BP was still
about the same level and they did an ECG and echocardiogram which they said
showed LVH.
They would not do a stress test until medication had brought my BP down a
few days later. As in 1992 at another hospital I was told that I had angina.
I did not believe that as I do a lot of walking and live in a hilly city and
it was not defiantly not that type of pain.
The digestive problems continue and I have been taking Proton Pump
Inhibitors for three years. In fact today I had another Barium X-Ray which
showed that my acid reflux is getting worse but did not show any sign of the
duodenal ulcer that was supposed to be there last year.
Derek.

Derek F said:

Quoted message said:

Quoted message said:

In this country (UK) doctors do not believe anything and are not
encouraged
to send patients to hospitals. You as a Dr can refer yourself, I am
surprised that you are allowed to prescribe your own medications.

After

I

Quoted message said:

Quoted message said:

had a negative angiogram two years ago the consultant said "This time

we

Quoted message said:

will sort out your B.P. at the outpatients clinic"
When no appointment came through I spoke to my GP about it. He looked

at

Quoted message said:

the
letter from the hospital after the angiogram and said he does not say
that
here. I phoned the consultants secretary and she said it is not on

your

Quoted message said:

notes.
Stalemate.
Derek.

Derek, would you be willing to send me a copy of the angiogram report?
Also, why was the angiogram performed. Did you have any additional

studies?

Quoted message said:

Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

This may be a bit jumbled as I have copied bits from various old postings
to
the N.G. :-)

This is British NHS where they do not willingly give patients their
records.
At the time of the angiogram in November 2001 I asked for a copy of the
CD
they recorded it on but was politely refused.
The initial report to my GP included: ETI + ve echo good LV function,
mild
LVH. o mitral/aortic on echo, aortic calcification. Angiography: arteries
normal therefore false + ve ETT.

fyi, there can be up to 40% stenosis in any coronary artery before the
angiogram will show it.

Quoted message said:

The angiogram was done after I had been sent to the chest pain clinic
with
similar symptoms to ones that I had previously had. This time the young
doctor who checked the output from the stress test said that my condition
had deteriorated greatly from the previous year. I offered to bet him a
months wages
that my angiogram would be OK but he refused the bet.
The year before even with what we now know to be a false positive the
consultant was 98%certain that I did not have a serious problem and but
offered to do anangiogram, being a gambler I turned it down as I would
not bet on such an outsider. He also agreed that I did not have angina.
The background is I have suffered from digestive
problems for many years and I always put chest pains down to wind. After
a
severe attack in 1992 when I was 57 (sweating, chest pain and pain in
left
arm and jaw) my doctor panicked and I was admitted to hospital. I was
connected up to the
usual monitors. My BP was evidently normal at that time as it was not
mentioned or
treated. After a few days they gave me the stress test in a hot little
room
and I did it without discomfort but with much sweating. I was told that
my
heart was not getting enough oxygen and that I had angina. They
prescribed
glycerol trinitrate which gave me a headache and I stopped taking it. Two
follow up visits to the hospital and they were satisfied that I did not
need
medication but of my own bat I started taking a mini aspirin each day
(probably not helping my stomach) .
At least in 1999 I was fortunate to find that my BP was very high before
any
harm befell me. Personally I do not understand why it was suddenly so
high
as it had been checked on several occasions and been 'normal' except in
the
previous September after a prostate biopsy when it was 180/80 which the
theatre nurse
put down to the stress of the occasion.

This could be an indication that your blood vessels are not dilating
properly, not uncommon with advancing atherosclerotic disease.

Quoted message said:

In February 1999 I went to my GP to get something
for my indigestion. I was waking up in the morning with acid reflux and
retching and choking. I was also having indigestion type pain/symptoms
with
sweating and a pain in the left arm and my chest. The Dr took my BP which
was
210/110 and sent me to the Chest Pain Clinic right away. My BP was still
about the same level and they did an ECG and echocardiogram which they
said
showed LVH.

yes, this does not suprise me.

Quoted message said:

They would not do a stress test until medication had brought my BP down a
few days later. As in 1992 at another hospital I was told that I had
angina.
I did not believe that as I do a lot of walking and live in a hilly city
and
it was not defiantly not that type of pain.

perhaps your atypical pattern represents 'acute coronary syndrome', a
symptomatic presentation of unstable plaque.

Quoted message said:

The digestive problems continue and I have been taking Proton Pump
Inhibitors for three years. In fact today I had another Barium X-Ray
which
showed that my acid reflux is getting worse but did not show any sign of
the
duodenal ulcer that was supposed to be there last year.
Derek.

Would you mind including your current medication list?

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

Patrick Blanchard said:

Derek F said:

Quoted message said:

> In this country (UK) doctors do not believe anything and are not
> encouraged
> to send patients to hospitals. You as a Dr can refer yourself, I am
> surprised that you are allowed to prescribe your own medications.
After

I

Quoted message said:

> had a negative angiogram two years ago the consultant said "This time
we
> will sort out your B.P. at the outpatients clinic"
> When no appointment came through I spoke to my GP about it. He looked
at
> the
> letter from the hospital after the angiogram and said he does not say
> that
> here. I phoned the consultants secretary and she said it is not on
your
> notes.
> Stalemate.
> Derek.
>
>
>
Derek, would you be willing to send me a copy of the angiogram report?
Also, why was the angiogram performed. Did you have any additional

studies?

Quoted message said:

Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

This may be a bit jumbled as I have copied bits from various old postings
to
the N.G. :-)

This is British NHS where they do not willingly give patients their
records.
At the time of the angiogram in November 2001 I asked for a copy of the
CD
they recorded it on but was politely refused.
The initial report to my GP included: ETI + ve echo good LV function,
mild
LVH. o mitral/aortic on echo, aortic calcification. Angiography: arteries
normal therefore false + ve ETT.

fyi, there can be up to 40% stenosis in any coronary artery before the
angiogram will show it.

Sometimes that depends on who is "reading" the angiogram, unfortunately.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

"Patrick Blanchard, M.D." <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Derek F said:

Quoted message said:

> In this country (UK) doctors do not believe anything and are not
> encouraged
> to send patients to hospitals. You as a Dr can refer yourself, I am
> surprised that you are allowed to prescribe your own medications.
After

I

Quoted message said:

> had a negative angiogram two years ago the consultant said "This time
we
> will sort out your B.P. at the outpatients clinic"
> When no appointment came through I spoke to my GP about it. He looked
at
> the
> letter from the hospital after the angiogram and said he does not say
> that
> here. I phoned the consultants secretary and she said it is not on
your
> notes.
> Stalemate.
> Derek.
>
>
>
Derek, would you be willing to send me a copy of the angiogram report?
Also, why was the angiogram performed. Did you have any additional

studies?

Quoted message said:

Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

This may be a bit jumbled as I have copied bits from various old

postings

Quoted message said:

Quoted message said:

to
the N.G. :-)

This is British NHS where they do not willingly give patients their
records.
At the time of the angiogram in November 2001 I asked for a copy of the
CD
they recorded it on but was politely refused.
The initial report to my GP included: ETI + ve echo good LV function,
mild
LVH. o mitral/aortic on echo, aortic calcification. Angiography:

arteries

Quoted message said:

Quoted message said:

normal therefore false + ve ETT.

fyi, there can be up to 40% stenosis in any coronary artery before the
angiogram will show it.

Quoted message said:

The angiogram was done after I had been sent to the chest pain clinic
with
similar symptoms to ones that I had previously had. This time the young
doctor who checked the output from the stress test said that my

condition

Quoted message said:

Quoted message said:

had deteriorated greatly from the previous year. I offered to bet him a
months wages
that my angiogram would be OK but he refused the bet.
The year before even with what we now know to be a false positive the
consultant was 98%certain that I did not have a serious problem and but
offered to do anangiogram, being a gambler I turned it down as I would
not bet on such an outsider. He also agreed that I did not have angina.
The background is I have suffered from digestive
problems for many years and I always put chest pains down to wind. After
a
severe attack in 1992 when I was 57 (sweating, chest pain and pain in
left
arm and jaw) my doctor panicked and I was admitted to hospital. I was
connected up to the
usual monitors. My BP was evidently normal at that time as it was not
mentioned or
treated. After a few days they gave me the stress test in a hot little
room
and I did it without discomfort but with much sweating. I was told that
my
heart was not getting enough oxygen and that I had angina. They
prescribed
glycerol trinitrate which gave me a headache and I stopped taking it.

Two

Quoted message said:

Quoted message said:

follow up visits to the hospital and they were satisfied that I did not
need
medication but of my own bat I started taking a mini aspirin each day
(probably not helping my stomach) .
At least in 1999 I was fortunate to find that my BP was very high before
any
harm befell me. Personally I do not understand why it was suddenly so
high
as it had been checked on several occasions and been 'normal' except in
the
previous September after a prostate biopsy when it was 180/80 which the
theatre nurse
put down to the stress of the occasion.

This could be an indication that your blood vessels are not dilating
properly, not uncommon with advancing atherosclerotic disease.

Quoted message said:

In February 1999 I went to my GP to get something
for my indigestion. I was waking up in the morning with acid reflux and
retching and choking. I was also having indigestion type pain/symptoms
with
sweating and a pain in the left arm and my chest. The Dr took my BP

which

Quoted message said:

Quoted message said:

was
210/110 and sent me to the Chest Pain Clinic right away. My BP was still
about the same level and they did an ECG and echocardiogram which they
said
showed LVH.

yes, this does not suprise me.

Quoted message said:

They would not do a stress test until medication had brought my BP down

a

Quoted message said:

Quoted message said:

few days later. As in 1992 at another hospital I was told that I had
angina.
I did not believe that as I do a lot of walking and live in a hilly city
and
it was not defiantly not that type of pain.

perhaps your atypical pattern represents 'acute coronary syndrome', a
symptomatic presentation of unstable plaque.

Quoted message said:

The digestive problems continue and I have been taking Proton Pump
Inhibitors for three years. In fact today I had another Barium X-Ray
which
showed that my acid reflux is getting worse but did not show any sign of
the
duodenal ulcer that was supposed to be there last year.
Derek.

Would you mind including your current medication list?

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

You are a very cheerful Bugger!
My medications are:
Securon 240 mg
Losartan 25 mg.
75 mg aspirin
2 X 20 mg Omeprazole.
I had an ECG last month which was "normal" and a 24 hour BP monitor which
had an average of 139/71. The highs (161/80) were when the monitor was
attached and taken off, I put that down to the statuesque nurse:-)
Derek.

Quoted message said:

My BP is currently in the 130-115/65-80 range w/o meds.
I was told that the new limits for BP are 120/80?

If it helps, my blood pressure usually rests on 120/80, and I am
considered healthy.

Russ.