Doctor Visit hypertension

[Cowboy]

Every time I visit the physician for a routine check up my blood pressure is elevated. Then they tell me to monitor my blood pressure daily for two weeks, which I do and all is fine. My question is how to lower white coat hypertension. The more I Think about it the more the systol goes up it seems. any advice. it makes visiting the doc a bit uncomfortable. Plus I want to avoid a false diagnosis of hypertension.
thanks

[Q.]

You've come to the right place! DEFINITELY DO NOT ALLOW THE MD TO PUT YOU ON DRUGS WITHOUT FIRST VERIFYING HYPERTENSION FOR YOURSELF! I say that because, right after my 1st wife freaked out and split over a bad grad school situation - something I was not involved directly with but was definitely the focus of her life at the time - I was put BP meds. NO DUH, my BP was up because I had no idea where she even was and I had a house that I couldn't afford all to myself (we lived more on the margin then than I do now). So, since few docs will take you off once you're on, I was on these for 11 years. Finally, it started getting worse and I bought my own monitor. That was also about the time that I started my education in fitness.

What I learned was that my BP probably was not high all those years and, when I started measuring it myself, it's pretty damned LOW at times. The other morning, it was 104/72 with a pulse of 58. Now I KNOW that the first reading at the doc's office will always be high but, if you take it again at the end of the visit, it will be back toward normal. Make sure they take several readings and give yourself time to settle in.

I was able to get off the meds several years ago and haven't had to go back but it wouldn't have happened with my MD approval if I hadn't provided the data by tracking it myself at home. BP varies all the time, as I bet you know, so you need a more representative sample than just once at the doc's office.

Go online or go somewhere and buy yourself a monitor. It will be worth investment to KNOW where you stand. Mine is Omron... PM or post here if you need more info.

[Cowboy]

I went out and bought the omron automatic bp monitor and will monitor my bp until my next doctors visit. my first reading was 132/78, theN i took it five minutes later it was 121/68, then another ten minutes later it was 123/80. so far, so good. thanks Q

[Q.]

I'm exactly the same way! I think that just anticipating the higher reading causes it to go up, even when you're doing it yourself. I've just come to accept that it WILL BE HIGHER the first time and not worry about it. I think that helps to start reducing that initial response by decreasing the anxiety over it. Also, I really do think that by you getting some positive feedback, i.e., lower readings, it helps to turn around that downward spiraling mindset of "OMG what the hell is happening to me" which just makes it worse and you can start feeling more relaxed. Unfortunately, MD's don't seem to catch on to this very well but mine has responded very favorably to me providing him with readings over time. To get a true picture, you do need to take them at different times of the day as much as possible. You might even find a connection such as with job stress so that might give you some direction as to where you need to focus your efforts to counteract this. One of the BEST feelings I've ever had was when I realized/demonstrated that I had some control over my own health in this area and I didn't have to just take the meds which is the standard approach by mosts MD's because their patients won't do the work to take control of their own health. Since you are at this site, I'd guess that you are NOT one of them... and I applaud you for it!

[nanook]

Here is a link I found on another site. It is a interesting perspective on blood pressure and blood pressure medicine.

http://www.drmcdougall.com/science/hypertension.html

[russ]

Originally posted by nanook:
Here is a link I found on another site. It is a interesting perspective on blood pressure and blood pressure medicine.

http://www.drmcdougall.com/science/hypertension.html

Always beware of health related websites which feature testimonials and products for sale prominently. It would be nice if head referenced the 'important review' of which he speaks, as I wonder if the quotes are out of context. He mixes sensible advice with some questionable advice.

http://www.americanheart.org/present...tifier=1200000 is a more reliable source of information.

[Q.]

russ knows my cynicism regarding the medical community and, although I think Dr. McDougall is normally a little "out there" (hey, he's making his living in the internet FGS!), here's a quote from his website that I would tend to agree with:

"The ultimate beneficiary of these new recommendations from the National High Blood Pressure Education Program will be the pharmaceutical industry and the prescribing doctors"
http://www.drmcdougall.com/news/bloo...ure_pills.html

So, the problem is balancing my own cynicism with obtaining the medical guidance I need to do what's best for my health. It's not an easy balance but I'm convinced that we should take responsibility for our own health, not blindly follow anyone else... not even our MD. That includes getting too much of our medical information (or any other) off the internet!

[Q.]

This just in... although nothing new here.

Too much salt in the diet is boosting Americans' blood pressure
and is prematurely killing roughly 150,000 people each year,
according to the nonprofit Center for Science in the Public
Interest's (CSPI) new report, "Salt: The Forgotten Killer."
Despite the pleas of health experts to cut back, salt
consumption has drifted upward over the past 30 years to the
point where Americans are now consuming about 4,000 milligrams
of sodium per day--about twice the recommended amount. CSPI is
filing a lawsuit against the FDA in federal court to compel the
agency to classify salt as a food additive. Presently, FDA
classifies salt as GRAS, or Generally Recognized as Safe, which
means that it is not closely regulated.

We also urgently recommend that consumers choose lower-sodium
foods, and propose that the FDA phase in reasonable limits on
the salt content of many high-sodium packaged and restaurant
foods.

The 2005 Dietary Guidelines for Americans recommends that young
adults consume less than 2,300 mg of sodium per day. People with
hypertension, African Americans, and middle-aged and elderly
people--almost half the population--are advised to consume no
more than 1,500 mg per day.

The bulk of Americans' salt intake is not coming from the salt
shaker. Only about 11 percent of sodium in the diet comes from
salt added while eating or cooking. Processed foods and
restaurant foods contribute almost 80 percent of sodium to the
diet. Thousands of processed foods, such as frozen dinners and
soups, contain between 500 and 1,000 mg of sodium per serving.

In addition to setting limits on sodium, CSPI also recommends
that government:

* require front-label symbols to identify high-sodium foods
* require chain restaurants to disclose sodium (and other
nutrients) on menus and in brochures
* prod food manufacturers to use less salt
* establish within FDA a Division of Sodium Reduction
* mount other initiatives to prevent cardiovascular disease,
including major campaigns to promote diets rich in vegetables,
beans, fruit, nuts, and other healthful foods

We encourage you to share this CSPI consumer alert with family
members, friends and colleagues.

To get a free copy of the study "Salt: The Forgotten Killer" go
to http://actionnetwork.org/ct/TpqbM6M1KjZF/SaltReport/ where
you can also find information on high sodium packaged and
restaurant foods. The 32-page report is also available for $8
from CSPI-Salt, 1875 Connecticut Ave., Suite 300, Washington, DC
20009-5728.

--------------------------------------------------

Visit the web address below to tell your friends about this.

http://actionnetwork.org/join-forwar...r=gdqbM6M1uB-F

If you received this message from a friend, you can sign up for
Center for Science in the Public Interest at:

http://actionnetwork.org/CSPI/join.html?r=gdqbM6M1uB-FE

[russ]

Originally posted by Q.:

"The ultimate beneficiary of these new recommendations from the National High Blood Pressure Education Program will be the pharmaceutical industry and the prescribing doctors"

I can see where they benefit the pharmaceutical industry, assuming that current guidelines would require an increase in the number of prescriptions.

How exactly does it benefit prescribing doctors? Is he implying that they get kickbacks for each prescription?

To be honest, Brad, I consider guys like McDougall to be a bit of a joke. Here's a guy who makes his money cashing in on the so-called 'worried well', throwing accusations all around. The guy's a profiteer with a guru-like mentality. While some of his recommendations may be on the level, he comes across as a poor critical thinker.

[russ]

Continued (edit time elapsed):

His synopsis of the current recommendations as well as the effects of anti-hypertensives is remarkably simplistic, I think.

A couple of selected quotes:

When you do both of the diet and exercise suggestions correctly, then you will effortlessly attain, and then maintain that ideal weight

Effortlessly? Right. Just make sure to return to his spa when the effort fails the first time.

Improving dietary and exercise regimens are clearly important, but don't do the trick by themselves in many cases (if not most----my recollection is that 60-70% of hypertensives will not achieve normal pressure with diet and exercise regimens alone).

As a result, this pharmaceutical approach does nothing to reduce the risk of heart attacks and very little to reduce the risk of strokes

Wouldn't it be nice if he would provide his references. It should go without saying that exercise and dietary modifications are imporant first steps in managing hypertension. An unfortunate reality is that many patients won't follow these recommendations and will require medication. And, as mentioned earlier, many who modify their diet and exercise regimens will remain hypertensive and they will still be at elevated risk for strokes and heart attacks.

While this is well outside my area of specialisation, I have seen a few presentations on this issue at work recently, and I'm quite sure that he's dead wrong in his analysis of the protective effects of antihypertensives, though different classes of drugs have somewhat different effects on stroke and heart attack in different age groups.

[Kaiser]

Speaking of business and medicine:

In business there is a saying: those who can, do, and those who can't teach.

My brother in law, the physician, said that there is a similar saying in medicine: those who can, do. Those who can't go into radiology.

[img]tongue.gif[/img]

[russ]

Originally posted by Kaiser:
My brother in law, the physician, said that there is a similar saying in medicine: those who can, do. Those who can't go into radiology.

And when confronted by our colleagues with that notion, there's a saying in Radiology which goes, "You're just jealous of us."

[Q.]

Originally posted by russ:
I can see where they benefit the pharmaceutical industry, assuming that current guidelines would require an increase in the number of prescriptions.

How exactly does it benefit prescribing doctors? Is he implying that they get kickbacks for each prescription?

To be honest, Brad, I consider guys like McDougall to be a bit of a joke. Here's a guy who makes his money cashing in on the so-called 'worried well', throwing accusations all around. The guy's a profiteer with a guru-like mentality. While some of his recommendations may be on the level, he comes across as a poor critical thinker.

I attempted to show my view of McDougall with my comment that he's making his living off the Internet (FGS!) so I would agree with you on that one.

As to how prescribing doctors benefit, you're probably right about that although I have noticed on ONE occasion - granted, not enough to drawn any real conclusions - that my meds were changed one time (when I was still taking them) to the same product that was on all the new pens and writing tablets they had in the office. I don't have any first hand knowledge of this but I do wonder how much the drug reps drive what the MD's prescribe and how much of the new information they obtain comes from the people selling the product. That would be pretty common place in most businesses but I'd like to think that my doctor was giving me what was best for me based on some kind of independent, professional assessment s/he arrived at as a result of their extensive training and continual efforts to stay current in their niche in the field of medicine... know what I mean?

Still, it has occured to me that it wouldn't be too far fetched for there to be influence from the pharmaceutical industry on the standards that the medical community, as a whole, uses as its basis for prescribing blood pressure meds, possibly others. They are in business to make money (= keep Wall Steet happy) and this is obviously a gold mine with the current state of public health and prescription drug costs. It's the kind of thing that happens in big business all the time and I see no reason why it wouldn't/couldn't happen here.

Caveat emptor.

[russ]

[quote]Originally posted by Q.:

Originally posted by russ:
[qb]

As to how prescribing doctors benefit, you're probably right about that although I have noticed on ONE occasion - granted, not enough to drawn any real conclusions - that my meds were changed one time (when I was still taking them) to the same product that was on all the new pens and writing tablets they had in the office. I don't have any first hand knowledge of this but I do wonder how much the drug reps drive what the MD's prescribe and how much of the new information they obtain comes from the people selling the product. That would be pretty common place in most businesses but I'd like to think that my doctor was giving me what was best for me based on some kind of independent, professional assessment s/he arrived at as a result of their extensive training and continual efforts to stay current in their niche in the field of medicine... know what I mean?

Caveat emptor.

I would hope that the change of meds was the result of analysis of new evidence, but you could be on target to some degree with your speculation, though I would doubt that a kickback was part of the equation.

Still, it has occured to me that it wouldn't be too far fetched for there to be influence from the pharmaceutical industry on the standards that the medical community, as a whole, uses as its basis for prescribing blood pressure meds, possibly others. They are in business to make money (= keep Wall Steet happy) and this is obviously a gold mine with the current state of public health and prescription drug costs. It's the kind of thing that happens in big business all the time and I see no reason why it wouldn't/couldn't happen here.

The influence of the pharmaceutical industry on medical practice is an area of heated debate. There is almost certainly some influence, although the degree to which they affect prescribing habits is tough to quantify. I'm not a big fan of DTC drug marketing, as this results in patients asking their MDs for specific prescriptions, and the result can be overuse of certain drugs, e.g., Vioxx. In the world of hypertension, I believe there has been some controversy as newer studies have apparently shown that the first line anti-hypertensive agents should be the rather inexpensive diuretics---not the best way to maximise profits.

[Brent]

This Idea of "White Coat" hypertension is an interesting one indeed. I am not a physician, although, I did stay at a famous Motel last night, but isn't it more about how the individual responds to the stimulus. for instance, white coats, are in general responding to anxiety faced in the uncomfortable arena of a doctor's visit thus, the invidivual responds by an overreaction of the flight or fight response (stress response). it's how the body reacts not necessarily the response. therefore, I think the docotors are thinking, that for the most part, these individuals experience this overreaction more often than not and thus may be in some sort of danger. They are per say more prone to anxiety and stressful situation. This is the only explanation I can think for the justification for treatment of white coat. I know some physicians are adamant about white coat, but this is just a thought.