New rules for blood pressure checkups
November 29, 2016
Despite an active lifestyle, including skiing and mountain walking, I've been taking high blood pressure medication for several years. Regular checkup by my VA doctor and my local one, I've been taking two pills a day for high blood pressure.
So when I saw an article in Consumer Reports magazine On Health headlined "New Blood Pressure Rules," I jumped to read it. Quickly I found a possible answer to a totally different problem doctors have not been able to help me with.
And that is a simple dry cough that hits me when I eat or drink any liquid. Not painful but it's bothersome. The article reported that "for people over the age of 60 get pressure under 140/90 raises the risk of side effects which can include persistent coughing." Also, those suffering from diabetes can expect stronger side effects.
Well, my cough problem dates back to when I started taking blood pressure pills.
No cigar, but it's something I want to bring up at my next medical meeting.
But back to the blood pressure article.
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If you've been told that you need to lower the readings in the past, you might not need to lower them that much. Many experts including the ones at Consumer Reports Best Buy Drugs say millions of Americans "don't need to aim so low when managing blood pressure." That means you can delay "or even avoid blood pressure medication, which reduces the role of side effects and lower costs."
Good news, yes; but, "it's been more than a year since that advice at a meeting of the National Heart, Lung and Blood Pressure Institute came out but the advice yet has not been adopted by many doctor's new blood pressure targets."
And there's the problem of false readings. Many things affect blood pressure, and one of the most common is "white coat anxiety" along with diabetes. That comes from going to the doctor's office for a checkup. Just the idea of a test can skewer the readings.
Or often a nurse takes the reading and only does it on one arm, when both arms measured gives a more accurate result.
To get an accurate reading:
Try to take a reading at the same time each day and record it. Avoid exercise, tobacco and caffeine for at least an hour before testing.
Go to the bathroom. A full bladder can raise systolic pressure by 20 to 25 points.
Rest for 5 minutes before taking a reading. Feet flat on the floor, legs uncrossed and cuff at heart level. Five or 10 points as a result.
Put the cuff on bare skin. Putting it on over clothing cam raise reading by up to 40 points.
Remain quiet during the test. Talking can raise the systolic 10 to 15 points.
Taking a test at home is easy if you follow the points above. Consumer Reports' top home monitors include Rite Aid Deluxe, $60 and Omron 7 series, $70. My kit is Life Source, from the VA so I don't know the price, but it works well. Easy to use. (Opening the case I found notes going back two years. Not good.)
Which med is best for you? The answer depends on you, such as health problems such as diabetes and ethnic background. Most generic drugs cost less than $30 a month:
Thiazide diuretics such as chlorthalidone, hydrochlorothiazide. Good for those with high blood pressure.
ACE inhibitors such as benazepril, and enalapril and lisinopril. For those with diabetes.
ARBs such as losartan. Side effects, coughing.
Calcium channel blockers such as amlodipine. Good for African Americans.
Whether it's life style changes combined with drugs, the target for most people is 140/90 if younger than 60 or have diabetes or kidney disease. And between 150/90 if older. The ideal remains 120/90, but you don't need to get that low to reduce of heart attack or stroke risks.
To lower levels without drugs:
Adopt a DASH diet rich in produce, grains and low-ft diary.
Drink moderately. One drink a day for most women or 1.5 ounces of 80-proof whiskey, no more than two drinks for men.
Be active. Brisk walking for 30 minutes most days. Regular Aerobic exercise. (I find that 25 aerobic minutes on the bike and treadmill refreshing.)
Cut back on salt. No more than a teaspoon of salt daily.
There's a lot more health advice in any issue of CR's On Health. Look it up on the Internet.
A new kind of movie
Director Ang Lee tried something different in his new film, "Billy Lynn's Long Halftime Walk." He speeds up the time a film frame appears on the screen. From 14 frames a second he goes up to 120 for increased image. This is a movie that shows the best of America and the worst. The best is what happens after a video of a 19-year-old U.S. soldier named Billy Lynn (Joe Alwyn) goes viral of him rescuing his wounded sergeant from sniper fire in Iraq.
The worst is when Lynn and his platoon are brought back to America for a promo tour. In Texas the platoon meets with a local oil driller who says business has never been as good. The GIs respond, "you keep on drilling and we'll keep on killing."
The film draws a line between the GIs and the Hollywood hype they are deluged with, like selling their life stories for $5,000 apiece. "That's my life to $5,000, is the answer."
Some fine scenes: Lynn rolling a single tear as the soldiers' lives are made public. A scene in which the eight soldiers repeat to one another, "I love you." It could be mawkish but isn't.
His platoon mates Kristen Stewart, Vin Diesel, Garrett Hedlund, Steve Martin, Tim Blake Nelson, and Chris Tucker co-star. Diesel gets a great one-liner when he tells Alwyn, "Don't worry, the bullet with you name on it has already been shot." Directed by Ang Lee, "Billy Lynn's Long Halftime Walk" tries a new tactic. Instead of appealing to our hearts and minds, director Ang Lee drills directly into us using a bizarre technology: High Frame Rate. Pretty much every film you've ever seen flashes 24 images per second.
Billy Lynn, named for the soldier (Joe Alwyn, angelic) given a hero's homecoming after watching his friend die, blasts at 120 frames. It's five times as fast — so hyperreal our eyes hurt. Today, Billy is going to go to an NFL game. He's going to meet Beyoncé. He's going to drink vodka, get high, and fall in lust with a cheerleader. It contrasts with his war experience sadly.
The movie is basically real life in the war vs. Hollywood hype. Maybe you don't want to see before a blood pressure test.
Sam Bauman writes about senior affairs, among other things, for the Nevada Appeal.
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