Surprised no one has mentioned the contrast between resting BP at home and hardly resting BP at the doctor’s after driving and walking. At my doctorI usually barely sit down before being ushered in and hooked up.
@MarkR … good job on the consistency with the BP measurement. In fact it’s normal to have fluctuations over the course of the day…or over the course of a minute, come to that. I usually do 3 readings at 30 second or so intervals and decide that the middle of the 3 is my reading for the day. I began this strategy back when I started doing BP readings in my office. Primarily because patients would reassure me that with a reading of something like 150/95, “it’s only White Coat Hypertension”…and I’d give a similar response to the one upstream…i.e. there’s no such thing in “health” as only WCH, any more than prediabetes, or a bit pregnant. Every once in a while, if one of may staff did a measurement after the appointment, it would be in striking distance of normal so could be something it’s reasonable to brush of as “stress” but I could never understand why folk were so cavalier. Then again, my mum’s first inkling of high BP was a stroke, so there is that as something to concentrate the mind.
What’s your CAC score, BTW? That might be a better indicator of “at risk for heart disease” than your BP readings. Or, come to that, a documented family history. This is the one thing I (and my healthcare providers, I guess) did not give enough weight to until that elevated CAC score that I’ve mentioned repeatedly for the past 3 plus years.
Healthcare is just barely beginning to adjust to the rapidly exploding mismatch between huge data available and Medical Professional time to look at it.
Familly history tells so much. Nobody in my family going back three generations before me (and I am now 74) has died of a heart attack or circulatory issues, except in the end stages of some other malady, and my blood pressure issues have always been from low pressure rather than high.
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@flyerboys …well, I can’t really say the same with any degree of certainty. My mum obviously had issues with ASCVD but, as she was a member of that generation of women who started to smoke in around the 1930s (her teens), I pegged that as the reason…and to be honest, it was the only one as she was always lightweight, a healthy eater, and a non Sedentarian to boot. I didn’t grasp the full picture myself until my intervention cardiologist asked direct and detailed questions.
My mum was the youngest of a largish family so a fair bit younger than her siblings as there had been a couple of miscarriages and one stillborn before she put in a surprise appearance. By the time my uncles died one by one(probably prematurely as none were retired as I recall) I was still pretty young. I have absolutely no idea of the proximate cause of their deaths…or even if autopsies were performed. As I explained to my cardiologist, as I realised “I don’t know” to every cause of death in these men possibly sounded a bit odd to American ears…my background and culture was such that condolences were always the first response to finding out that someone had died rather than questions about the causes or what they’d done to warrant it etc…at least, not in front of me.
Mind you, since my GPs managed to ignore a Red Flag in my lipid profile that deserved more attention for so long, I doubt a proper family history would’ve made much difference.
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Probably. Writing MAHA reports? We’re not there yet.
Yep. Last time I arrived for some testing at a local hospital, I got there, then got annoyed that they only have valet parking at that building (I don’t do valet parking), had to drive across the street to park there instead. Then I walk across, go up the flight of stairs, register my presence at the desk, and 30 seconds later they call me in and first thing take my blood pressure, left arm this time, but hanging down because the chair I was in had the upper arm rest (for bloodwork) on the right side. Sure enough it was elevated compared to my normal BP. Then they did the bloodwork. The whole thing took no longer than 5 minutes. This is a bloodwork factory - they have two large rooms, one with perhaps 20 such seats (used mostly for general bloodwork), and the other with 12 seats (used mostly for cancer related bloodwork, because the place is an oncology/hematology center). And adjoining the 12 seat room, they have a chemotherapy center with 30+ beds/chairs in a large room.
I suppose they take BP first to determine if they might have issues drawing blood? But nevertheless, they record the BP in the patient records, and before you know it, all the docs there think you have “high blood pressure”!
I don’t know, don’t think I’ve ever had that test. The cardiologist is sending me for some sort of new test called “Coronary CTA with FFR”, but they won’t schedule it until they receive bloodwork less than 30 days old (some nonsense about needing bloodwork before using contrast, but I’ve had contrast a few times before with no such requirement). Apparently it’s a relatively new test where not only do they take “pictures” of the vessels, but they also determine the flow rate (FFR) through them. Very cool.
I hope it works well. Last time I had an MRI with contrast, the first part (without contrast) went well, then I remained stationary, then they added the contrast into the IV, and then … the machine broke down and they couldn’t get it to do the second half of the test. That makes the whole thing useless. Turns out it was a simple software bug in the MRI machine. They fixed the bug overnight (the tech actually told me that they installed a new version early the next morning right before my repeat MRI!) and then had me wait for the contrast to exit my system. Since the failed MRI was at 6:30am, they were able to schedule me early the next morning again, and that time, the entire procedure went smoothly.
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Coronary CTA with FFR is what I had as a diagnostic requested by the intervention cardiologist. It was the CAC that initially opened my eyes to the fact that I’d been bamboozled by reassurances that my mildly elevated LDL-C wasn’t a problem.
The bloodwork is going to include an eGFR, I imagine. The CTA angiogram uses a contrast medium so you get checked to see if your kidneys can handle it. The angiogram will show the degree of blockage (if any) and the FFR the flow rate.
Yep. Low blood pressure is not as common for seniors these days as high blood pressure, but I am on the low end of normal. Last time in my bp came in at 90/65 and my pulse was 52. It was not until I got home and read my chart that I understood why my doc asked if I had any issues with dizziness or fainting. And I do get dizzy if I sit for a long time and stand up suddenly. I hoped I was really fit from all my hiking, weight lifting, etc., but bradycardia also is associated with hypothyroidism and I have had subclininical hyperthyroidism for a decade or more.
But at this point it’s up to me to think to ask the questions.
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Indeed, there are a few causes other than fitness that’re associated with low resting heart rate or heart rate response to exercise. Chances are your low BP and heart rate are the result of the work you’ve put in … although that doesn’t preclude a bradycardia that’s due to some underlying pathology too, I guess.
Interesting thing about heart rate is it’s more than a number (I did a training workshop years ago with that title) The thing that I find interesting is that, given that a lower resting heart rate is usually found with increased levels of fitness, you get folk who have no reason to include themselves in the “superior fitness” or "athletic category, will note their own low resting/ambient heart rate and assume that they are.
I too have to exercise a bit of caution when leaping up from a sitting or resting position because of postural hypotension. It was much worse when I was younger and probably chronically anaemic from menorrhagia. My husband was partly right, I guess, when he reckoned I was too fit and should time when I stand up so it’s not too l9ng till the next heart beat. He was only half joking
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So, I just checked a couple of metrics my Garmin has a guess at…
If only the feeling matched the guesswork. I can accept the VO2MAX…I entered my 60s with a measured reading of 45 and change and don’t have any symptoms of a lowered cardio respiratory fitness…but a fitness age of 65??? I felt much younger when I actually was. There’s a definite mismatch between the chassis and the engine.
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Agreed! But…until AI can perform all of the functions to collect and analyze health data, diagnose, and perform treatment - our current health care shortage in the US will be a problem. Things are fixin’ to get worse, US doctors are looking at moving someplace warmer (in a moral / psychological sense).
“The Medical Council of Canada said in an email statement that the number of American doctors creating accounts on physiciansapply.ca, which is “typically the first step” to being licensed in Canada, has increased more than 750% over the past seven months compared with the same time period last year — from 71 applicants to 615.”
Training new doctors is under threat with the Big Bad Bill -
“At a time when our country urgently needs more doctors – especially in underserved areas – this bill would create new financial and logistical barriers that disproportionately harm low-income students,” said Dr. Shannon Udovic-Constant, president of the California Medical Association, in a statement."
Good resource on currentish efforts -
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I don’t know, don’t think I’ve ever had that test. The cardiologist is sending me for some sort of new test called “Coronary CTA with FFR”, but they won’t schedule it until they receive bloodwork less than 30 days old (some nonsense about needing bloodwork before using contrast, but I’ve had contrast a few times before with no such requirement). Apparently it’s a relatively new test where not only do they take “pictures” of the vessels, but they also determine the flow rate (FFR) through
But you have heard of it, right? And the rationale for its use as a screening tool for detecting subclinical ASCVD. I’ve mentioned it repeatedly over the past 3 years as I’ve related my late (unnecessarily belated) diagnosis of advanced coronary artery disease…along with other tests over and above the normal stuff.
Coronary Artery Calcium scans…and CT angiography…aren’t new to the field of cardiology. Have probably been in use for a good 20 years or more as an alternative to catheterization when indicated.
I was in my mid 50s when I first had an inkling of my “mildly elevated” LDL-C (that’s toggled around 125-135 mg/dL fairly consistently since…and possibly before, for all I know) Maybe that range was considered within normal limits back then…but it’s certainly not nowadays. I fell for the Big Bamboozle of healthy lifestyle (and zero symptoms) protecting me from cardiovascular disease …along with similar errors over high HDL, low triglycerides and hs-CRP of > 1.
I don’t know at what age early detection and intervention might’ve headed off measurable ASCVD…probably well before meaningful treatment (statins etc) became available…but for sure, if I’d gotten a warning of where I was headed as recently as a decade ago (when CAC scans etc were definitely around) I wouldn’t have received the shock I did when my CT angio and FFR results made me look like a cardiac cripple!
As I became aware of my genetic predisposition to ASCVD (and the realisation of quite a strong family history…as noted upstream) thoughts turned to the next generation(s). On discovering my dramatically elevated Lp(a) and Apo-b lipoprotein …both mentioned many times over the last 3 years also…I suggested that my daughter ask for those to be added to the Usual Suspects on her next annual physical. A huge sigh of relief to discover that I haven’t passed these on (the migraine and bunions are bad enough!) Should anyone make the mistake of imagining this is overkill, I should mention that my daughter is now 44…just about entering perimenopause in all probability and losing the temporary protection against heart disease that us girls have during our reproductive years. It’s a sobering thought to realise that, if she had been following in my footsteps with elevated Lp(a) and Apo-b lipoprotein, she would’ve missed that window of opportunity to prevent the early pathological changes.
BBC has a nice article on walking:
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I got into a fight with an insurance company many years ago, they pointed to my “high blood pressure” as just one of several reasons to deny coverage. (This is post employment, as COBRA was expiring.)
I got a home BP machine and took it several times daily. Not good enough for them, obviously, but enough to realize something was going on. As it turns out, I have “white coat syndrome”; my BP is always elevated at the doctor’s office. I can get there 20 minutes early, sit quietly in the waiting room, doesn’t matter, when they strap me in, my BP goes up. (To test, I once brought my home machine in and did a comparison - the results agreed with the “official” meter, and sure enough many BP was elevated 15-20 points over normal readings at home.)
[sidebar: The primary reason they wouldn’t insure me is that some doctor somewhere had written in a chart many years ago at a hospital before a surgery “possible COPD” and they found it - years later, buried in the morass of my medical history.
[Between that and the BP, no one would insure me. Finally my sister, who by luck is a pulmonary doctor (PhD doctor, not MD) went through my records, found the errant citation, and concluded that is was NOT “possible COPD” although I did have some degraded lung function. She wrote a letter to that effect and voila! I get insurance. Unimaginably stupid system.]
Anyway, yeah, “white coat syndrome” exists. My doc is 1.4 miles from my house. There is no traffic getting there. I am not stressed, yet once in the office the numbers bounce up.
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Years ago (I see that it was 2011) the BMJ had a fun article on the value of walking…
It gave me the idea of a theme for my SPIN classes in the run up to Halloween. It was so popular I dusted it off each subsequent year. Anyways, it was based on the timed walking speed of the Senior Fitness Test but the performance/application of it is a bit trickier to do than the description in the article. It’s actually intended to measure “natural” walking speed. The speed you can attain when you’re not thinking about it, or for test taking purposes. That Hawthorne Effect always creeps on.
It actually was a fun class…I’m amazed at the cognitive function that put the 50+ minutes together with such a popular music selection😉 (or maybe putting such classes together enhanced it?)
I’ve struggled to stay ahead of the Grim Reaper, lo, this past 18 months…but that’s down to my foot. Thanks for this reminder!
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Yes indeed, White Coat Syndrome does exist…but not necessarily as an innocuous finding because of the setting and something to be dismissed as such. It’s oftentimes an early Heads-Up on something “not quite right” going on. An early departure from healthy homeostasis. Not unlike, say, an elevation in fasting blood glucose or A1c being shrugged off as “only” prediabetes…or a “mildly elevated” LDL-C being of no consequence in light of everything else being in such great shape.
I got my first alert to “borderline high cholesterol” from an insurance company underwriter back in my mid 50s. I was selling my practice and realised that I no longer needed really big insurance coverage (happy to say those premiums actually were a waste of money) I needed that exam where someone comes to your home and does a blood draw. The nurse who did it was praising my excellent health and fitness and felt sure I’d get the lowest premium. I didn’t. “Borderline high cholesterol” was the reason. I returned very promptly to my primary care physician’s office wondering what he’d missed. Lipid profile showed something like total cholesterol of 230 mg/dL, HDL-C around 80 or so, triglycerides about the same, LDL-C toggling around 125-135…and hs-CRP of .8. Doc was a bit miffed at an insurance company lackey playing doctor…did that old ASCVD risk calculator and reassured me my risk was low for an event over the next 10 years, and that there was more to preventing heart disease than tinkering with individual lipids. I guess the laff’s on me for waiting so long to refute that notion.
I can’t help wondering how intervention at that stage with a low dose statin would compare with the supervised neglect I actually received.
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