Resolved question:
Hi Dr Rodney!
My father is 62 year old and takes medicine to control high blood pressure.
I have been measuring his blood pressure using an automatic device (g-tech, with handcuff, I guess it is quite accurate) and I am attaching in this message measurements we have made on the past weeks.
Although the average of 137 x 86 seems ok, I'm concerned about these several high
measurements that are over 150 x 90. What's your view on that? We should consider
the average of these high measurements may require the increase on the medicine?
Actually, his doctor already recommended increasing the medicine after he measured 160 x 100
in the doctor's office. However, I agree with my father that this measurement is not reliable
in comparison to the many measurements we made at home. My father is reluctant in increasing
the medicine because he think that, if it is not necessary, then he will not be able to reduce
medicine in the future because the body gets used to it.
What's your opinion?
Thanks!
Submitted:
4 Days
Category:
Family Physician-GP
Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concern.
Firstly yes the automatic devices are pretty accurate but I always recommend getting the BP measured at 3 different intervals using the manual BP apparatus. Based on all the values, most of his values are normal, as the chart suggests and hence i do not think there is any need to increase the dosage right away. What medicines is he on? Whatever he is taking seems to be working. BP is something that keeps varying all the time. So in his case, since his values have been monitored over a period of time, it will be more prudent to take into consideration the average and not a few values that are over 150/90.
Please provide a detailed drug history. And any other significant medical history? Since how many years old patienthas he been on BP medication?
I will advise you get a nurse or someone to check his BP 3 times, at different intervals using the manual BP apparatus. It is possible that your dad probably got anxious in front of the doctor and his values shot up. That is a possibility and it is also very common. 3 different intervals can be done over a period of one week, on alternate days preferably at a time when your dad is relaxed, avoiding the work hours. Once you have 3 different values, it will be suggestive of how effectively his BP has been under control and we can take a decision based on that.
However from your chart, it seems unlikely he will be needing a change. Minor modifications can be done based on his values and it won't be difficult to switch to a newer dose.
Hope this was helpful,
Regards.
Hi Dr Deepu, Here is what my dad told me about the medication he is currently in: Atenolol – 25 mg – 1 pill each 12 hours (for 20 years) Losartano – 50 mg -1/2 pill every day (for 10 years) I hope the names make sense for you, if not I'll look for the basic compounds on these medications. I'm sharing a file BP.jpg which highlights, in red, the measurements which are over 140/90, together with date and time (1st and 2nd columns). Average is 137/86. As I told you, as far as I know 137/86 is OK for a 62-year-old person (not excellent, but not bad as well); I would like to hear your opinion on these red measurements... If they are a concern or if we should take the average as a better prediction of risk. Thanks!
Hello.
Thank you for the follow up.
These red values, can be ignored considering that the average is around 137/86.
However it is my advise to you that you get his values evaluated 3 times, at different intervals as i mentioned in my last email. This is just to be absolutely sure.
He has been taking Atenolol and Losartan for a long time and they have been able to keep his BP under control at most times. Hence there is no need to change it now, for the time being. We can take a decision once you get his BP evaluated by a manual apparatus and send me the three values as i requested for. You can get it done over a period of one week and you can get his BP checked at around a time when he is relaxed, every alternate days. 3 values are more than enough observed over a week, and more values will give a confusing picture.
If those 3 values average show that his BP is over 150/90, then slight modifications in the dosage can be considered. But based on the automatic BP apparatus readings, i don't think it will be necessary.
Do get back to me with the follow up BP values.
Hope you have a great day,
Regards.
Hi Dr Deepu,
Here are the 3 measures you asked, made in 3 different days.
134 x 86
133 x 81
147 x 82
Regards,
Pedro
Hello Mr. Pedro.
Thank you for getting back with the values.
According to the latest guidelines, in patients 60 years old patientor over, the goal of treatment is to maintain blood pressure under 150/90 mmHg.
Since none of your father's value are above this level, no change or increase in dose is required.
Kindly ask him to continue his medications regularly along with a healthy diet and regular exercise.
Let me know if I can assist you any further.
Regards.