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How Much Medication Is Required To Manage Abnormally Low Diastolic Blood Pressure Level?
Question: I have a question about blood pressure. I had well-controlled high blood pressure for about 8 years. Then about 4 months ago it jumped up. I'm not entirely sure why...possibly anxiety. It went up to about 135/95 when I was at home. It would be much higher at the doctor...as high as 160/115...but doctors make me very anxious so it's hard to get an accurate reading there.
I was on Lisinopril 20mg. The doctor added Amlodipine 5mg. My systolic went way down. The average over the past month has been 115. Sometimes it's as low as 97. However the diastolic hasn't changed nearly as much. The average over the past month is 87. The difference between the two (pulse pressure) seems low to me (average of 28, and sometimes as low as 22).
Because of my suddenly increased blood pressure and suddenly increased anxiety I ended up having a cardiac workup. The EKG was normal other than a very rapid heart rate (122). At home my heart rate is around 85 at rest. My chest x-ray showed that my heart looked normal. They had me on a heart monitor for about 4 hours and although the heart rate was fast it was regular (no afib). Blood work was all normal...thyroid, kidney function, cardiac enzymes, potassium, were all fine.
So my question is about the diastolic blood pressure. Apparently they went and changed the classifications for blood pressure on my, so the diastolic shows stage I hypertension. But I wonder if that is accurate. I only have an automated oscillometric home blood pressure machine. Any time I get my blood pressure taken at the doctor's office both numbers shoot up. I've increased my exercise to about 45 minutes every day but that doesn't seem to be doing much for the diastolic either.
Do you think I should get more medication? Or is the diastolic good enough? Is the narrow pulse pressure a concern? If I did increase the medication I assume that would push the systolic down further.
I was on Lisinopril 20mg. The doctor added Amlodipine 5mg. My systolic went way down. The average over the past month has been 115. Sometimes it's as low as 97. However the diastolic hasn't changed nearly as much. The average over the past month is 87. The difference between the two (pulse pressure) seems low to me (average of 28, and sometimes as low as 22).
Because of my suddenly increased blood pressure and suddenly increased anxiety I ended up having a cardiac workup. The EKG was normal other than a very rapid heart rate (122). At home my heart rate is around 85 at rest. My chest x-ray showed that my heart looked normal. They had me on a heart monitor for about 4 hours and although the heart rate was fast it was regular (no afib). Blood work was all normal...thyroid, kidney function, cardiac enzymes, potassium, were all fine.
So my question is about the diastolic blood pressure. Apparently they went and changed the classifications for blood pressure on my, so the diastolic shows stage I hypertension. But I wonder if that is accurate. I only have an automated oscillometric home blood pressure machine. Any time I get my blood pressure taken at the doctor's office both numbers shoot up. I've increased my exercise to about 45 minutes every day but that doesn't seem to be doing much for the diastolic either.
Do you think I should get more medication? Or is the diastolic good enough? Is the narrow pulse pressure a concern? If I did increase the medication I assume that would push the systolic down further.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello,
I would explain that this narrow pulse pressure is not concerning.
The high systolic blood pressure means that your blood pressure values are not under control.
For this reason I agree with your doctor on the decision of starting amlodipine.
There is not any specific reason why your diastolic blood pressure values are raised, as long as your blood lab tests are normal.
It may be related to the fact that arterial hypertension is a progressive disorder, leading to increased peripheral resistance due to the blood vessels rigidity.
Of course anxiety is playing an important role in increased blood pressure values, especially at the doctor office ( which is also called White Coat Syndrome).
Coming to this point, I would encourage you to follow a healthy lifestyle ( a lot of physical activity, avoid smoking contacts) and reduce caffeine and salt intake.
Hope you will find this answer helpful!
Feel free to ask me again whenever you have any other questions!
Kind regards,
Dr.Iliri
I would recommend as follows:
Detailed Answer:
Hello,
I would explain that this narrow pulse pressure is not concerning.
The high systolic blood pressure means that your blood pressure values are not under control.
For this reason I agree with your doctor on the decision of starting amlodipine.
There is not any specific reason why your diastolic blood pressure values are raised, as long as your blood lab tests are normal.
It may be related to the fact that arterial hypertension is a progressive disorder, leading to increased peripheral resistance due to the blood vessels rigidity.
Of course anxiety is playing an important role in increased blood pressure values, especially at the doctor office ( which is also called White Coat Syndrome).
Coming to this point, I would encourage you to follow a healthy lifestyle ( a lot of physical activity, avoid smoking contacts) and reduce caffeine and salt intake.
Hope you will find this answer helpful!
Feel free to ask me again whenever you have any other questions!
Kind regards,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I agree that the systolic blood pressure was elevated, but now it is in the normal range (115). However the diastolic is still high (87). I'm not going to stop taking the medication that I am on, but should I increase the medication to get the diastolic down further? If I do will it decrease the systolic to the point I'm dizzy?
How accurate are the home blood pressure machines? I tried taking my machine into the doctor to compare to their readings and it wasn't even close. But just being there makes me anxious now, and every time they took my blood pressure with my machine or theirs it just went higher.
How accurate are the home blood pressure machines? I tried taking my machine into the doctor to compare to their readings and it wasn't even close. But just being there makes me anxious now, and every time they took my blood pressure with my machine or theirs it just went higher.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
I would not recommend increasing further the dose of amlodipine with such diastolic and systolic blood pressure values.
I would just recommend reducing maximally salt and caffeine in your diet.
Regarding the blood pressure machines, they have a good accuracy (up to 90%), but manual blood pressure machine is more accurate.
Anyway, the high blood pressure values at the doctor office are not concerning. They are just related to the anxiety (White Coat Syndrome) and do not need to be treated, because these blood pressure spikes do not increase your cardiovascular risk.
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
I would not recommend increasing further the dose of amlodipine with such diastolic and systolic blood pressure values.
I would just recommend reducing maximally salt and caffeine in your diet.
Regarding the blood pressure machines, they have a good accuracy (up to 90%), but manual blood pressure machine is more accurate.
Anyway, the high blood pressure values at the doctor office are not concerning. They are just related to the anxiety (White Coat Syndrome) and do not need to be treated, because these blood pressure spikes do not increase your cardiovascular risk.
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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