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Hi there, 38 year old male concerned about his blood

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Posted on Sat, 9 Feb 2019
Question: Hi there,

38 year old male concerned about his blood pressure.

I am obese, but work out regularly (almost every day), don't smoke, drink moderately (I used to drink heavier but have cut back substantially the last few years), and try to eat healthy (whole foods, lots of vegetables, avoiding processed foods most of the time). I also take some heart healthy supplements like fish oil, garlic, and CoQ10.

I'm seeing the doctor about a few issues I'm having. My blood pressure is generally in the old prehypertensive range (less than 140 systolic and 90 diastolic), though I get occasional isolated readings above this. I do have a phobia of blood pressure taking, so it is difficult to get a good reading - it's almost always high in the doctor's office, but at home despite struggling, I usually can do better.

One of the things that concerns me is there is sometimes a large difference between blood pressure (10-25 points systolic) between the left and right arm when taking it. I know anything above 10 can indicate problems, including atherosclerosis. The issue is not always there, but with a cuff, seems to be there more often than not.

Here's where it gets weird. I also have an Omron wrist blood pressure machine. I like it because it's a bit easier for me to use and the results track pretty well with the cuff overall. The one big difference is, I don't see nearly as much variation between arms on the wrist machine vs. the cuff machine. There is still occasionally some, but it's much less often and less severe when there is.

I know interarm difference varies and there can sometimes be differences even in young, healthy people, but I worry about atherosclerosis because of my family history. IF the interarm difference was caused by plaque buildup, would the difference be similarly substantial between both the cuff and wrist machine, or is it likely that since the wrist differences aren't nearly as concerning, whatever is happening is probably not atherosclerosis?

P.S. I had an echo a little over a year ago of my heart, and while there was very mild LVH, there was no mention of any plaque or anything, though I'm not sure how visible that would be in an echo, and I know that involves different blood vessels.

Thanks much for your input/help. I see my doctor again in February.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that the difference between the cuff and the wrist blood pressure values is probably related to the fact that you are obese and it is more difficult to measure the blood pressure in the cuff than in the wrist (because there is a lot of fat tissue in the arm compared to the forearm).

From the other hand, some difference in blood pressure between the two arms is quite normal in every healthy individual, because of the anatomical position of the blood vessels in both arms.

In my opinion, there is nothing to worry about!

Regarding high blood pressure at the doctor office, it is related to White Coat syndrome and does not need to be treated.

I would just recommend checking periodically every 6 months your blood lipid profile and consult with a dietitian in order to help you loose some weight.

It is also important avoiding caffeine intake as you are anxious and high blood pressure is often related to your anxiety.

Hope to have been helpful!

Wishing all the best,

Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (27 minutes later)
Hi Doctor Sharka and thanks for the very helpful answer! If you don't mind, I have a few brief followups.

Good to know regarding some variation as being normal. It also makes sense that since I am over ideal weight the cuff has a tougher time getting accurate BP.

I crunched the numbers and even with cuff only my average interam averages 11, whereas at the wrist it's under 5. From the sounds of it, you consider this fairly normal and not necessarily indicative of atherosclerosis? I should just try not to worry?

I will work with my doctor to monitor both blood pressure (hopefully every 6 months as you suggest to avoid unnecessary stress) and lipids. My cholesterol tends to be quite low overall (although that includes HDL, which is also low). My doctor seems happy with cholesterol in general.

Re caffeine, I do have one large cup of coffee a day and one large matcha green tea (which wouldn't have as much as the coffee, although it would have some), but that tends to be the only caffeine, and I was under the impression the antioxidant benefit would outweigh caffeine risk. Do you feel this is a reasonable amount? My anxiety is almost purely medical; it's not something I experience in everyday life necessarily; it's just about BP.

I'm also working to lose weight and do consult a dietician (and have improved my diet a lot, even if the weight is difficult to lose). I'm also getting a thyroid test soon on the off chance that it's one of the reasons I'm having so much trouble losing.

Thanks again for all your help!
doctor
Answered by Dr. Ilir Sharka (3 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

In my opinion, the difference in blood pressure values could also be related to the machine accuracy. Can you please check your machines with another person? This would help determine if the blood pressure machines are working normally.

I agree with you on checking your thyroid hormone levels, because thyroid gland dysfunction can trigger anxiety too.

Anyway, I don't think that you should panic about atherosclerosis just based on some blood pressure fluctuations.

Anyway, another test to help put your mind to peace would be Doppler ultrasound of the carotid arteries, which would help exclude the presence of atherosclerotic plaques.

Hope you will find this answer helpful!

If you have any other questions in the future, please don't hesitate to ask me again!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (1 hour later)
Thanks Doctor.

The machines were verified as best as possible at a doctor office some time ago. That said, most doctors don't compare blood pressure in both arms. The one who did for me with a manual cuff (she's retired now) didn't seem to find a problem. Since your explanation of why the wrist cuff might be more accurate, I think I'm at peace with the difference most likely being <10 points and not being that concerning.

Regarding the doppler, my previous doctor advised against it because she thought it might increase anxiety as that test is known to have false positives, but I will bring it up to my current doctor along with my concerns and see what he thinks.

Thanks again for the assistance.
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful to you!

If you have any other questions in the future, please feel free to ask me directly at any time!

Wishing good health,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7538 Questions

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Hi there, 38 year old male concerned about his blood

Brief Answer: I would recommend as follows: Detailed Answer: Hello! Welcome to Ask a Doctor service! I passed carefully through your question and would explain that the difference between the cuff and the wrist blood pressure values is probably related to the fact that you are obese and it is more difficult to measure the blood pressure in the cuff than in the wrist (because there is a lot of fat tissue in the arm compared to the forearm). From the other hand, some difference in blood pressure between the two arms is quite normal in every healthy individual, because of the anatomical position of the blood vessels in both arms. In my opinion, there is nothing to worry about! Regarding high blood pressure at the doctor office, it is related to White Coat syndrome and does not need to be treated. I would just recommend checking periodically every 6 months your blood lipid profile and consult with a dietitian in order to help you loose some weight. It is also important avoiding caffeine intake as you are anxious and high blood pressure is often related to your anxiety. Hope to have been helpful! Wishing all the best, Dr. Ilir Sharka, Cardiologist