Question
Nurse Red,
I am a Type II diabetic with borderline hypertension. My doc put me on 10 mg of Prinivil even though I was only borderline. He said it was a precaution against possible kidney problems. I went along with that. Now my blood pressure is o.k. most of the time (117/76 yesterday). Occasionally, however, the top number goes to as high as 160. The bottom number always stays between 70-80. Why the fluctuation in the top number? Also, as long as the bottom number is below 90, what would you say the upper limit is for the top number? 200?
I am curious to know why the top number fluctuates more than the bottom number. Does the top number fluctuate pretty widely with exercise and activity?
Thanks
Charles Cox
Answer
HYPERTENSION
YOU HAVE AN APPOINTMENT WITH THE DOCTOR FOR YOUR D.O.T. MEDICAL RECERTIFICATION. IT’S BEEN 2
YEARS SINCE YOUR LAST APPOINTMENT AND YOU ARE PATTING YOURSELF ON THE BACK FOR BEING IN
SUCH GOOD SHAPE. YOU NEVER GET SICK. AS YOU LEAVE THE HOUSE THAT MORNING, YOU REALIZE YOU
HAVE A FLAT TIRE ON YOUR VEHICLE. AW JEEZ, NOW YOU’RE GOING TO BE LATE FOR THE DOCTOR. YOU
SET ABOUT CHANGING THE FLAT WHEN THE LUG WRENCH BREAKS LOOSE AND YOU SCRAPE YOUR
KNUCKLES..... HARD. YOU ARE NOT HAVING A GOOD DAY.
DRIVING ACROSS TOWN, YOU HIT EVERY RED LIGHT AND A DETOUR. YOU ARRIVE AT THE DOCTORS OFFICE
AND THE ONLY PARKING SPOT YOU CAN FIND IS 2 BLOCKS AWAY. YOU RUSH DOWN THE STREET TO THE
CLINIC AND ARRIVE OUT OF BREATH BUT ONLY 10 MINUTES LATE. YOU ARE BACK ON SCHEDULE.
AFTER FILLING OUT THE PAPERWORK, THE NURSE TAKES YOU TO THE INNER OFFICE AND BEGINS TAKING
YOUR HEIGHT, WEIGHT, AND VITAL SIGNS. YOU JOKE ABOUT BEING OUT OF BREATH AND BEGIN TELLING
HER ABOUT YOUR MORNING. YOU BEGIN TO WONDER WHY SHE IS TAKING YOUR BLOOD PRESSURE FOR
THE THIRD TIME. SHE REMARKS THAT IT IS RATHER HIGH. 168/100 TO BE EXACT, BUT THAT IT IS PROBABLY
DUE TO THE STRESSFUL DAY YOU’VE HAD . SHE ASSURES YOU SHE WILL CHECK AGAIN WHEN YOU HAVE
HAD A CHANCE TO RELAX AND ‘CHILL OUT’.
THE PHYSICIAN COMES IN TO COMPLETE YOUR PHYSICAL AND WHEN HE ASKS HOW YOU ARE, YOU TELL
HIM ABOUT YOUR MORNING AND THAT NOW YOU HAVE HIGH BLOOD PRESSURE. THE DOCTOR ASSURES
YOU IT WILL PROBABLY COME DOWN ON IT’S OWN, BUT WANTS TO KEEP AN EYE ON IT FOR A WHILE. YOU
START TO RELAX A LITTLE.
20 MINUTES LATER, THE NURSE CHECKS YOUR BLOOD PRESSURE AGAIN. YOU HAVE BEEN QUIETLY
READING A MAGAZINE IN THE OFFICE. SHE PUMPS UP THE CUFF AND SLOWLY RELEASES THE PRESSURE.
SHE GRINS AT YOU AND SAYS. 120/80, PERFECT. YOU COLLECT YOUR D.O.T. CARD AND LEAVE. YOU FEEL
BETTER.
AS YOU PULL INTO THE YARD TO BEGIN YOUR WORK DAY, YOU MEET YOUR BUDDY IN THE PARKING LOT
WHO IS ON HIS WAY OUT. HE’S LOOKING AT THE GROUND AND RUBBING HIS FOREHEAD. HE TELLS YOU HE
WOKE UP WITH A HEADACHE BUT CAME TO WORK ANYWAY. AFTER ALL, IT WAS JUST A HEADACHE. BUT
NOW HE IS NOTICING THAT HIS LEFT HAND AND LEG FEEL WEAK. HE WAS ON HIS WAY TO THE DOCTOR’S
OFFICE BUT DOESN’T FEEL AS IF HE CAN DRIVE SAFELY. YOU WALK HIM TO THE OFFICE AND CALL THE
RESCUE SQUAD TO TRANSPORT HIM TO THE LOCAL HOSPITAL. THE RESCUE SQUAD TAKES HIS PRESSURE
WHEN THEY ARRIVE AND SEVERAL TIMES OVER THE NEXT 15 MINUTES. IT REMAINS CONSISTENTLY 180/120.
THE RESCUE PERSONNEL TRANSPORT HIM TO THE EMERGENCY DEPARTMENT WHERE INTRAVENOUS
MEDICATIONS WERE STARTED TO CONTROL THE BLOOD PRESSURE AND HE IS ADMITTED TO THE HOSPITAL.
AFTER THREE DAYS, HIS PRESSURE IS NORMAL AND THE LEFT SIDED WEAKNESS HAS RESOLVED. HE IS
DISCHARGED FROM THE HOSPITAL ON MEDICATION THAT HE MUST CONTINUE TO TAKE TO REMAIN
NORMAL.
WHILE THESE SCENARIOS MAY SOUND LIKE A ‘MADE FOR TV’ MOVIE SCRIPT, THEY ARE NOT
UNREASONABLE AND EITHER ONE COULD HAPPEN TO YOU. WHILE HIGH BLOOD PRESSURE IS COMMON ALL
OVER THE COUNTRY, IT IS VERY COMMON IN THE TRUCKING INDUSTRY, AND HAVING SOME KNOWLEDGE
ABOUT IT WILL CERTAINLY HELP YOU STAY SAFE, HEALTHY, AND ON THE ROAD.
DEFINITION
HYPERTENSION IS THE CONDITION MOST COMMONLY REFERRED TO AS HIGH BLOOD PRESSURE. IT IS THE
MEDICAL SITUATION IN WHICH THE PRESSURE AGAINST THE WALLS OF THE BLOOD VESSELS IS
PERSISTENTLY HIGHER THAN NORMAL. WHEN MEASURED WITH A BLOOD PRESSURE CUFF, THE READING
WILL BE RESULTED IN TWO NUMBERS, FOR EXAMPLE 120/80. THE UPPER NUMBER REPRESENTS THE
MAXIMUM FORCE THE BLOOD EXERTS AGAINST THE VESSEL WALL WHEN IT IS PUMPED OUT BY THE
HEART’S CONTRACTION. THE LOWER NUMBER IS THE FORCE REMAINING WHILE THE HEART IS AT REST
AND REFILLING BETWEEN BEATS. IF THE UPPER NUMBER CONSISTENTLY REMAINS OVER 140 OR THE
LOWER NUMBER OVER 90 THAT IS HYPERTENSION.
WHAT CAUSES IT?
THERE ARE ONLY A FEW KNOWN SPECIFIC CAUSES OF HYPERTENSION. THESE INCLUDE: KIDNEY DISEASE,
HORMONAL PROBLEMS, CERTAIN COMPLICATIONS OF PREGNANCY AND TUMORS. HOWEVER, THESE CAUSE
ONLY A SMALL PERCENTAGE OF THE TOTAL CASES OF HYPERTENSION. IN MOST CASES, THE CAUSE IS
UNKNOWN. (ESSENTIAL HYPERTENSION). CERTAIN ASSOCIATIONS HAVE BEEN OBSERVED AS CAUSATIVE
FACTORS. THESE INCLUDE: HEREDITY AND RACE. THOSE WITH STRONG FAMILY HISTORIES OF HYPERTENSION,
ESPECIALLY BLACK MALES ARE PREDISPOSED TO HIGH BLOOD PRESSURE. WHILE THIS DOES NOT MEAN YOU
WILL DEFINITELY HAVE HYPERTENSION, LACK OF EITHER FACTOR DOESN’T MEAN YOU WON’T DEVELOP IT .
SYMPTOMS AND DANGER SIGNS
THERE ARE NO RELIABLE SYMPTOMS OF HIGH BLOOD PRESSURE! MOST OFTEN, THE FIRST SIGN OF
HYPERTENSION IS ACTUALLY A SYMPTOM OF ONE OF IT’S COMPLICATIONS, SOME OF WHICH MAY BE
PERMANENT. THESE SYMPTOMS ARE NOT TELLING YOU THAT YOU HAVE HIGH BLOOD PRESSURE, IT IS
TELLING YOU THAT THE PRESSURE HAS BEEN TOO HIGH FOR TOO LONG. PERSONS WITH HIGH BLOOD
PRESSURE MAY COMPLAIN OF HEADACHE, VISION CHANGES, TENSENESS, WEAKNESS OR TINGLING OF
ARMS AND LEGS. BUT THESE SYMPTOMS ARE INCONSISTENT. THEY ARE NOT THE SAME FROM PERSON TO
PERSON. THE BOTTOM LINE IS THAT THE ONLY RELIABLE SIGN OF HYPERTENSION IS PERSISTENTLY ELEVATED
BLOOD PRESSURE READINGS.
COMPLICATIONS
BLOOD PRESSURE THAT REMAINS HIGH OVER A LONG PERIOD OF TIME CAN DAMAGE THE BLOOD VESSEL
WALLS AS WELL AS THE ORGANS THEY SUPPLY. SOME OF THESE COMPLICATIONS CAN BE DEVASTATING,
NOT TO MENTION DEADLY. THEY INCLUDE: STROKE, BLEEDING INTO THE BRAIN, HEART ATTACKS, AND
KIDNEY FAILURE. VERY OFTEN THESE COMPLICATIONS ARE IRREVERSIBLE. IT IS, THEREFORE, VERY IMPORTANT
TO RECOGNIZE HIGH BLOOD PRESSURE EARLY AND TO TREAT IT CORRECTLY.
TREATMENT
HYPERTENSION DEMANDS TREATMENT IF IT IS PERSISTENT. YOUR BLOOD PRESSURE CAN GO UP FOR SHORT
PERIODS OF TIME DURING PERIODS OF STRESS, AND DOES NOT REQUIRE TREATMENT IF IT RETURNS TO
NORMAL ONCE THE STRESS IS REMOVED. HOWEVER, IF THE BLOOD PRESSURE REMAINS ELEVATED OVER
SEVERAL READINGS UNDER NON-STRESS CONDITIONS, IT MUST BE DEALT WITH. IT CAN BE TREATED NON-
MEDICALLY, WITH MEDICATIONS, OR A COMBINATION OF BOTH PLANS. THERE ARE A NUMBER OF WAYS TO
IMPROVE HIGH BLOOD PRESSURE WHICH DO NOT INVOLVE MEDICATION. THESE INCLUDE:
1.DIET MODIFICATION FOR YOUR GENERAL HEALTH AS WELL AS TO IMPROVE HYPERTENSION, YOU
SHOULD AVOID SALT AND SATURATED FATS. SALT CAUSES YOUR BODY TO HOLD ON TO FLUIDS WHICH
INCREASE THE BLOOD’S VOLUME AND INCREASES PRESSURE. INSTEAD OF SALT, TRY USING LEMON, PEPPER,
GARLIC, OR A SALT SUBSTITUTE. SATURATED FATS ARE INVOLVED IN BLOOD VESSEL DISEASE
(ATHEROSCLEROSIS). IT COMMONLY AFFECTS THE VESSELS SUPPLYING THE HEART AND BRAIN. WHENEVER
YOU CAN, CHOOSE BAKED OR BROILED FOODS OVER FRIED, AND MAKE GREEN LEAFY VEGETABLES AN
IMPORTANT PART OF YOUR DIET EVERYDAY.
2.EXERCISE- EXERCISE WILL “TONE UP” THE HEART AND CARDIOVASCULAR SYSTEM. IT -WILL RECEIVE THE
PRODUCTS OF STRESS, AND WILL STIMULATE THE PRODUCTION OF ENDORPHINS WHICH ARE INTERNALLY
PRODUCED NATURAL RELAXANTS. TAKING A BRISK HALF HOUR WALK EACH DAY WILL HELP NOT ONLY
YOUR BLOOD PRESSURE, BUT YOUR GENERAL STATE OF HEALTH. DON’T OVERDO IT! THE KEY WORDS ARE
MODERATE AND REGULAR. MAKE A HABIT OF IT EVERY DAY.
3.WEIGHT CONTROL- THIS EFFORT GOES ALONG WITH THE FIRST TWO. BEING OVERWEIGHT DOES NOT
CAUSE HYPERTENSION, BUT IT IS A CONTRIBUTING FACTOR, NOT TO MENTION THE ADDITIONAL STRAIN IT
PUTS ON THE HEART AND CARDIOVASCULAR SYSTEM. MEDICAL SUPERVISION MAY BE NEEDED, BUT A
DIETARY AND EXERCISE PROGRAM WILL HELP.
4.STRESS REDUCTION- STRESS DEFINITELY PLAYS A ROLE TENSION. THERE ARE MANY TECHNIQUES
AVAILABLE INCLUDING MEDITATION, DIRECT IMAGING (THINKING OF A QUIET PEACEFUL PLACE OR
SITUATION), AND THERAPEUTIC MASSAGE. FIND ONE THAT WORKS FOR YOU AND USE IT!!
ALL OF THESE MEASURES MAY HELP, BUT IF YOU FIND THAT YOUR PRESSURE REMAINS OVER 150/100 AND
THE DOES NOT RESPOND TO THE ABOVE MEASURES, MEDICATION MAY BE NEEDED. THERE ARE MANY
MEDICATIONS AVAILABLE, AND THEY ALL ACT IN DIFFERENT WAYS ON THE BODY. THEY MAY BE USED
SINGLY OR A COMBINATION OF MEDICATIONS MAY BE PRESCRIBED BY YOUR PHYSICIAN. HE WILL
MONITOR YOUR PRESSURE’S RESPONSE TO THE MEDICATIONS AS WELL AS CHECKING YOUR LAB WORK TO
DETERMINE THE EFFECTS ON OTHER PARTS OF YOUR BODY SYSTEMS. THE FOLLOWING WARNINGS ARE VERY
IMPORTANT.
1. TAKE YOUR MEIDACTION REGULARLY AND AS PRESCRIBED. MANY MEDICINES WORK
BEST BY MAINTAINING CERTAIN BLOOD LEVELS.
2. YOUR MEDICATION NEEDS MAY VARY OVER TIME. IT IS ESPECIALLY IMPORTANT TO
CHECK YOUR BLOOD PRESSURE FREQUENTLY AND VISIT YOUR PHYSICIAN WHEN IT FLUCTUATES (
HE MAY NEED TO FINE TUNE YOUR TREATMENT).
3. DO NOT STOP YOUR MEDICATION UNLESS ADVISED BY YOUR PHYSICIAN. EVEN IF YOU FEEL
WELL, YOUR PRESSURE CAN GO BACK UP WITHOUT THE MEDICATION AND REMEMBER YOU WON’T
KNOW WHEN IT IS UP! IF YOUR PHYSICIAN THINKS YOU CAN COME OFF OF THE MEDICATION, HE WILL
PROBABLY WANT TO DO SO GRADUALLY WHILE CHECKING YOUR BLOOD PRESSURE
CLOSELY.
WHAT THE D.O.T. REGULATIONS SAY ABOUT HYPERTENSION
THE DEPARTMENT OF TRANSPORTATION HAS DEFINITE GUIDELINES WITH REGARDS TO ISSUING MEDICAL
CERTIFICATES TO PERSONS WITH HYPER TENSION.
MILD HYPERTENSUON IS DEFINED AS READING BETWEEN 161 AND 180 N(UPPER NUMBER) AND BETWEEN 91
AND 104 ( LOWER NUMBER). WITH MILD HYPERTENSION, A MEDICAL CERTIFICATE CAN BE ISSUED FOR A
THREE MONTH PERIOD, DURING WHICH TIME TREATMENT CAN BE STARTED TO BRING THE PRESSURE BELOW
160/90. IF THIS IS SUCCESSFUL, A ONE YEAR CARD CAN THEN BE ISSUED. THE DRIVER WILL CONTINUE TO BE
EXAMINED ANNUALLY AND ONE YEAR CARDS MAY BE ISSSUED IF THE PRESSURE REMAINS UNDER CONTROL
UNDER 160/90.
MODERATE TO SEVERE HYPERTENSION IS DEFINED AS THE UPPER NUMBER BEING ABOVE 180 AND THE LOWER
NUMBER BEING ABOVE 104. NO CARD CAN BE ISSUED TO THE DRIVER UNTIL THE PRESSURE IS BELOW
181/105. AT THAT TIME, A THREE MONTH CARD MAY BE ISSUED ASND TREATMENT CONTINUED TO BRING THE
PRESSURE UNDER 160/90. WHEN THE PRESSURE IS BELOW 160/90 A SIX MONTH CARD CAN BE ISSUED. AFTER
THAT, A NEW CARD CAN BE ISSUED EVERY SIX MONTHS.
SUMMARY AND GUIDELINES
HYPERTENSION IS SNEAKY AND DEALY, BUT IS TREATABLE IF RECOGNIZED EARLY. IF YOU DON’T IGNORE IT,
YOU CAN IMPROVE YOUR OVERALL CHANCES IMMENSELY. SO REMEMBER:
1. HIGH BLOOD PRESSURE IS A SILENT KILLER AND DISABLER.
2. THERE ARE NO RELIABLE SIGNS OR SYMTOMS OTHER THAN AN ELEVATED BLOOD
PRESSURE.
3. SIGNS AND SYMPTOMS ARE A LATE INDICATOR OF THE COMPLICATIONS RELATED TO
HYPERTENSION.
4. HAVE YOUR BLOOD PRESSURE CHECKED REGULARLY, EVEN IF YOU FEEL FINE.
5. IF YOUR BLOOD PRESSURE REMAINS OVER 140/90 UNDER NON-STRESS
CONDITIONS, SEEK MEDICAL ADVICE.
6. MODIFY YOUR DIET TO AVAID SALT AND FATS, EXERCISE MODERATELY AND WATCH YOUR
WEIGHT.
7. TAKE PRESCRIBED MEDICATIONS AS DIRECTED AND DO NOT STOP UNLESS
ADVISED BY YOUR PHYSICIAN.
8. CONTINUE TO CHECK YOUR BLOOD PRESSURE REGULARLY NO MATTER WHAT.
THE ABOVE ARTICLE IS FOR INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED TO PROVIDE SPECIFIC TREATMENT
RECOMENDATIONS. SUCH RECOMENDATIONS CAN ONLY BE MADE AFTER AN INDIVIDUAL HAS BEEN EXANMINED BY A
QUALIFIED MEDICAL PROFESSIONAL.
CHARLES MICHAEL BRIGGS, M.D.
APRIL 1997
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Answer
Thank you for the response. Great info.
Charles Cox
Answer
Very Welcome. -->
Keeping you safe, healthy and on the road.
Visit us at
_________________
Keeping you safe, healthy and on the road.
Visit us at