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Question about blood pressure

constantprayer
Posts: 18
Joined: Jul 2012

Happy New Year to all!

I have a question about high blood pressure.  I was a little hesitant to post my question, because it seems trivial when placed along side some of the struggles I read about on this site.  But this site has been so helpful to me and I was hoping to ease my concerns.

My radical nephrectomy was done in late August.  Right kidney removed.  Stage 1 RCC, clear margins.

I had my 3 month checkup (labwork and chest xray) and the urology doctor says all looks good.

My question is this... I go this month for more blood work that will be sent to my nephrologist.  If all looks good I don't have to see nephrologist again until April.

In my initial appointment with the nephrologist, I was told to watch my blood pressure.  I was told that it should be maintained at 120/60 with low protein or 130/60 with protein.  I am on blood pressure medicine that has kept it within these margins.  But in the past few weeks, my blood pressure has been creeping up... for the most part hanging out around 158/66.  I'm not sure if I should worry about this or leave it alone.  If I understood right, high blood pressure is hard on my remaining kidney.  But I don't know when to be concerned about "how high".

There are some very experienced people on the board and I was wondering if you could let me know if I should even be concerned.

Thanks in advance for your help.

 

icemantoo's picture
icemantoo
Posts: 1453
Joined: Jan 2010

Three main things contribute to chronic kidney disease which is adverse to your kidney as well as your heart. The first 2 are the fact that you are getting older and that you have lost some kidney function as a result of your neprectomy. The third is high BP which the Nephrologist will monitor more closely than your GP. Unfortunately recurrance is not the only thing we have to be concerned with. Anything much over 120/80 is high.

icemantoo's picture
icemantoo
Posts: 1453
Joined: Jan 2010

Three main things contribute to chronic kidney disease which is adverse to your kidney as well as your heart. The first 2 are the fact that you are getting older and that you have lost some kidney function as a result of your neprectomy. The third is high BP which the Nephrologist will monitor more closely than your GP. Unfortunately recurrance is not the only thing we have to be concerned with. Anything much over 120/80 is high.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

No need to be shy about posting your question and high blood pressure is a serious concern.

You've not put any information at all about yourself on your "About Me" page and I can't easily find anything that tells me about your age, gender, pathology, or anything else that would help in attempting to try to answer your question.

Do you have kidney disease?  If not, why are you seeing a nephrologist? Did you have a BP problem before your dx of RCC? What was your BP before your diagnosis?  Were you on meds for it at that time?

It's always sensible to maintain good blood pressure levels but are you sure your nephrologist said 120/60 and not 120/80? 120/60 sounds like odd advice to me.  What does "with protein" refer to?

Are you monitoring your BP yourself? If so, are you using a wrist or an arm monitor? How often do you take measurements? At the same time every day? Are you ensuring that it's taken when you haven't had a meal, or coffee, or alcohol, or a hot bath within the previous hour or so, and that it's with an empty bladder?

You're correct that high blood pressure increases the burden on your remaining kidney - undesirable.  Of course, perhaps more importantly, it increases your risk of heart attack and stroke.  So you are right to be anxious and 158/66, if accurate, is something you should be seeking consultation on.  Both the systolic and pulse pressure are higher than one would wish so do pursue it with your medical advisers - don't panic about it but do seek advice.

 

 

 

adman's picture
adman
Posts: 257
Joined: Jul 2012

Mr. Wedge,

Are you saying that a 'wrist' monitor is less accurate than a regular 'cuff' monitor?
I'm only asking b/c I was just thinking that I was going to get one for when I travel.
I take my BP at home 3-5 x's/ week with a regular 'cuff' model.

I regards to your post about a 158/66 reading being too high. I'm not an MD but the '66' portion seems fine to me. Is the smaller # the diastolic?

Mine last night laying in the chair was - 99/58
Usually at the doctor it's around 130/70-80

Thanks.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

M, when you say "cuff", I'm assuming you're referring to the one that goes round your upper arm.  The wrist type also has an inflating cuff, but of coursa it's much smaller.  (There are new kinds under development that are like wrist watches but I don't suppose any have yet been seen. )

Generally, the current crop of digital brachial sphymomanometers (that is the arm-cuff type) are more reliable than the radial (wrist) ones, but it's a matter of conjecture, and ripe for serious research, whether arm and wrist types actually give different information about your circulation.  If you use a wrist one, you must use it on your left wrist - closer to your heart, whereas with the arm type the medical cognoscenti say you should measure on both arms, since a significant difference is warning of peripheral vascular disease (PVD).  PVD is usually asymptomatic so this could be important.  The manufacturers tend to recommend you measure on both arms, and thereafter stick to the arm on which you got the higher systolic reading (the top number).

If you buy one of the modern digital types, not the old rubber bulb and dial kind, you not only get a better measure, but also they are compact and normally come with convenient zip bags, or such like. so they're no more cumbersome than a toilet bag, when you're travelling.

As regards measures, it's a bit hit and miss and people are inclined to make too much of single measures.  Doctors and nurses know better but most of them don't know all that much about it.  Often measurements are taken with no regard to what the subject has been doing beforehand, with a cuff that is too small or too large, 'isn't positioned correctly, isn't with the correct tension, is taken with either the patient or the doctor/nurse talking (both should be silent) etc etc so the reading is pretty nearly worthless.   A once-in-a-blue-moon measurement is therefore pointless.  However, I'm sure a lot of people will regard you taking yours 3-5 times a week as the behaviour of a hypochondriac (which you probably are at present!).  For the whole of last year I took mine daily, sometimes several times in the same day, with one radial and two brachial monitors, with rotating order among them and have written records of all those measurements.  D.V.  I'll be able to analyse the data and draw some tentative conclusions, which I'll publish for comment from people knowledgeable and interested in the topic.

It may turn out that I'm unrepresentative of any population, and it may turn out that I'm getting indications of high risk of doom but I find my pressure varies considerably most of the time - my systolic pressure can change by 20 points in five minutes when sitting quietly in the same position.  Sometimes systolic will vary while diastolic remains constant and vice versa.  A hard workout reduces both systolic and diastolic substantially.  All of which makes a single reading, under uncontrolled conditions once or twice a year pretty silly (or at least one shouldn't exaggerate the reliability of the information received).

Your measurement at the doctor's of around 130/70-80 sounds ideal.  In Europe, the level that's considered good is a little higher than in America (where, my guess is, there's much more hard sell of expensive and often unnecessary medication).   It's possible to have too low a blood pressure - also not at all good for you.  Yours at home is fairly low but you spoke of it as taken lying down?  It is best taken sitting upright, on a chair with a back, relaxed, with both feet flat on the floor and the monitor at the same height as your heart.

The measurement of 158/66 isn't very healthy - systolic is around 30 points too high and diastolic too low, by comparison.  The difference between the two is important and shouldn't be too large.  "High" BP means too high a figure for EITHER systolic OR diastolic (or both).  Just like stage and grade in RCC, there are recognised categories of elevated BP with climbing rates of increased mortality from something like 130/85 and markedly higher risks at, say, 160/100.

Not many people are aware that the significance of the measurements changes very considerably with age.  When younger, the diastolic figure is the one to watch; approaching age 60 or so, the systolic is more diagnostically important than the diastolic and from then onwards, while elevated systolic or diastolic are still important, the clinically most indicative figure is the 'pulse pressure', which is the difference between them.  If a good BP is around 120/80 - a diff of 40, the figure we mentioned above 158/66 is decidedly unhealthy, with its high systolic and low diastolic and a difference of 92.  Actually, there a higher diastolic number would be healthier, although, ideally, a fair-sized reduction in the systolic would be far preferable.

Recent research continues to throw new light on blood pressure, about which medical science knows surprisingly little.  For instance, it's usually been thought that if you get a wildly high reading you should consider it unreliable - maybe an artefact of unreliable technology or sloppy measurement - and take it again a few minutes later and treat that reading, if it's much lower, as the "correct" one.  It now seems more likely that they were both correct and your BP spiked, which is something to worry about since it betokens greater susceptibility to cardiovascular problems aand, in particular, stroke.  In fact, it's one parameter to be taken into account in choosing type of BP medication because, for instance, beta blockers, in particular, tend to increase the variability in a patient's blood pressure.  The best meds are those which keep your Bp more on an even keel.

This may go a bit beyond what you asked about but still, some of the above may interest someone else, if not you.

 

 

adman's picture
adman
Posts: 257
Joined: Jul 2012

..much appreciated.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

M, as a footnote to what I said above, I can add a little more personal experience from my appointment with my oncologist yesterday. 

As you may have picked up, I'm in north-east Scotland in a location that is one of the top three cancer research centres in the World but where, ironically, the range of treatment options for patients is woefully limited, due to our tiny population size (c. 5.5m.)  However, the treatment I'm receiving from our NHS is exemplary in every way

My appointment ran for (I didn't check) about an hour or so.  Prior to my seeing my onc, I had a session with a nurse standing in for my regular cancer nurse who was on leave.  She was very friendly and effervescent, introduced herself with appropriate pleasantries, sat me down in a comfortable armchair and asked whether I would prefer tea or coffee.  She then took my blood pressure. I asked, on which arm and she said I could choose.  I commented that the received wisdom now is that it should be taken on both arms but that I always take mine on the left, these days, so "let's make it the right".  She used an appropriately sized cuff, placed it properly, tensioned it suitably and then started asking me about my well-being since my last appointment, while the monitor was operating.  I grunted in reply to some enquiries and then pointedly stared at the digital screen readout lest she should think me rude, or odd, in not responding to her enquiries. 

The reading came out at 160/90 with pulse at 66.  My resting pulse is usually below 60 at the present time.  I said I was surprised at this but that it was, maybe, understandable, since I'd just been driving for 3/4 hour, then limped painfully (due to pulled back muscles from shifting some heavy logs and playing golf, rowing...) for some distance from the car park and tramped through the huge hospital. I also gently remarked that BP measurements should really be taken with neither patient nor nurse/doctor speaking.  She took the point and said she would take it again in a few minutes, when my system had settled down a little more. 

We then talked through my record card of the side-effects, etc  I've been having (none of the 15 on the record card, other than pain, but some minor unlisted ones).  This took a little while, while I enjoyed the tea and cake supplied and she took my BP again: right arm at 147/85 and then left arm at 140/87. 

In the following discussion with my onc, with the nurse also in attendance, my onc said she would only start getting concerned if my BP were over about 150/90.  (She regards my own monitoring of my BP at home as more dependable information than the hospital measurements and knows that that is giving no cause for concern.)

As a reflection on this,  perhaps two individual factors should be borne in mind.  The first is that I'm 70 and have a very dire prognosis - stage 4 grade 4 metastatic, necrotic, sarcomatoid chromophobe - incurable with any therapy currently known to medical science.  So (as my GP also thinks) in view of that, other matters, such as slightly elevated BP are the least of my worries since I wouldn't be expected to last much longer anyway, in the ordinary course of affairs.

Funnily enough, the other factor is that, despite the above scenario, I'm generally living as though I don't have cancer - the tumour pain is manageable and actually diminishing since I started on Votrient and I have virtually no side-effects from the treatment (BP under control with a pill).  I continue with golf, several rounds a week (winter weather permitting), hard workouts on my rowing machine and normal domestic and other daily activities.  In fact, I have no compromises of normal lifestyle, other than not being able to run at the moment  and that's just due to an arthritic knee problem, which will probably debar my hoped-for resumption of running marathons :-( Accordingly, on the 'if it don't seem broke, don't fix it' principle, we aren't going to get too bothered if my BP is slightly higher than it was earlier in life.

adman's picture
adman
Posts: 257
Joined: Jul 2012

Mr. Wedge,

 

If you're nothing, you are a great and very entertaining writer, for sure. Thank you!! Your commentary is always comforting and creative.

Your little corner of the world seems like a wonderful place to live. Wish I could visit, sounds simply marvelous!!

Keep swinging....~M

 

 

 

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

You're right Michael - if I couldn't write I'd be nothing and Scotland is a great place to live. Hope you may visit some time. Do you play golf?- I forget whether you've ever said.

adman's picture
adman
Posts: 257
Joined: Jul 2012

....play golf, although, 'seaside' or 'dune' courses like what Scotland is typically known for are just a little more challenging than my skills usually allow. With that said, a very wise man once said these words to me..."A bad day on the golf course is always better than a day in the office". 

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