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High Blood Pressure

Exertional Diastolic Hypertension

10/12/2009

Question:

I am 51 years of age and seem to have an increase in diastolic values either on exertion or during normal activities. At rest my BP value returns to somewhere around 120 to 130 over 80 to 90. My pressures have been as high as 140/104, with and increase in pulse rate during normal daily activity. I am very fit, do not have a familial history of heart disease, don`t smoke, drink in relative moderation and have a 12-lead that is completely unremarkable. I do not experience any chest pain or headaches. My cholesterol is high, but i am taking steps to lower it utilizing grape seed extract combined with niacin bound chromium, as well as omega-3 supplements to increase HDL`s. I will only take statins as a last resort. I have taken steps to decrease sodium intake and take potassium supplement with co-enzyme Q10. My question is this; why the increase in diastolic values coupled with and mild increase in pulse rate during normal activity where i don`t believe any existed before, and what risk does this present? I was never diligent in watching my pressures, as men in my profession tend to think they are "bulletproof" when it comes to medical problems, so i don`t know how new this condition is.

Thank You in advance

Answer:

You do not have to be concerned about your diastolic blood pressure.  The diastolic pressure is not closely related to risk in people over age 50.  The best correlation with risk has been seen with the pulse pressure (the difference between the systolic and the diastolic pressure).  That means that at any given systolic pressure, the lower the diastolic the greater the risk.  As long as your systolic pressure is around 120 to 130, you do not have to treat it.

A normal resting heart rate should be between 60 and 100, but it is better to have a pulse closer to 60.  Usually, regular exercise and avoiding coffee can lower the resting heart rate.  In the absence of heart disease, a variable pulse rate is probably harmless.

Regarding your high cholesterol, statins are by far the most efficient drugs to lower LDL.  They are safe and well tolerated by most patients.  However, statins are not very good at increasing HDL cholesterol.  For low HDL, weight reduction, exercise and weight loss (where appropriate) work best.  Niacin can raise HDL by 15 to 25%, but sometimes causes flushing.  Fibrates (like fenofibrate) can also help increase HDL by about the same amount.

Fish oil lowers triglycerides, but has little effect on HDL cholesterol.  A high potassium intake can lower blood pressure by a small amount.  The usefulness of coenzyme Q10 is unproven.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati