Low blood pressure

[Eddie.]

Thanks guys for keeping the thread alive.

I'm already doing salt caps, but it only seems to temporarily increase it, and fuck, it makes me retain much more subcutaneous water.

That's my BP right now, but it shouldn't be an issue, because from what I understand, what is meaningful is the MAP, which is at 64.

View attachment 298580

By the way, it’s because I’m taking 5mg of Nebivolol in the morning and 40mg of Telmisartan in the evening. I’m doing it to prevent LVH, and without Nebivolol, Trestolone makes my resting HR shoot up to almost 90-100.

Maybe I should lower the Telmisartan dose to 20mg instead.

IMO that diastolic looks dangerous, i would drop the telmisartan completely. Nebivolol is ok if you're dealing with high RHR but taking a blood pressure medicine proactively while it might cause you problems by itself i don't think it's a good idea.

R u taking magnesium? That will lower your blood pressure and you might be sensitive to it.

Also if you have big arms those blood pressure machines can be off by as much as 30 points.

Yes i'm taking 500-750mg before bed but it doesn't reduce my BP. I had the same BP before i started magnesium. My arms are 18,5-19in but i've bough an extra XXL cuff which goes a long way. I think this could be an issue if you're fat. My arms are lean and veiny, i think it's not that difficult to find the pulse and get a right measure.

 

[buck]

As a side note, medical error seems to be the 3rd leading cause of death in the US, i don't always go with what modern medicine tells me what i should be doing. I interpret the data and take responsibly for my choices.

Your Health Care May Kill You: Medical Errors - PubMed

Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death. Error rates are significantly higher in the U.S. than in other developed countries such as Canada...

pubmed.ncbi.nlm.nih.gov

 

[Ghoul]

As a side note, medical error seems to be the 3rd leading cause of death in the US, i don't always go with what modern medicine tells me what i should be doing. I interpret the data and take responsibly for my choices.

Your Health Care May Kill You: Medical Errors - PubMed

Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death. Error rates are significantly higher in the U.S. than in other developed countries such as Canada...

pubmed.ncbi.nlm.nih.gov

It's important to note they aren't referring to errors emerging from "Best practices as established by high quality evidence over long periods of time, endorsed by organizations dedicated to excellence and advancement in their field.", but the nurse giving you the wrong meds.

It's far more likely the typical primary care provider inflicts harm by failing to update his knowledge with guidelines like these than by following them.

I only mention this because otherwise it gives license to "feels" based medicine.

 

[buck]

It's important to note they aren't referring to errors emerging from "Best practices as established by high quality evidence over long periods of time, endorsed by organizations dedicated to excellence and advancement in their field.", but the nurse giving you the wrong meds.

It's far more likely the typical primary care provider inflicts harm by failing to update his knowledge with guidelines like these than by following them.

I only mention this because otherwise it gives license to "feels" based medicine.

And for years BP and glucose levels far higher then now and were the accepted standard for normal ranges even though healthy ranges show something different even decades ago. Just because it is endorsed by the powers that be does not mean it is best practice. Only acceptable practice as i see it.

Yes they are talking about actual errors that are made, including wrong meds prescribed or given etc.. and not using errors from the accepted practice even though science often shows those practices are not the best. If we added accepted practices in that are not actually the best practice the rates would have to be far higher. I have been misdiagnosed on more then 1 occasion with Dr using the their best judgement. And the errors that are made in surgeries are far from rare. As i can attest. And the list goes on.

 

[Ghoul]

And for years BP and glucose levels far higher then now and were the accepted standard for normal ranges even though healthy ranges show something different even decades ago. Just because it is endorsed by the powers that be does not mean it is best practice. Only acceptable practice as i see it.

Yes they are talking about actual errors that are made, including wrong meds prescribed or given etc.. and not using errors from the accepted practice even though science often shows those practices are not the best. If we added accepted practices in that are not actually the best practice the rates would have to be far higher. I have been misdiagnosed on more then 1 occasion with Dr using the their best judgement. And the errors that are made in surgeries are far from rare. As i can attest. And the list goes on.

I can only assume you haven't read my journey from broken neck and decades of misery before me to the operating theater of one of the top 10 neurosurgeons in the world for what was at the time, a procedure under clinical trial, so you're preaching to the choir:

One must always be their own advocate.

My point is that usually, general practitioners (and most specialists frankly) are far behind the latest thoroughly endorsed standards, which are relatively conservative.

Medical practitioners rarely advance far beyond the education they left medical school with, in my experience.

People here are more prone to seeing the latest, well supported standards for lower blood pressure, and then a reference to "medical errors" and I don't think they're thinking "those guys are behind the times" because they want to pursue something more cutting edge, but rather "meh, what do they know, my BP is 130/90 and I feel fine, these quacks don't know what they're talking about."

 

[buck]

I can only assume you haven't read my journey from broken neck and decades of misery before me to the operating theater of one of the top 10 neurosurgeons in the world for what was at the time, a procedure under clinical trial, so you're preaching to the choir:

One must always be their own advocate.

My point is that usually, general practitioners (and most specialists frankly) are far behind the latest thoroughly endorsed standards, which are relatively conservative.

Medical practitioners rarely advance far beyond the education they left medical school with, in my experience.

People here are more prone to seeing the latest, well supported standards for lower blood pressure, and then a reference to "medical errors" and I don't think they're thinking "those guys are behind the times" because they want to pursue something more cutting edge, but rather "meh, what do they know, my BP is 180/90 and I feel fine, these quacks don't know what they're talking about."

I totally agree with you. I have had to call Dr to intorm them they prescribed the wrong dose. Had the same thing happen to my mother as well as wrong medication. My previous point was it is just not nurses making a mistake.
The best Dr in the world will make errors on occasion we all do. I do not blame them for some of their mistakes. I was a professional and was known to make mistakes at my job too. Everyone is human.

Dr.'s also have to do what is accepted even if they think the standard is wrong or they open themselves for lawsuits. I have had that conversation with them and they have laughed and agreed with me. I tell people all the time Dr. give opinions i make decisions.

My post you commented on was just 1 more time i was letting people know they need to be in charge of their health care.

 

[NotHuman]

Thanks for sharing, really fresh of the presses. Notably, it's from the European Society of Cardiology. The American guidelines still specify <80, which is also what I would go with based on the totality of the evidence. But I'm sure that even the wacky Euros would acknowledge that a diastolic that is too low (certainly <60) is harmful in most cases.

I came across this 2021 meta analysis saying low diastolic isn’t related to CVD mortality. Not as new as the 2024 study just posted but it’s a pretty large cohort. What’s your opinion here? You may have seen this before.

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049819

 

[MyNameIsJeff]

I came across this 2021 meta analysis saying low diastolic isn’t related to CVD mortality. Not as new as the 2024 study just posted but it’s a pretty large cohort. What’s your opinion here? You may have seen this before.

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049819

Good to see you over here NotHuman!

I have to admit that I'm not familiar with Mendelian randomization analysis. Seems to be an instrumental variable regression where the instruments are genetic variants. So there's a whole discussion to be had about instrument strength and validity. If done correctly, it would be powerful. But considering how novel the methodology is, that's a big if.

When statistical methods disagree, it's always good to rely on a theoretical model. In this case, we know that cardiac perfusion happens during the diastole. Below a certain threshold of diastolic pressure, there will be hypoperfusion, resulting in damage to the heart muscle. That diastolic pressure threshold may be crossed without symptoms like lightheadedness appear. An indeed, the empirical evidence is in line with this theoretical model: The lower the DBP, the higher the level of cardiac troponin T, which is a marker of damage to the heart muscle.

DBP<60 is particularly harmful for those with atherosclerosis (whether it be soft plaque or calcified plaque). So if a CT coronary angiogram shows no plaque, and your hs-cTnT levels are normal, your low DBP should be fine. But if you do not have that information, then pay up to get it. Or consult a cardiologist to adjust your BP medication until you are above a DBP of 60, and preferably 70 (if systolic can be kept below ~135, see discussion on ISH).

https://www.sciencedirect.com/science/article/pii/S0735109716349221