I am a 35-year-old male scientist working in India. I first
realized that my BP was on the higher side in January 2015. I had flu like
symptoms and was feeling a bit dizzy. A medical officer at my work place
checked my BP using manual BP measuring instrument at his clinic and it was
around 140/100 mm Hg. One week later I
measured it again at the same clinic and it was 146/102 mm Hg. Over the next few weeks I occasionally used
to go to the clinic for measurements (randomly at different time of the day
when in office) and it was always around 140/100. In March, I took advise from a couple of
doctors. I was advised to get an ECG, echo, USG whole abdomen, lipid profile
and haematology tests done. The reports
are attached below.
ECG
USG whole abdomen
Haematology
echo reports were
normal (not included here)
My first doctor prescribed the anti-hypertension drug
(Telma-40). I however after talking to several colleagues and taking advise
from another doctor over phone decided not to start the medicine and started
walking for an hour in the morning and reduced my salt intake. In the meanwhile
I kept monitoring my BP. Over a month I saw a small reduction in the levels
136/96. I discussed the situation with another doctor in May who advised
diuretics (Chlorthalidone CTD-12.5). I started taking the diuretic one per day.
In a week my BP was lowered to 126/86. However I started to feel very tired
very soon. This was in the months of May- June.
In July I consulted another doctor (highly recommended by several of my
colleagues). He asked me stop the medication and to undergo an ambulatory BP
check up two weeks after all the residual diuretics were flushed out of my
body. In the first week of August I got the AMBP report that is attached below.
Ambulatory BP
Based on these results my doctor asked me not to panic and
to continue with my exercises and diet control. At the moment I am not taking
any medication. I am continuing my morning walks (recently been irregular
because of rains). I generally feel ok but get tired while climbing steps and
picking up my 3.5 year old daughter. That is it for now, will keep updating.
Dear patient- please start taking your medication and stop doctor shopping. You clearly don't want to hear any advise except your own.
ReplyDeleteTabula rasa forum processing of this patient-data:
ReplyDeleteComment by Rakesh Biswas: Thanks for building up the discussion and adding more inputs. Unfortunately you may not find a lot of humans who would like to take medicines from the age of 35 till the age of 70. How many of us would like to do that with our own stage 1 hypertension would also depend on how much we have managed to scare ourselves of the impending life and complicated death due to hypertension? I needed some technical advice to help decide if the interpretation of the Ambulatory BP monitoring is right in concluding this is stage 1.
August 10 at 7:31am
Priyank Jain What is the NNT for patient with Stage 1 and Stage 2 HTN?
August 14 at 7:42pm · Unlike · 2
Priyank Jain I wonder if guidelines should include shared decision making, and risk communication as part of the recommendations, and having easy to understand risk (NNT) would be helpful in decision making for individual patients.
August 14 at 7:44pm · Unlike · 2
Rakesh Biswas Thanks Priyank, Your NNT question is pretty intriguing and would require some heavy searching from interested team members (Vasumathi, Bhavik) and the answer to it would even help our guideline development committee. Also Priyank would you be able to help find someone who can interpret the Ambulatory BP monitoring results for this patient and conclude firmly that this indeed represents Stage 1 hypertension?
7 hrs · Like
Vasumathi Sriganesh Here are five PubMed references - where the abstract discusses Stage 1 hypertension and NNT
http://www.ncbi.nlm.nih.gov/pubmed/... ...See More
24016209 19300109 19124429 10679494 9717855[uid] - PubMed - NCBI
NCBI.NLM.NIH.GOV|BY PUBMEDDEV
5 hrs · Unlike · 1 · Remove Preview
Rakesh Biswas Thanks Vasumathi, Priyank this paper http://www.ncbi.nlm.nih.gov/pubmed/10679494 has the NNT answer to your question.
Long-term absolute benefit of lowering blood pressure in hypertensive patients...
NCBI.NLM.NIH.GOV|BY OGDEN LG , ET AL.
31 mins · Like · 1 · Remove Preview
Vasumathi Sriganesh Glad that it helped! Looking forward to knowing about how it has helped handle the case
18 mins · Unlike · 1
Rakesh Biswas Thanks Vasumathi, It helps just in terms of numbers i e 81 patients like him would need to be treated for one patient to benefit in their group i e those with stage 1 hypertension with no risk factors while for those like him with stage 2 hypertension 60 people would need to be treated for one of their group to benefit. Priyank, Amy it perhaps helps to think that even if he turned out to be stage 2 (supposing we have not interpreted his Ambulatory BP results right) it is not a major difference in terms of NNT?