View Full Version : Medications--Hypertension and Type II Diabetes

August 2nd, 2013, 06:15 PM
I've been diagnosed with mild hypertension and borderline diabetes, both a few years back. I've been on Metformin for about two years and my HGA1C is down to 5.7. After being on Micardis 40 mg for several years and having my pressure back in the normal range, a doctor (not my regular doc) suggested I try doing without it for 6 months. My pressure used to be about 140 over 90 w/o meds, but I think from having started swimming regularly some 14 months ago, I have brought it down to an average (resting) rate of about 135/73 (with a resting pulse in the 65-74 range). I went back to my regular doc and he wants me to go back on the BP meds, because he believes in an "aggressive" approach and says it is still too high. He also says that Micardis will help protect my kidneys.

I am wondering two things...
1) Should I always and everywhere listen to the doc...or get a second opinion. What will the meds do to my swimming times? Positive or negative effect...or does it differ from person to person? Anyone with any experience with this?
2) If my bottom number is already as low as 73, I am wondering how safe it is for it to possibly go down another ten points.

BTW...I am 55.

August 2nd, 2013, 11:11 PM
I've quite a bit of experience in this area, as I'm an internist. Several thoughts. First, great job with lowering both your glucose and BP; hope you've enjoyed the process of getting fit and feeling well.
Your current pressures are probably fine without medication; you're on the fence. I'd wonder what your urine protein is; if its up at all, you should go back on a low dose of Micardis. If not, you could do without it. Many of us thought that pushing bp down lower would always be better, but excellent clinical trials reported in the last few years show that this isn't the case. Still, I'd doubt the Micardis will affect your swimming if you do restart it.
Whether to trust one physician or always get another opinion is the toughest question. You obviously want someone who is willing to listen to your preferences and input before making a final decision.
Good luck, and keep swimming!

August 3rd, 2013, 01:27 PM
I realize there are a couple of additional thoughts I should add.

First, do you have a validated blood pressure cuff you can use at home? It should be an arm cuff (not wrist or finger). It should be big enough for your arm (many adults need large or extra-large). For many of use, home readings differ from office readings. The medical (and specifically the Hypertension) community has come around, finally, to recognizing that home readings if valid provide a better basis for making decisions about treatment.

Which leads to your question which I didn't address before: Is it safe to go below 73? The answer is maybe not, particularly if your home readings are lower still. As I alluded to in my earlier response, its quite possible to go too low. It strikes me that at this point if you re-institute Micardis with the goal of protecting your kidneys, you're going to need a lower dose. And thus you should monitor it to be sure it doesn't go much below 70 on average.

August 5th, 2013, 10:34 AM
Thanks, that was very helpful. Gary

jim thornton
August 8th, 2013, 11:18 AM
Tom, I am semi-self-diagnosed with ISH, or isolated systolic hypertension. My upper number, in other words, is high-ish (140 plus on various occasions), but my lower one is usually in the 70s. My resting heart rate is in the low 40s, occasionally high 30s. My family doctor, who I go to every 6-7 years, told me not to worry about it and to quit testing myself on those drug store bp machines. I have taken his advice and basically done my best not to worry about it. What say ye? BTW, my friend/teammate switched from old beta blockers to these new, much more selective ones, and he's found they control his BP quite well without the drastic limiting of his heart rate of the older pills. In practice, he used to be unable to get his heart rate up to 120; on the new med, he is up to 140 and feels he can work a lot harder. The med he takes is Bystolic (nebivolol), which is a cardioselectivebeta blocker. What this means, essentially, is that it dilates your peripheralblood vessels to lower blood pressure (which you want!) but it does NOT limityour heart rate the way older generation beta blockers do.

August 8th, 2013, 05:56 PM
A few nights ago I listened to a WHYY (Philly public TV) show (and fundraiser) featuring a Dr. Fuhrman, who happens to be from UPenn. the discussion was about micronutrient rich diets and their impact on health. His website is here: http://www.drfuhrman.com/default.aspx. Click into the reverse disease tab. This is a quote from the website:

"Thousands who have recovered from their medical problems have been calling Dr. Fuhrman‘s EAT FOR HEALTH program a medical miracle. They are not just talking about the people who successfully lost weight after failing for years on one diet after another, but about the diseases, such as heart disease, high blood pressure, diabetes, allergies, asthma, autoimmune illnesses (including lupus) and headaches which they have witnessed simply melt away."

He isn't trying to sell anything and even if it doesn't work for you, it's kind of a "Pascal's Wager" and can't hurt. This might allow you to reduce or eliminate medications and certainly seems to promote more viable longevity.

I believe one should certainly listen to what a medical doctor indicates. But, no single doctor is all-knowing, so seeking out a second opinion, especially on a serious issue, at least in my experience with family and friends, has been very valuable -- dramatically impacting life and quality of life. We are lucky in Philly to have a large number of highly ranked medical teaching hospitals to consult when needed. NYC certainly provides the same advantage.

August 8th, 2013, 11:21 PM
I don't prescribe Bystolic myself, but it might turn out to be a worthwhile alternative. I have a new found appreciation for the effect of beta-blockers, having taken one for a couple of months after my little health care adventure last year. While my wife likely appreciated that I could sit still and speak slowly, I felt like my tape speed was about 1/3 normal. There are some who definitely benefit from this effect (performance anxiety, migraine,...) but for most, hypertension can be controlled without the unwanted effects. And for someone with diabetes, you'd definitely want to start with either an ACE-inhibitor or an ARB.

As for your readings, they don't sound troubling. And I'd re-emphasize my skepticism for non-validated readings.

There is a very large body of sound research on how to lower blood pressure by lifestyle modification. It is both feasible and healthy. The hard part is that we have to consistently change our habits.