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High Blood Pressure

Blood pressure and pulse pressure

10/10/2008

Question:

I was recently told that I was prehypertensive with a blood pressure of 135/93. A week later I went to donate blood and had a blood pressure of 108/93 (before donating). I frequently feel light-headed when standing from a seated or laying position.

My basal pulse is 40, and even during the day it seldom goes above 50. Is it likely that the higher blood pressure readings are erroneous? I thought that my slow pulse together with my PVC`s and skipped beats (noted by my physician) might be making it difficult to get an accurate reading. Nurses often attempt to get a reading within 10 seconds, where I can often go 5 seconds without feeling a pulse.

I am 46 and feel like I am living through a continuous all-nighter. I am rapidly losing muscle strength and slowly losing endurance. They are calling it chronic fatigue. Last year I was cycling 150 miles per week. This year I have to walk it up hills. Can this possibly be related to prehypertension?

Answer:

Prehypertension (a blood pressure between 120 and 139 systolic and/or a diastolic pressure between 80 and 90) is generally asymptomatic and benign.  It is not clear when treatment for hypertension should be started, but most experts recommend to hold off with drug treatment until your blood pressure reaches 140/90 or higher.

Your low heart rate is probably due to the fact that you used to exercise and is unlikely to cause problems.  You are right that anyone measuring your blood pressure has to give the cuff enough time to deflate to account for the slow pulse.

You complaint of increasing fatigue and inability to exercise should be taken seriously.  If it was not done already, you will need a good history and physical exam, and some basic lab tests, including a blood count, thyroid test, echocardiogram and possibly a more detailed work-up.

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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