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Comment by llm_nerd | Hacker News Reader

I suffer from hypertension (which pushed as high as 170/120) and went through a period where I was measuring my blood pressure many times a day to try to essentially hack what the problem was to try to find a natural solution.

What I learned is that, for me,

-salt intake had zero impact

-coffee had no impact

-stress level had almost no impact

-alcohol had no impact

-exercise / activity levels had no impact

The single and only controllable factor I could find, short of drugs, was that if I was cold my blood pressure spiked significantly. I had much higher BP in the winter than in the summer, and could improve it by wearing layers, gloves, etc.

My body decided to go full ham on blood pressure and it was destroying my kidneys. I would be constantly annoyed by the sound of my own heartbeat doing things like trying to sleep.

Telmisartan + Caduet (which is amolodipine + lipitor) and now my blood pressure averages 100/60. And courtesy of the lipitor my cholesterol and triglycerides dropped 60%, from high to normal. Many thanks to the very brilliant people who work in that field and developed those drugs.

Anyways, thanks for coming to my TED talk on the magic of modern medicine.

View on HN

Mmm.. I have been measuring my blood pressure for 5 years, twice a day, and I can't say I agree with you.

- Coffee increases systolic by 15 mmHg for 6 hours, so does smoking.

- Lisdexamphetamine (I am diagnosed ADHD) decreases BP by 10 mmHg

- Good sleep for 5+ consecutive days decreases BP. One day isn't enough.

- Rebound hypertension when forgetting my BP meds is a thing. +10 mmHg the next day.

- Low carb diet decreases BP steadily after the first week or so, especially if your metabolism is out of whack (understandable due to the deleterious effect of fructose on nitric oxide production)

- Amateur BP readings (wrong time of day, single measurement, not relaxed enough) can add 30 mmHg easily. Readings taken at the GP's office are worthless for this reason. My advice is measure every 3 minutes until your BP measurement stabilises. The correct reading is the lowest. Sometimes you need 15 minutes to reset to baseline.

- Also important is the delta between systolic and diastolic. Mine is around 40 mmHg, if it's higher than that, it's an indicator of a stress peak (bad sleep, bad day, overwhelmed) that usually resolves after a couple days.

Many people have very different responses to stimuli: Some people see a spike from salt. Many don't. Some see a spike from coffee, while others actually see a decline! I merely gave my own personal observations from my own rigorous monitoring/hacking regime. I found no "do this and improve nn mmHg" simple solution, beyond the stated observation about avoiding coldness. I have zero reason to disbelieve your own observations about your own carbon machine, however.

Some people will be like me, many others won't, but the real lesson is that there are no hard and fast quick fixes.

Certainly, but I'd like to see the methodology of your experiments if you're able to say that a stimulant like coffee doesn't do anything, nor exercise. It might not do anything in the short term, but I dare you to drink 3x your daily coffee intake and see if you can't see any change, or to increase/quit your fitness routine and whether it doesn't do anything over a year.

I have tracked by BP over 50 kg of weight change, and BP correlates really nicely with fitness level, stress, etc. even though trends are visible over months, not hours.

There certainly are no quick fixes, apart from taking a BP pill (I take telmisartan+amlodipine, the latter replacing a diuretic that made me drier than the Sahara desert)

I went a week with no salt (and serious minimization of dietary sodium), no coffee or caffeine of any sort, adjusted my sleep schedule to be idealized, no alcohol (although I was a minimal consumer already and now am a zero consumer), very little sugar or simple carbs, took potassium supplements, etc. After seven days my BP was just as insane. And while people always have a stereotype of people with hypertension, I've been very active and fit over my entire life.

I started donating blood -- some report it as beneficial to BP -- and the effect was extremely short lived for me and very minimal regardless. I still donate blood regularly now as I'm an O- and they remind me constantly.

People are different. Someone who has mild hypertension probably can tweak some lifestyle dials and control it. I had severe hypertension with nothing to point the finger at (e.g. obesity, lifestyle, etc). For whatever reason my body was malfunctioning and in a recursive death loop of escalating hypertension.

What is your diet? FWIW I'm in the same boat: both my parents have hypertension, one is a smoker, the other isn't, one is overweight, the other isn't. My mum has taken heroic hypertensive doses to keep hers at bay, for decades. I've been diagnosed with it in my 20s when I was fit as a fiddle... it must be a genetic component, though these days I do believe it's because of a diet too high in carbs than my genes can handle.

Have a look at the effect of fructose on blood pressure. Low carb seems to work well for me, but I'm not consistent enough to see my BP trend down to the point I can throw my pills away. I'm working on it.

And yeah, the entire salt scare is pretty much nonsense that's slowly being debunked. I have a friend who eats more salt than a goat, and he's got hypotension. Go figure. Hyponatremia is not fun, I tend to use salt liberally these days.

I was replying to another thread. I repeat here. My dad has hypertension due to [Conn's syndrome](https://en.wikipedia.org/wiki/Primary_aldosteronism). The only thing that helped tremendously was surgery.

You could of course argue that if he ate a ton of salt, his blood pressure would surge. But I wish he would've taken the surgery sooner rather than trying to out-diet and out-exercise his genetics as the diet/exercise had really small effect.

Isn’t being cold leading to an increase in blood pressure a well known physiological reaction to cold temps, that will spike BP but not be the under lying cause?

> many people have different responses to stimuli…

My favorite example of this is from figure 2g of [0]. It shows the time series of blood glucose levels from two participants after eating a cookie or a banana, and they have nearly the opposite responses to each other. It was the thing that convinced me that a ton of modern nutrition that isn’t personalized is basically useless.

[0] https://www.cell.com/fulltext/S0092-8674(15)01481-6

I'm sorry—30 mmHg?

Maybe I am misunderstanding, or there is something wrong with my own knowledge, but "30 mmHg" added to systolic seems extremely high.

I am currently an EMT-B student here in the United States, and taking vital signs like blood pressure is our bread and butter. We practice it several times a week, on different people with different body types and different blood pressure baselines. Anything more than ±4 mmHg in a manual reading is terrible accuracy, and anything like +30 mmHg probably comes from someone who doesn't know how to use the equipment.

But again, maybe there is something I am missing. If there is I'd love to be educated and hear about it!

It's not high if you don't know how to measure your blood pressure. Your BP increases a lot if you're moving around, and not properly rested.

When you're at the GP's office, you might have been rushing to get there, you do a minute of small talk and then they strap on a cuff and tell you "oh my, it's very high", this is the reason. And it happens so often it even has a name: https://en.wikipedia.org/wiki/White_coat_hypertension

I have seen dozen of times, because of effort, anxiety, whatever, my BP being 160/110, which drops to 130/85 after 15+ minutes of complete relaxation. Many amateurs (which apparently includes most GPs) simply do not let the BP settle. The medical value of tracking BP is to know its baseline at rest, otherwise it's a meaningless number.

Lisdexamphetamine decreased your BP? That's pretty wild. I specifically have to take by BP before my doctor's appointments to monitor it from going too high. This seemed like SOP for my doc.

If something increases heart rate, sometimes the body will vasodilate to compensate.

My heart rate doesn't increase with AMPH. It makes me calmer, which is literally why we're prescribed them.

Stimulants can act tranquilizing for some ADHD people.

And for some people, drugs like Valium act as stimulants. My dad had that problem. He also had two different medical conditions that were rare enough that they each got separately dramatized on "House, MD". When my mom passed away, I got a copy of his medical file. There were multiple binders, filling multiple shelves.

Just before our wedding, my dad had an crisis, and had to go to the hospital with an infection. He went to Johns Hopkins. They put him in the research wing. The doctors couldn't figure out what the heck to do with him because he was reacting so weird to so many medications. They ended up having to pump him full of vancomycin in hopes that he would last long enough on the three hour flight to get back home where his regular doctor could see him.

People are individuals, and their bodies can react in weird and unexpected ways.

Unmedicated ADHD causes a great deal of anxiety. Making your brain operate as intended reduces anxiety, which lowers your vitals.

That said, whether I'm oversensitive or more attuned than most ADHD people, I take a light dose, which doesn't turn me into a productive robot machine going 1000 mph.

Stimulants follow a U-curve, and I wouldn't be surprised to know that most people take far too much and have to keep increasing their dosage. A single 30 mg dose makes my anxiety skyrocket, I usually take 20mg twice a day, I've recently experimented with lowering to 15mg twice a day and I think I like it even better.

> Lisdexamphetamine (I am diagnosed ADHD) decreases BP by 10 mmHg

Vyvanse saved my life.

Pulse pressure, systolic-diastolic, is far more important clinically than I realized.

https://www.ncbi.nlm.nih.gov/books/NBK482408/#

Do you have a favorite device you use? I've been considering getting something "smart" to auto log my BP.

I have an "OMRON M7 Intelli IT" machine. It's a good brand.

Just to echo sph, get an Omron device. Don't waste your time and money with the many random brands.

Omrons are accurate and reliable, and most new models like the Silver have bluetooth and with the Omron connect app will share the data with Apple Health if that's your platform, or you can just keep it in the app and it gives you trends and insights.

I think the problem is that you've been measuring YOUR blood pressure, but you should have been measuring OPs blood pressure.

Maybe if you did that, you wouldn't disagree so much?

> - Also important is the delta between systolic and diastolic. Mine is around 40 mmHg, if it's higher than that, it's an indicator of a stress peak (bad sleep, bad day, overwhelmed) that usually resolves after a couple days.

Is this universally true or just you? Is there any source for this? My diastolic pressure is always in the normal numbers while my systolic pressure is borderline high, resulting in a pretty high delta (50-60 mmHg). Sometimes I also get numbers in the normal range for systolic pressure, but maybe 75% of the time it's a bit high.

Diastolic is the pressure at rest, systolic is the pressure during a heart beat. The reasonable explanation of a higher systolic than usual is your heart pumping more volume than usual. Usually and in my experience this means being anxious or not completely rested/sleep deprived.

The takeaway is that people vary hugely in their sensitivities and the different medical histories behind the same condition. I know someone who is extremely sensitive to salt, and even on BP meds, they must have quite a low salt diet to control their blood pressure. Even though it isn't much of an issue for others, it is for them.

Thanks for sharing publicly. May I ask if the Caduet has any side effects? I'm going through a similar issue. I know that my problem is alcohol, being overweight and middle age (40+). I'm also on Telmisartan which takes it down from 170/100 to about 135/85 on a good day which is still too high for my liking. I might try asking the doc for dual therapy on my next visit and Caduet sounds like a good candidate. My cholesterol also on the high side just outside of normal range! I know I need to lose 20-25lbs but I can't see it happening because of a combo of dad/work life.

>I know that my problem is alcohol, being overweight and middle age

The middle-aged part for sure, but I don't drink, I'm an ideal weight and have a mid to high level of fitness -- high cholesterol and a super high BP before medication. Sometimes it just be the way it is.

Caduet comes with a list of warnings, primarily courtesy of the Lipitor (atorvastatin) component. Periodic bloodwork is necessary to make sure there isn't liver damage occurring, etc. I've endured zero side effects of any sort, and my bloodwork has been stellar. With a 10/20 caduet (which means 10mg amlodipine / 20mg atorvastatin) my triglycerides fell from 2.63 to 1.06, cholesterol from 6.33 to 3.64, LDL from 4.23 to 2.2.

Was super surprised at the scale of the improvements.

What's your potassium level?

Potassium relaxes the walls of the blood vessels. It's a counterbalance to sodium.

Doctors will say 3.5 is fine, but there are several studies demonstrating that as you approach 4.5, the risk of cardiac events drop.

Doctors get very tense about potassium supplementation in fear of hyperkalemia.

But the RDA for potassium use to be ~4200mg. I'm guessing most don't remotely approach the new or old RDA.

If you're taking potassium sparing medications, things are further complicated. K levels would have to be checked more often.

I supplement with potassium citrate. My blood pressure has normalized.

4.5 mmol/L. Coincidentally just got a blood test six days ago (this is in Canada and Lifelabs lets you see your own results). I don't go out of my way to consume potassium at this point, but my potassium has been 4.5 steady for all the tests I've gotten over the past year. My sodium has been rock solid at 139 mmol/L as well.

I didn't add it as one of my listed items, but I did try supplementing with potassium before starting with medication and for me it wasn't beneficial, though it certainly would be for people with deficiencies.

Hyperaldosteronism.

If someone has a consistently low potassium level, you should see an endocrinologist and get tested for Hyperaldosteronism.

Surplus aldosterone causes the body to retain more salt, which in turn increase blood pressure.

Consistently low potassium, early onset of hypertension, taking three or more BP medications (one of which is a diuretic), all red flags.

Hyperaldosteronism should be pursued.

I had my left adrenal gland taken out to address it.

Potassium and sodium are also excreted together, so decreasing sodium/increasing potassium typically results in beneficial impacts on the other.

> Doctors get very tense about potassium supplementation in fear of hyperkalemia.

Supplementing with potassium is not recommended because it's not very effective. 99 mg of potassium citrate gives you only 38 grams of potassium- *you need ~100 pills to get your daily value!* You will see much better results from changing your diet to include more potato (note: 1/4 of the potassium is in the skin), beans, and spinach (although a lot of spinach- 10oz has as much as a large potato). One large potato can give you 900 mg of potassium.

>not recommended because it's not very effective

My guess is that it's effective for those that are chronically K deficient, through Hyperaldosteronism or some other condition.

That would still be four large potatoes a day, to hit the original RDA. Every day.

I buy it in powder form to get the high levels needed. https://www.bulksupplements.com/products/potassium-citrate-p...

Agree, the dosing on tablets are ridiculously low.

Eating several large potatoes, bananas, avocados every single day sounds miserable.

Beans are not recommended if your goal is normalising electrolytes and micro-nutrients. Phytic acid in beans messes with your micronutrient absorption, in other words you absorb fewer than if you abstained from beans (or any other vegetable high in phytates). Quite counterproductive if you're trying to figure out the correct dosage of supplements.

Same with nuts and other seeds. Fine, in moderation. Phytic acid literally is a chemical countermeasure to stop animals from eating the next generation of a plant.

Oxalic acid, abundant in spinach, is another fun one.

Soaking the beans and discarding that water before cooking them greatly reduces the phytic acid. Beans are excellent for health. You just have to follow the traditional methods of prepping them.

Look out for kidney stones with spinach, and other foods that are high in oxalates.

I've had multiple lithotripsy procedures, thanks to kidney stones.

I wouldn't wish kidney stones on my worst enemy.

GP mentioned taking Telmisartan, which is potassium sparing and one should be careful with potassium supplementation while taking it.

Agree. That's why I noted

>If you're taking potassium sparing medications, things are further complicated. K levels would have to be checked more often.

Hydration is a big part too: I have venesections done every two week or so as a treatment for hemochromatosis. I.e. They take 450ml blood and dump it.

If my blood pressure is low before hand, the nurses get me to drink two jugs of water, blood pressure goes up to normal range with in minutes. Same before they let me drive home.

This has turned out to be a really useful tip for me life in general. If I'm feeling shit, I now suspect low blood pressure and force myself to drink two or three pints of water. It usually results in me feeling much better

> venesections I.e. They take 450ml blood and dump it.

Blood letting - wow!

> Haemochromatosis

  Haemochromatosis is an inherited condition where iron levels in the body slowly build up

https://www.nhs.uk/conditions/haemochromatosis/

Myself being someone who suspects that they have high blood pressure (based on infrequent measurement), would you mind sharing if you had any recurring symptoms (outside of hearing heartbeat) when your blood pressure was at its peak?

Pain on the back of the head constantly, specially at the end of the day.

Been on Olmesartan since then and couldn't be happier

This exact symptom literally happened to me a couple of months ago. It was the kinda pain that started in one shoulder and rounded itself up into my head and front temple, and it _always_ started in the early evening.

After doing a bit of research I got myself a monitor, and sure enough my readings one between 150-170/90ish. I'm also a type 1 diabetic to add to it.

My initial decision to seek treatment was recurring massive migraines that would wake me up in the middle of the night and last for hours. I had known that I had high blood pressure but didn't really track it closely at all, always attributing the few really high readings I did get to white coat syndrome (which is a very real, but it also can be an easy dismissal as well). During one of those migraine sessions I hopped on Amazon and ordered a unit.

It came and I was sure it was defective because it kept measuring 170+ / 120+, which seemed impossible. A few days later I stopped by a pharmacy with one of the big units, and it read the same thing. So I visited my doctor.

He put me on 5mg of amolodipine and it did very close to nothing. Then it was upped to 10mg and still little benefit. It was the addition of telmisartan that completely changed everything for me. The effect was overwhelming.

It's hard for me to really identify the symptoms because I lived with it, I suspect, for many years. It was my norm. I will say this: at my current blood pressure I constantly feel way more relaxed, physically. Like my body doesn't feel in a constant fight state.

Thanks. This is very helpful to me. I have weekly migraines. I never thought to attribute it to high blood pressure.

For the record, my blood pressure is not nearly as high, but its typically 140/85 as infrequently measured. I’ve never measured during a migraine, but I will now.

dizziness can also be a symptom.

My story exactly. Chronic headaches before, not one since (over 4 years).

Same experience here. After finally treating it (current blood pressure - 96 / 56) my number of headaches of any sort has declined dramatically. It used to be just a normal event that I would lose a day+ a week to monster headaches, where now I have close to none.

One strange thing: In the past I'd get auras and then not long after an enormous headache. I still occasionally get auras...but then it just resolves and the day goes on normally. Very strange.

If you suspect you have high blood pressure, please have yourself checked by a medical professional. Hypertension is known as the "silent killer" due to its frequent lack of symptoms.

My dad has hypertension due to [Conn's syndrome](https://en.wikipedia.org/wiki/Primary_aldosteronism). The only thing that helped tremendously was surgery.

Wow, that sounds like quite an ordeal. Glad you landed okay! I had no idea medication could have that strong of an effect.

I also have been checking my levels a little obsessively, unsuccessfully trying to find ways to drop them. And like you, I noticed that I spike during cold weather. I’m probably particularly sensitive because I have very low body fat.

You probably tried potassium chloride/bicarbonate already?

I just tried upping dietary potassium with more bananas and avocados and reducing sodium, haven’t looked in to potassium chloride/bicarbonate

Supplementing it is totally different in my experience.

So, my heart was pounding and erratic at night, and my blood pressure would spike at random intervals.

The root cause was that I moved to a 2000’ higher elevation, and was dehydrated.

Since winter air is lower humidity, I suggest you drink two extra pints of water per day, spread across three-four sittings.

Will it work? Probably not. But, I’d give it an over 10% chance, and it will cost you nothing.

> I would be constantly annoyed by the sound of my own heartbeat doing things like trying to sleep.

Wait what? explain more please.

Pulsatile tinnitus (didn't know this name before but just looked it up), which is when blood pressure is so high that in quiet you hear your own heartbeat and the whooshing of blood in your veins.

I periodically have that, plus regular tinnitus.

PT is the one thing so far that I haven't been able to get fixed with the four different high blood pressure medications that I'm currently on.

Ever run real hard and felt your heartbeat in your ears? Like that but always. It can also happen if you have valve or other heart defects that cause enlargement, but that isn't loud in your ears. It's just so loud in your chest that you can hear it. Sometimes other people can as well.

Raynauds?

Secondary Raynaud's absolutely. In any below room temperature setting my fingers would be incredibly cold to the point of being debilitating. I ended up being a glove wearer in situations where it looked pretty goofy.

This has dramatically improved/disappeared under the medication listed above.

Wow, it sounds so familiar to myself! I have all the same symptoms and went down the path of testing BP and blood glucose with similar results. How did you get the doctor to prescribe the drugs? Or was it a pretty straightforward diagnosis?

Definitely does not sound straightforward given all the things they tested and excluded. It also very atypical and medicating specifically for this would be unusual. That said it sure sounds like it perfectly treats the root problem.

If you have symptoms like Raynauds and POTS (note that POTS can be hard to demonstrate, so may be less convincing to a doctor) then Amlodipine or similar may be helpful. If you take it and you feel lightheaded when standing up, or have trouble with exercise or fatigue, you probably don't need it and it isn't good for you.

You may have more consistently high blood pressure rather than transient spikes if you don't have POTS, or if you don't react immediately to cold temperatures. In that case an angiotensin blocker like Telmisartan may help. It can take weeks to become effective, vs Amlodipine should show effects in just a few days.

If you have high blood pressure then just telling your doctor you want Amlodipine or something will probably be enough- convincing insurance will be harder. Amlodipine can be used off-label for Raynauds. If you don't have particularly high blood pressure and haven't systematically tried to exclude causes it will be harder to convince your doctor. They might let you try it for a bit to see if it helps, and the generic isn't too expensive.

Thanks for the reply! I'll keep researching.

To add to the great reply by hwillis, I just went to my doctor with a concern about my blood pressure and he prescribed amlodipine with follow-up bloodwork to make sure there aren't other factors. When the amlodipine wasn't effective he upped the dose with another set of bloodwork, and then he added telmisartan and lipitor (coupling it in with the amlodipine for convenience) given cholesterol issues with my bloodwork.

There are a lot of different blood pressure medications (like a ridiculous array of options) and I let my doctor decide. There are side effects but I have suffered zero of them, and now that the blood pressure is under control my bloodwork across the board has been improving significantly.

Thanks for the reply. Yeah it seems like hypertension is right up there with fatigue as one of those more general symptoms that can be really hard to nail down a fix for. I'm glad it all worked so well for you.

I don't like combining drugs, especially something like amlodipine with Olmesartan. Individually, each drug is cheap enough and commonly stocked that I can go into most any Walgreens anywhere and get my prescriptions fulfilled. Do them as a a combo, and suddenly it can only be custom ordered and I have to wait days for it to arrive. And it's also much, much more expensive when combined.

One extra pill to take at night does not make a huge change to my nightly routine of taking all my drugs. So taking one less pill wouldn't be a huge improvement, either.

But the lack of availability and much higher cost of the combined drug means that I don't ever want to do that again.

Amlodipine is a calcium-channel blocker which lowers blood pressure by promoting systemic vasodilation. This would have a beneficial side effect of counteracting idiopathic vasoconstriction caused by Raynaud syndrome.

If the drug is taken with food (when drug absorption is highest), some folks will develop edema in their legs for several hours.

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