My Data-Backed Battle and Defeat of Hypertension

Today — October 29th, 2023 — is World Stroke Day. Controlling hypertension is a significant action you can take to improve your odds.

Preface

A popular tech forum recently had a submission detailing how to properly take one's blood pressure¹. Given that this is a topic I'd recently been focused on, I offered up my personal experience living with and then dealing with hypertension. My comment yielded a surprising appreciation for its openness².

I'm publishing this piece for awareness, not because my experience is unique³. Get checked⁴. Get treatment. Improve your habits where possible. The earlier the better.

Hypertension is a killer. Not only does it shorten your life, it makes quality-of-life destroying events like strokes far more likely⁵. It assaults your organs, and could have consequences that we don't even realize are related. In my case hypertension came with lifestyle disrupting massive weekly migraine headaches.

The Tell-Tale Heart.

Thump thump 💓. Thump thump 💓. Thump thump 💓.

I suffered chronic high blood pressure for years.

160/120 was a typical reading, with occasional 180+ readings. It had been this way for years, though I checked infrequently. I knew I had high blood pressure going back to my teenage years (I am 51 now), but hadn't realized how much worse it had gotten over the decades since.

High blood pressure has a strong correlation with heart disease and stroke, putting a continuous stress on organs that can lead to kidney damage and diabetes. I should have dealt with it long ago.

There aren't a lot of obvious symptoms of high blood pressure, but I did suffer pulsatile tinnitus: I could hear the whooshing of my blood and my own pulse almost all the time. I would struggle to find sitting and sleep positions that minimized these disruptive noises.

Being a social anxiety sort I hoped that lifestyle remedies would work, avoiding the awkward social situation that is a doctor visit⁶.

I'm close to an ideal weight and moderately actively, and have never smoked and barely drank, eliminating the normal explanations and "easy" solutions. I had to try the other common remedies.

I grabbed a home blood pressure device and started logging the data in Apple Health, later having it auto-populated with a bluetooth equipped unit. This wasn't a neurotic or stressful exercise, but instead was like everything else in life where one can obtain quantitative numbers to measure and monitor and choose best actions.

I tried cutting caffeine out of my life, to no change. Minimizing sodium and supplementing potassium yielded no change. I tried regular meditation sessions and increased my exercise and activity regiments to no change. I altered sleep schedules, cut the little alcohol in my life to nothing, and even started donating blood⁷, to no change. I tried cutting fluid intake to no change.

The one factor that I had little ability to control — stress — was the wildcard that contributes in unmeasured ways to the readings, likely adding to variability.

Turning to Modern Chemistry

Overcoming my fears, I visited the family doctor where I tested at 170+/120+. He prescribed a 5mg dose of amlodipine (Norvasc)⁸ as a start. The chart below starts right after I started taking this pill daily.

These charts are simple enough that I've removed the legend and axis labels⁹. The blue scatter series is systolic pressure, while the red scatter series is diastolic. Both have a complimentary LOWESS trend line. The vertical axis is mm Hg, with the background colour coded into red/bad and green/good zones relative to systolic pressure. Blue samples in the red area are bad. An ideal blood pressure would have the systolic and diastolic falling at or below the corresponding 120 and 80 solid horizontal lines

There were significant improvements, but this coincided with the weather warming. My blood pressure is seasonally affected: it was terrible in the summer but extra terrible in the winter. I was doing something though, so I continued occasionally measuring, hoping it would remain under control.

There is another measure called pulse pressure that is the simple difference between systolic and diastolic pressure. A pulse pressure above 40 is considered bad, in some situations and for some people. Blood and pulse pressure will vary over the day, and it is really only with enough random samples that a clear picture really begins to emerge.

My pulse pressure for the correlated period was seldom below 40.

A pandemic you might have heard about started washing across the lands. Those with high blood pressure had worse outcomes making me somewhat anxious about the whole thing: With four kids in the household, COVID was inevitable, yet my hypertension remained barely managed. 2020 was a planetary year of hiding away. I made little progress on this file.

As cold weather returned at the end of 2020 into early 2021, my blood pressure rose to dangerous levels again. The dose of amlodipine was increased to 10mg, with the following chart being the spring and summer of 2021 after the new 10mg regiment was in place. Things were better, but again warm weather made them appear better than they were.

There were still dangerously high sporadic readings, and things got out of control when the weather turned cold, but I felt like I had taken action.

For the whole of 2022 I tried to put it out of mind. I was taking a high dose of a respected drug, and had done something. The few readings I took were not great, not terrible. My doctor had requisitioned a blood test that I would get around to at some point.

In early 2023, during a cold-to-the-bone weather event¹⁰, I suffered migraine-like headaches that would wake me from sleep and send me vomiting into porcelain for hours. I had endured weekly multi-hour migraines for as long as I could remember, but this was an escalation that motivated me to seek further remedies. While my blood pressure wasn't outstanding during these events, I was sure it must be related.

A Second Molecule Enters the Fray

Back to the doctor where a secondary medication, 80mg of telmisartan (Micardis)¹¹, was added to the mix.

Once again the chart that follows begins directly after starting the new regiment. Telmisartan takes about four weeks to achieve its full effects, captured in the rapid month-long slope at the outset.

If comparing with the prior charts, note that the y-axis peaks out 20-30+ mm Hg lower. A lot of blue data points fall within the green zone, as does most of the blue trendline. Winning! The period of April to May included finding a new home, which in the Canadian market is a tremendously stressful event, but even through that the numbers were manageable.

Telmisartan was a game changer. Within a few weeks my readings were great. Measurements often fell at 110/70 or below, and the median reading since March has been 114/73, since July 107/70. The headaches and migraines disappeared. I occasionally get the normal pre-migraine visual aura, but it fades and no migraine follows. Pulsatile tinnitus disappeared.

Pulse pressure saw an improvement, with far more readings falling within the good range.

My body simple feels far more relaxed at all times. Meditating has gone from being an exercise of trying to gain control over self, fighting against physical stresses, to being a switch. It is a staggering difference.

My physical norm for years was always being in a fight/flight physical state where there was a constant tenseness. That has washed away.

At times my blood pressure drops to measures that would be considered abnormally low (e.g. 85/55). I have never felt any dizziness or negative effect from this. It gives me headroom that a cold-weather escalation of blood pressure should average on the good side of normal. I may switch to a lower dose during warmer months and a higher dose in the winter.

As to side effects, I've experienced none. These are serious medications that have reported side effects and should be actively monitored.

Cholesterol?

After putting me on 10mg of amlodipine my doctor requisitioned tests to be completed at my leisure. I finally got them completed early this year¹². We now knew that I had damaged kidneys from years of unmanaged blood pressure, with mildly decreased kidney function and a lower eGFR than ideal.

Another discovery was that I had terrible blood cholesterol levels.

LDL was at 4.23 mmol/L. Triglycerides at 2.63 mmol/L. HDL was down at 0.90 mmol/L.

When telmisartan was added to my regiment on January 30th of this year, Caduet 10/20 was used to replace the amlodipine in addition to adding a statin. Caduet is a combination of both amlodipine and Norvasc / atorvastatin in a single pill (for convenience as the two are often prescribed together), in this case in the doses of 10mg and 20mg respectively.

After several months on Caduet there were measurable improvements in my blood cholesterol levels.

Now LDL was at 2.20 mmol/L (-48%). Triglycerides at 1.06 mmol/L (-59.7%). HDL was up to 1.00 mmol/L (+11% -- this is the one measure where higher is better).

These are significant improvements. Between the two tests my diet moved to including far more eggs and saturated fats, and less sugars and carbs in general. This wasn't being capricious or destructive, but was based upon my evolving understanding of nutrition. A lot of the dietary advice and products held to be heart healthy, based upon viable theories and best intentions, might not be.

This whole section on statins and cholesterol is somewhat orthogonal and I include it because of the time overlap. There is debate that the benefits of statins are oversold in an absolute risk improvement sense, but a 2.0+ mmol/L improvement is enormous, and correlates with about a 50% relative risk improvement. The benefit of statins are optimized if they're early enough that they prevent decades of additional damage.

Unexpected Observations

I wear my Apple Watch all day every day since 2018, and occasionally browse into the various calculated health measures in Apple Health.

One of the measures is "VO2 max", which is an estimated calculation of how hard your heart needs to work to accomodate a given level of fitness. If climbing a flight of stairs leads to a sustained level of unexpectedly high heart activity, VO2 max will be poor.

While again I'm seemingly physically fit and active enough, my VO2 max was always calculated by Apple Health as below average. I stopped looking at its dirty lies and slanderous insults.

While doing data pulls for this piece I noticed that since I started conquering my blood pressure problem, my VO2 max has risen from the basement to now being classed as above average.

Weird. I haven't started any new aerobic activities. It could be simple coincidence.

Similarly, my walking activity heart rate has fallen measurably. The obvious observation is that my cardiovascular system has an easier time meeting normal physical events.

Is this meaningful? I have no idea. It could be a measurement quirk, or maybe I've developed an advanced case of Ambulatiocardio Retardis that will cause my arms to fall off. The other activity based measures are more random (e.g. cardio activities where I am intentionally trying to maximize exertion), but that is likely courtesy of the randomness of the activity more than being any correlation.

Conclusion

For me this issue feels like I can file it away as "resolved". I'll continue to monitor and look forward to further developments in bloodwork related to cholesterol and kidney function, but it does feel like a weight has been lifted.

I hope this journey helps advise and motivate others to take actions on theirs. And I wanted to do a bit of a callout to the brilliant minds in medicine who made these extraordinary molecules.

Thanks for reading.

Footnotes