High BP and Diving?

[TSandM]

The problem is that there is no drug with a completely safe profile. Diuretics are generally well tolerated, but can cause electrolyte abnormalities that might lower seizure threshold (important for people on Nitrox). Beta blockers are generally well tolerated, but especially when first instituted, can cause slow enough heart rate to create blackouts -- not a good idea underwater. Calcium channel blockers are generally pretty safe, but can cause low heart rate or low blood pressure, and therefore fainting -- again, not good. ACE inhibitors are some of the best drugs we have, because they work WITH your physiology instead of against it, but some people develop serious allergic reactions to them, sometimes after taking them for long periods, and those reactions affect one's breathing.

What DAN has to say about medications for hypertension is the distillation of what's known about the medications, their side effects and the frequency with which they occur, and the physiology of divers. I do not think you are going to get any advice from any individual physician on this board which is more valid than what DAN is disseminating.

 

[Spencermm]

I had very high blood pressure and had been on meds for 2 years when I decided to take ow.
I had a Doc who was not familiar with scuba and wouldn't clear me to dive. I suspected it had more to do with ignorance and liability than anything else.
Like you, I was GOING to dive, but at the time I was also pretty concerned about my safety underwater.
After an extensive and refreshing talk with DAN(refreshing because they genuinely care and listen to you- a comodity in 2008 service industry), this is what I did:
I switched Docs to one more familiar with diving. I had some ticker tests done that all came out positive. And finally, something I should have been doing all along- I made some lifestyle adjustments that had an effect on my bp. I stopped drinking so much alcohol and stopped eating so much salt(I consumed more salt than any 12 people should consume). I was already exercising a great deal.
Witrh the above changes my bp is down to a little less than normal. I take 1/2 the meds that I did, and I suspect I will be able to be off the meds soon.

 

[TSandM]

Spencer, congratulations! The lifestyle changes are the hardest ones to make, but a lot of people could take a lot less medication if they could manage them.

 

[ArcticDiver]

What prompted my question, and I thank you for your answer TS&M, was a discussion with my doc during my periodic health assessment. We both had some time so I brought up this thread.

As we went through the various medications I was impressed by two things:
First, his comment that, in the end, it is a trial and error process on the part of the provider and the patient. He takes the data, massages it with his gut impressions gained from treating many patients and comes up with a starting place. Most of the time he prefers ACE inhibitors to start.

Second, he never, not once, mentioned behaviour modification as the first treatment option. It got me thinking that none of the medical providers I know start with behaviour. They all go straight for the organic and drugs, especially for their mature patients. But, I know several people who lowered their BP and improved overall quality of life by changes in diet, exercise and lowering anxiety levels.

This thread has sort of followed the meds first theme also for most people. So, I wonder if that is just the societal norm now?

 

[Spencermm]

ArcticDiver, You addressed TS&M in your thread. She can answer this much better than I, but I will throw in my 2 cents.
I think it very much is a societal norm. I won’t get into the post WW II big business drug companies and their mass marketing strategies.
We are the instant/immediate gratification generation, with microwaves, remote controls, Internet, fast food, buy-now, pay-later, etc. We, as a society, are much more likely to take a pill than to change our behaviors- it’s just easier, faster, and much less complicated. In the psych field we call it the “silver bullet syndrome”.
Spencer

 

[TSandM]

ArcticDiver, there are two reasons why doctors reach for the meds right away. One is that they want to reduce the BP quickly, and the meds will work. They can always be weaned if the patient is successful in lifestyle strategies. The other is that most of us, if we have been practicing for any length of time, have gotten profoundly discouraged at having ANY impact on lifestyle. You can sometimes get people to take their medications; you very rarely have any effect on their weight, their sodium intake, their smoking, their alcohol consumption, and their fitness. The information about all those things is out there everywhere, but very few people make the effort. In the end, the most effective thing we can do for BP is prescribe meds. It's kind of sad.

 

[ArcticDiver]

... It's kind of sad.

As they say in church: "Amen, Sister!"