In another thread we were discussing pain and hypertension (HTN) came up. Mainly, that several people noticed that they were diagnosed (dx’d) with HTN soon after being diagnosed with PsA or at around the same time. There are a couple of possible reasons for that:
It could be pain related. Increased pain can definitely cause an increase in blood pressure. This has stymied my PCP. She isn’t sure if my HTN is just benign essential hypertension or if it is a result of near constant pain. I’m not sure either. There are other factors to consider too. I tend to think it was the prefect storm for HTN. (Caffeine, nicotine, high stress jobs, pain, and high NSAID use)
NSAID related. NSAIDs are know to affect blood pressure and can cause hypertension and other cardiac issues. This is true even for the OTC meds like Aleve and Ibuprofen. They affect the patient’s kidneys and cause fluid retention that results in higher blood pressure.
Corticosteroid related. Sort of has a similar effect to NSAIDs. The end result is higher blood pressure.
Note for both NSAIDs and steroids that discontinuing the drugs can normalize the BP, but in some cases there may be permanent renal impairment that means a permanent problem with HTN.
So, the above are reasons that we would be more susceptible to hypertension and some of the possible causes. For people with uncontrolled or labile hypertension, that is something that must be addressed with your doc and soon. They can help you with medications, but there are things that you can do to help your situation like discontinuing caffeine, adding light exercise like walking, eliminating as much sodium from your diet as you can by eating fresh foods and experimenting with other seasonings and practicing yoga, Tai-Chi, or meditation. Try finding ways to reduce stress in your life.
My BP was difficult to control until I got the right meds and eliminated sodium from my diet. I take lisinopril and a diuretic. I have continued with the NSAIDs, but have reduced the amount I was taking.
Since I rarely have pain when not moving my BP is easy to ascribe to pain. I have always had a low BP until PsA but it was noticed once I have been sitting a while it goes back down to a low BP but when up and around for a while it pops right up with my pain level. My primary has no interest in treating it for if I rest as I should it is not elevated for long. I run 140/90-100 with pain/activity and fall back to 90-110/70-50.
Despite 20 years on high dose NSAID's, I always had low BP (usually 90/70). I've been having really poorly controlled disease and a lot of pain this past year, and my BP has been creeping up. After my last bout of steroids it got really high. I'm on 20 mg of prednisone again, but am tapering (again). I'm hoping once I get enough Stelara in my system in the next month, and hopefully less pain, and taper off the pred. my BP will go down again. I *really really really* don't want one more thing to deal with.
I did get a full workup from a cardiologist within the past year, just to check things out, and everything was fine. So whatever I've got going on is very intermittent.
Interesting.... I have had super low BP for years and I also have a problem with salt...my body isn't getting enough so I need to add salt to my diet and have also been told to have electrolyte drinks occasionally. I'm going to ask my husband to test mine occasionally and see if it changes. We have a blood pressure monitor as my husband suffered from exercise induced rhabdomyolysis a few years ago and had to monitor his BP several times daily.
This is an interesting thread, I too have always had lower than normal blood pressure (would pass out a lot as a teen ager because if this) and also constantly low sodium levels (bitching leg cramps at night) Both of these have been better since 2005 when I started regular anti inflammatory meds. I’ve always put my more normal BP down to getting older but always wondered if the anti inflammatory meds made a difference due to the effect they can have on the kidneys…either way I don’t suffer with postural hypotension much any more
Thanks Grumpycat, this certainly made me go hmmmm. Mine is most likely lack of excessive. I used to be on my feet fifteen to sixteen a day doing heavy exercise, now I do very little comparatively.
I'm in a crisis with my husband at the moment as he has the flu and we are in the middle of taking him off of the hydros and switching him from an G.P to managed care with an Primary/Osteo/Heart surgeon combo, he is cooperative but extremely uncomfortable and grouchy :). Prayers would be helpful and much appreciated to keep keep this old broads BP down today.
Thanks for this thread. I, too, have very low blood pressure but when I had it taken last week prior to pool therapy it was elevated--rather alarmingly high for me. That morning I was in a lot of pain and had a lot of inflammation. I don't know enough about human biology to be sure whether inflammation and BP are linked, but it would seem logical. If you've got swelling in a lot of places that must do something to mess with your blood pressure, right? Anyway, it is a relief to know that others experience this too.
Thorough presentation of an interesting topic. Thanks GrumpyCat.
I only seem to have issues with BP when at a doctors office. My rheumy never seems to have a proper size cuff on hand. I have big arms and have found that an improperly sized cuff seems to indicate higher BP than I measure myself. The readings at the rheumy's office also are wildly inconsistemt which I take to indicated measurement issues rather than a genuine physical concern. They sometimes used a wrist cuff which didnt seem accurate at all.
Once I brought in my own cuff & demonstrated I was in normal range in order to be able to proceed with a remicade infusion.
My PCP is much better at getting reliable readings and noting any mitigating factors. I periodically provide him with a set of measurements I take at home. The readings in his office are only slightly higher than those I take at home. The few times he has called high readings to my attention were visits where I was experiencing a lot of pain.
First, it’s so hard to counsel this on the interwebs. I’ll give you a few tips though based on what I do. If you are truly concerned about your blood pressure, then it doesn’t require too much inconvenience to stop in to see the primary care doc.
I document my BP daily, at the same time: morning and evening. I make sure that I am relaxed and that everything is similar each time. If I get a whacky high or low reading, I retake it after 30 minutes. I also document my pain number out of 10 when I take my BP. After a week or 2 of numbers, I am able to tell if I am having issues related to pain or if something else more nefarious going on. Either way, if the readings are consistently greater than 130/90, my doc needs to know because it needs to be treated.
Unless your BP, is truly “high”, so greater than 130/80 for two or more readings on different dates, it won’t be something that will be treated with meds. If your BP is just high for you, but within normal limits, it bears watching.
Robyn said:
HM, my bp has always been low, dangeroulsy so at times. Lately, however, I noticed it’s been creeping up. Now I wonder if this should concern me?
Thanks for the excellent topic and suggestions. Especially concerning recording home BP measurements and noting pain levels. I can see where that may really help to differentiate what might be going on, as well as, to possibly alert one to an emerging issue. I appreciate your efforts ;)
OK, I will pipe in finally. I was diagnosed with hypertension at the same visit as they discovered I had a positive ANA, which was the first step in diagnosing PSA for me. The swelling and high blood pressure all happened at the same time for me. I got a few months of meloxicam (which worked wonders for me) before they snatched that away and also will not allow me to take any NSAIDs at all. They tell me that all NSAIDs will aggravate blood pressure. Now, I went from normal blood pressure my whole life to readings like 185/130 even after having hydrochlorothiazide added (the first, most conservative, drug they add around here for hypertension). It took several visits and adjustments to be able to control my blood pressure, to where I am now finally running around 130/90. It is still not ideal, but it is so much better. To be able to get this reading, I take 25 mg of hydrochlorothiazide and 75 mg of carvedilol every day.
I resent not being able to take NSAIDs, I really do. It seems I am missing out on such a helpful tool to manage this inflammation. My body also did not tolerate methotrexate very well (normal liver functions strayed out of normal range while on it) so I can not take that either. I am limited to Humira and Ultram. That's all I am being given for the arthritis and inflammation. It stinks. I wonder whether after a certain period of time of controlled hypertension, they will eventually allow me to take NSAIDs. I sure hope so.
I spend my time controlling the few things that I can. Try to sleep (don't sleep well the last few months), try to eat much better by adding several servings of vegetables to my daily diet, and that alone, is a simple improvement that I can make. Cannot increase my activity much while in a sustained flare, but I can certainly eat more veggies and my body likes that.
Since going on treatment I have gained 8 lbs. I have the IBS issues and colitis. Shortly after starting diclofenac my heart got off rhythm. Was put on verapamil. I had low (normal) blood pressure before. After diclofenac my bp was high. The rheumatologist does lots of lab work on me once a month. The neurosurgeon told me to keep my bp down because I am at a high risk for another aneurysm. The neurosurgeon's nurse was concerned about the blood thinning and clotting problems diclofenac can cause. It is what it is though. I'm just going to change the things I can. Exercise, diet, etc. Keeping my bp under control is very important. I have a genetic defect in my PICA artery. That is where the aneurysm was. I don't check my bp often but it is normal now.
My cardiologist diagnosed me with tachycardia. Never had bp problems before except after the aneurysm. It was temporary due to the trauma of the hemorrhage. After starting diclofenac my heart felt like it was vibrating. Pulse and bp got high. I have read about tai chi for PsA. I think it would be helpful. I used to be active. loved pilates and zumba. Now it is hard to even lift a pan or do simple things. Getting up the stairs is hard. The fatigue is so bad. There are things I need to do each day that helps with energy. Drinking water, taking my vitamin, drinking oj helps.
Shelly, I hope you can go back on nsaids soon. I don't watch Dr. Oz much but he mentioned foods for lowering bp. Verapamil has my bp under control so far. My ANA is not positive. I used to take meloxicam. It never affected my bp. The diclofenac seems to work better for me but really messed my bp up.
Shelly said:
OK, I will pipe in finally. I was diagnosed with hypertension at the same visit as they discovered I had a positive ANA, which was the first step in diagnosing PSA for me. The swelling and high blood pressure all happened at the same time for me. I got a few months of meloxicam (which worked wonders for me) before they snatched that away and also will not allow me to take any NSAIDs at all. They tell me that all NSAIDs will aggravate blood pressure. Now, I went from normal blood pressure my whole life to readings like 185/130 even after having hydrochlorothiazide added (the first, most conservative, drug they add around here for hypertension). It took several visits and adjustments to be able to control my blood pressure, to where I am now finally running around 130/90. It is still not ideal, but it is so much better. To be able to get this reading, I take 25 mg of hydrochlorothiazide and 75 mg of carvedilol every day.
I resent not being able to take NSAIDs, I really do. It seems I am missing out on such a helpful tool to manage this inflammation. My body also did not tolerate methotrexate very well (normal liver functions strayed out of normal range while on it) so I can not take that either. I am limited to Humira and Ultram. That's all I am being given for the arthritis and inflammation. It stinks. I wonder whether after a certain period of time of controlled hypertension, they will eventually allow me to take NSAIDs. I sure hope so.
I spend my time controlling the few things that I can. Try to sleep (don't sleep well the last few months), try to eat much better by adding several servings of vegetables to my daily diet, and that alone, is a simple improvement that I can make. Cannot increase my activity much while in a sustained flare, but I can certainly eat more veggies and my body likes that.
The DASH diet is a good one for lowering BP. You can go to the NIH website and order numerous great publications with instructions on how to implement it, and these are free too.
