Blood Pressure

Medical Q&A [Moderated]
1

Hello BBM,

Quick question regarding BP. I’m 23M, 6’0, 71kg, very lean and reasonably muscular (although you’d still describe me as slim). Waist:Hip of 0.82.

I’ve previously had a few high BP readings (systolic between like 125-130 ish) and as someone who tends to get anxious regarding medical things, I really wasn’t sure whether this was due to anxiety when getting the readings done (even when at home, trying to relax etc) or if I actually have slightly high blood pressure (which worried me being only 23)

My lifestyle is as follows: lift 5-6 times per week
Run for 20-30 mins 3 times per week (started recently, have really lacked in cardio for last couple of years)
Completely plant based diet, low sodium intake (for past 3 months - was vegetarian before this but wasn’t as strict with salt or junk).
0 processed foods
Never smoked, don’t drink

I took a few readings this morning and I still felt anxious. I know my resting pulse is usually like 60bpm. Regardless, I sat and tried to relax and took these readings -

118/65 - pulse 77
126/62 - pulse 75
120/69 - pulse 81
122/70 - pulse 79

I know white coat-htn is in-itself a risk factor for hypertension later. Leaving that aside - is it fair to say that I’m likely now roughly within normal ranges? My thinking is that considering my pulse is elevated due to ‘anxiety’ - my BP way well be a few points higher than normal too. Is there any cause for concern here? I really don’t know what else I could change with regards to my lifestyle so looking for any guidance or reassurance. When I’m relaxed and not thinking about this stuff, I’ll occasionally stand and be momentarily light-headed which doesn’t seem suggestive of HTN to me. Thanks guys.

2

I would not be concerned about these numbers in your situation.

Carry on, although I’d still recommend periodic monitoring moving forward (annually at minimum).

3

Thanks very much Austin - i have two follow-up questions.

  1. Is it reasonable to still try gain a bit of lean weight? I’d love to be a bit closer to 75kg. I’ve never been one to put much fat on anywhere so I think this would be a slow increase.

  2. is it also reasonable to phone my GP and ask for a lipid test?

I don’t have a family history of heart disease but I remember you saying it’s a good idea to get this checked once… is this still the case at 23?
The only thing which slightly concerns me is that I’ve pretty aggressive vertex balding which I’ve read some meta-analysis’ conclude that this is a risk factor (RR like 1.3-1.4) for CHD. Perhaps I’m being a hypochondriac but I’m trying to be as healthy as I can for as long as I can.

Thank you again. You and the team are a really great resource to have around and to learn from.

4

If you’d like, that’s fine. I’d just monitor your waist measurement while you gain weight to make sure things aren’t going too far.

I think it is very reasonable to ask for a lipid test. Some clinical guidelines (and clinicians) don’t recommend testing men until much later, like 35 years. This is one of the few screening guidelines I disagree with, and would happily screen anyone’s blood lipids earlier in life. And to be clear, this isn’t just a one-time check. A regular lipid panel (and/or apoB measurement) should be monitored serially over the lifespan, although the testing interval should be individualized based on a person’s risk. The Lipoprotein(a) measurement is the one that all people should probably have done once, preferably early in life, and particularly if they have a strong family history of heart disease and/or aortic stenosis.