24-hour blood pressure (oh no!)

[Mooge]

Hi all,

I'm interested in getting feedback about 24-hour blood pressure tests and how people deal with them.

A quick summary of my situation: I am very far advanced along the non-directed donation process including having met and matched with my recipient.

The first time I was in the nephrologist's office (about 4 months ago) he measured my BP and it was high. As I had never had this problem in the past, he said that perhaps I had white-coat hypertension and that I should monitor my BP at home. I was already very committed to donating and nervous that I would be disqualified  - and of course, unhappy about possibly having to deal with hypertension.

A few days later I got a good home monitor and checked my BP pretty obsessively (about 3x per day) for 3 weeks. The results were absolutely fine! No sign of high BP at all. I sent the excel file to the nephrologist and he was perfectly satisfied. I continued to monitor my BP regularly 2-3 times a week from July on, and didn't have a single abnormal reading.

However....here in Israel all transplants have to be approved by a Ministry of Health committee. When I had my interview they asked about the BP, I told them the story, and they seemed fine with it. However, when they made their decision about our surgery they approved me pending 3 normal BP readings in a health clinic. Just hearing about it made me very nervous and when I tried to measure BP in the clinic it didn't go well.

The nephrologist has suggested a 24-hour BP test and it is scheduled for the beginning of next week.

I don't believe that I have a fear of doctors per se, but as I said, the donation is very important to me (only you guys know how much...) and I *am* afraid of being disqualified. If I actually had high BP that would be one thing, but 3+ months of monitoring has reassured me that I don't! I am not an anxious person in general and my anxiety about this issue is very uncharacteristic of me, I guess just because of how invested I am in donating.

Any tips or suggestions about how to stay calm for the 24-hour test, or stories about other people with white-coat hypertension dealt with it would be most appreciated!

Thanks,
Mooge

[sherri]

Mooge,

I also have very "sensitive" blood pressure and when I went to the evaluation my blood pressure was very high. I did the 24 hour blood pressure monitor and the nephrologists were satisfied with the readings. I actually had the report reviewed by an independent nephrologist at another hospital to make sure that it was safe for me to donate. Basically you are going to wear the pressure cuff and go about your business. Every thirty minutes the cuff will inflate ( or whatever time interval the machine is set, night and day will be different) and when it inflates the instructions ask that you just stop moving so it can get the reading. The initial reading will be visible the rest of the readings will not be visible so this will take the "pressure" off of you knowing what the numbers are. You will also keep a log and write down your activities, for example if you are exercising you will write the time so that the pressures will be correlated with the type of activity.

You may want to ask the nephrologists for evidence based articles about the incidence of developing hypertension if one has white coat syndrome or masked hypertension. You also want to take into account other risk factors like family history or overweight. I know to this day, my blood pressure goes up a few mm/Hg when I start to carry extra weight. Exercise definitely helps keep my blood pressure at a normal level.

 One of the most important part of the evaluation is that the donor is not put in any danger during or after the surgery. I commend the Israeli system for taking this task seriously and evaluating you closely. While you may really want to donate, in order to protect the entire living donation system, careful attention must be paid to protect donors.

Keep us posted on how your progress continues. Wishing you a Shana Tova, Happy and Healthy New Year.

Sherri

[jstx]

I also had to wear a 24 hour bp monitor. My bp was sky high when I went in for my all day evaluation. My surgeon said it was probably a combination of things: nerves, traveling long distance, white coat syndrome & the fact they used contrast dye in my sonogram. But the 24 hour cuff was easy; I wore it for a period when I didn't have to go to work & I laid low around the house. I'm not sure I'd exercise with it on but I enjoyed my day & tried to pay attention when it started a reading. A couple times I didn't stop moving enough (I was sewing!) and it had to re-run the reading. But it all turned out fine and they allowed me to donate. I know how much you want to do this because I felt the same way, but it really is to your long-term benefit to go through this. Good luck!