Blood Pressure - Predonation

[fredpeh]

Hello everyone!
I've been reading all the posts for months but this is my first time posting.  I am an Eastern Orthodox priest in the Pittsburgh area being tested as a kidney donor for one of my parishoners.  He is a young father with three little children and while I am somewhat apprehensive (I was initially terrified!), I am determined to do this to help this man live and be a Daddy to his kids. 

I'm coming to the end of the testing process:  been through just about everything with no problems.  I am 52, healthy, exercise regularly, no medical problems at all.  During the testing process my blood pressure was high:  150.  It's never been high in my entire life, I know it was from the anxiety since I was feeling quite anxious as I met the surgeon, nephrologist, etc. for the first time.

The transplant people recommended that I wear a 24 hour blood pressure monitor just to be sure.  The blood pressure for the entire 24 hour period was fine:  115-125 except for two instances which were 150 and 160.  I distinctly remember what happened when it was 150:  I was agitated and upset about something.

The nephrologist said that overall my blood pressure is fine but these two readings are a concern but they won't cause me to be rejected as a donor.  I'm relieved:  I want to do this for this man after coming this far along in the process. 

My question to anyone who might know:  is this a cause for concern?   I know there is a possiblity for high blood pressure after donation.   (I've read everything I could possibly read about kidney donation, including articles from the New England Journal of Medicine)

Any thoughts?    Thank you everyone for all the posts.   Spending many months reading everyone's information and stories have really reduced my fear.

Father Ed

[snatiep]

Hi Father Ed!

I have a terrible case of "White Coat" syndrome.  I had all of my testing done on one day and of course the physical with the Dr was the last thing of the day.  He took my blood pressure and I saw his eyebrows go up.  He said "Lets just wait a minute or two and check it again."  He took it again and it was a even higher!  He rolled in the ekg machine and pasted sensors all over my body.  Of course that made my blood pressure go up even higher!  The ekg was perfectly normal and he said he couldn't figure out why my blood pressure was so high.  I told him...."no offense, but its you!"

I have been involved with the University of Minnesota kidney donor study and have been thoroughly checked over every six months since my donation to my Sister two years ago.  I'm just fine and so is my blood pressure!

[sherri]

I also have "white coat" syndrome and had elevated blood pressure at my visit to Hopkins. I call it my Hopkins blood pressure. I also did the 24 hour monitor and was accepted as a donor. I am now 3 years out and my blood pressure is starting to go up. In the doctor's office I was 140/80 and sometimes higher. At home I have been monitoring my blood pressure and it ranges btw 120 -130/80. I am trying to add more exercise to my regimen which I see helps. After I exercise my blood pressure is in the 120's. I am now 47, have a family history of high blood pressure and obviously kidney disease, as I am a family donor. My PCP is giving me 6 months to try some lifestyle changes, drop a few pounds before resorting to meds. I am taking some herbal remedies to see if that helps. The nephrologist who I saw outside the transplant center did tell me that i may become hypertensive given the white coat and family history and of course just by being a donor. Donors do have a slightly higher incidence of higher blood pressure and proteinuria than the regular population.

Good luck with your donation experience.

Sherri

[Fr Pat]

     I recently read a summary of a scientific study of "white coat syndrome" that showed that it is a genuine problem for many people. They even noted that blood pressure tends to go up more if a doctor does the test, and less (but still some) if a nurse or technician does the test. It can be worth buying an at-home electric tester so as to check frequently and see what the real average blood pressure is. And instructions for the machine I use for that even suggests doing the test 3 times with a few minutes in between each test, and then push the button for the average reading. I noticed myself that the buzzing sound when the cuff automatically inflates  scares me enough to send the pressure higher than it will be five minutes later!
I do think it prudent for donors to check their blood pressure at home, even daily, to notice if and when there is a consistent change.
     Fr. Pat

[Orchidlady]

Another hint to folks: when you have your blood pressure taken, make sure they use the right size cuff. There is a smaller and larger cuff option, and the incorrect cuff size can impact the reading.
My blood pressure both pre and post donation has ranged around 110-118/70-78. I went for my physical yesterday, and the nurse who took my pressure told me it was 140/80. I told her no way! My blood pressure never, ever ran in that range! Well, sure enough she had used the small cuff which did not fit properly. While not "manly" arms, my arms are a bit larger because of my exercise. She admitted the larger cuff fit better and my blood pressure was a normal range for me of 118/70. My husband also was advised to use the larger cuff after measuring his arm. If the smaller cuff is used he has the same problem - higher numbers.

[WilliamLFreeman]

Fr. Ed & y'all,

Great replies.  After reading Fr. Ed's initial post, I was going to reply that I also had the "White Coat Syndrome" (WCS) each time I visited the transplant center for a new evaluation  -- and I am a physician myself!     But y'all beat me to it.

The reason was as described: I was anxious/worried that I would "fail" an evaluation test, because by that time (after the several early tests had been done where I live [100 miles away] and first visit with the nephrologist) I had self-identified myself as a living kidney donor (unless I was found to be medically ineligible).  The Center's head nurse told me that the WCS happens to a fair percentage of potential donors.

I am not aware that people with WCS are at higher risk to develop high blood pressure later than are people without WCS, when age, sex, and initial blood pressure reading are the same.  But maybe a good study is out there somewhere showing that.  (It would be difficult research to do well.)

What is known, & is not mentioned in the posts, is that the greatest risk factor to develop high blood pressure is probably age.  Living kidney donors on average have an increase of 6 (six) points systolic after donation.  That means that living kidney donors on average are likely to develop high blood pressure a few years earlier in life than they would have if they had not donated.

Fr. Pat's & Sherri's posts suggesting we take our blood pressure daily is a good one.  I do.  Consumer Reports rates Omnicare home B/P monitors the best.  (That company name is by my memory  ; if it is incorrect, I will correct it when I get home.)  One of their models takes B/P automatically 3 times, one minute apart; displays the average of the three; and also calculates & stores the weekly average.  That model is a bit more expensive, but is the model I use.  It is best to take your B/P the same time every day, 5 minutes after sitting support with both feet on the ground.

Bottom line, Fr. Ed & everyone:  no need to worry about having WCS.  DO worry about developing high blood pressure after donsting, if for no other reason that we get older year by year.     The most effective steps to prevent or postpone getting high blood pressure later in life are:  exercise, and low salt diet starting now.

Bill

[Orchidlady]

Good advice on daily BP, Bill. I would add a further step that, if someone does take daily readings, take it at the same time each day and write it down. The key is to have a history to track trends and patterns. You then have a written document that can be shared with your physician if there are concerns. My husband has to take blood pressure daily, and also makes notes on occasion if he knows something that would have affected that reading - if he is sick, had a bit more sodium the day before etc.  A history of readings really is helpful to your doctor if you think you may have issues.

[WilliamLFreeman]

Orchidlady,  Good points & advice.

Y'all,   A correction.   The company name of the best-rated home B/P monitors is Omron.  [The model I have is "HEM-790IT."  It automatically takes 3 B/Ps 1 minute apart & averages them (& still lets you see the 3 individual readings), plus averages all readings for a week, plus keeps in its records the weekly averages for the last 8 weeks.]

Bill

[jstx]

I also had VERY high blood pressure readings when I went into the transplant center for my all day evaluation and "meet and greets" with the surgeon, nurse coordinator, etc.  They told me that part of the problem was probably white coat syndrome and anxiety (after all it isn't every day that you discuss giving up a perfectly functioning body part), but that they've also seen people's blood pressure increase after the 3D CT with contrast dye.  They told me that the dye can raise blood pressure and that is a good reminder for after surgery.  I guess the dye is one of the things we have to be very careful with and there is another type of dye that can be used for CT scans (I think it is an oral dye.....).  I also want to say that my doc recommended a while back that I get a blood pressure cuff for taking my readings at home and she only recommended Omron cuffs.  She said they have been shown to have more accurate readings.  So, even if you don't get the model that Bill mentioned in his posting you should probably stick with an Omron cuff of some type.  My doc also said to get a cuff that goes on your arm (not one for your wrist or finger, etc).  She seems to believe that the arm cuffs give more accurate readings too.

[Aries7]

Father Ed,

I also am a "white coat" syndrome sufferer. I normally have (and always have) lower blood pressure. The day of my testing, mine was high as well. This was also a very busy, crazy day as they did all of my tests in one day. I also think the cuff they used was too big for me.

In my case, my coordinator had me take my blood pressure at home over the course of a few days. I had to take it at different times during the day and evening, write it down and call her with the info for each reading. All the readings were my normal lower readings and the transplant center was fine with that and I was approved to donate.

Best of luck to you!

Linda

[Snoopy]

I'm going through this now, myself.  As I continue my testing to get cleared to donate, one of the doctors didn't like my last BP reading all that much. I tried to assure him that, though I'm not afraid of the white coat per se, I am afraid of "flunking" my BP exam and washing out as a donor.  I think I know how pilot cadets and astronaut candidates feel!  I am scheduled to take a 24-hours Holter BP test this week, and am debating requesting my family to radiate calm around me for that day.  I'm not a particularly tense person, but do everyday things like running for a train, etc., cause significant spikes in BP during such a test? And, can one read the current BP on the device at the time, so I know when to pay attention to explain any such spikes?  Finally, does anybody have any good short-term tips for maintaining low BP? I mean, I know about cutting salt and exercise, but can I learn biofeedback or something over the next few days?
        Thanks, Snoopy

[sherri]

The 24 hour blood pressure monitor will take your blood pressure at an interval of every 30 minutes or every hour depending on the time of day/night. the readings are then averaged and reviewed by a nephrologist who will decide if it is safe for you to be a donor. The initial blood pressures can be seen ( I think the first 3) then the remaining ones are hidden. Nothing prevents you from taking a blood pressure on your other arm if you are really curious (it should be within 20 mm/Hg of each other as long as there is no disease) but it may end up causing you more stress. The suggestion is that you go about your regular day. The purpose is to get a view of what your pressure will be when in a familiar environment. It is not supposed to be an opportunity to "cheat" the system. If you fabricate a relaxing no stress day so that your blood pressure may be on the lower end, you will just be a hypertensive patient you happened to have had a 24 hour blood pressure monitor that did not represent their usual blood pressure. The idea of all these tests is to make sure it is safe for you to donate so that your future health is not compromised, and that the entire donor process of screening donors remains rigorous and valid for the safety of transplant medicine.

Suggestions for lowering blood pressure. Follow a low sodium diet, increase your exercise, do some deep breathing. I definitely see a difference in my blood pressure (which had started to elevate 3 years post donation) with regular exercise. Massages help relax me, deep breathing and just slowing down sometimes. There are some biofeedback therapies out there but I am not sure of the results. However, anything that reduces stress is usually helpful.

Good luck with your testing.

Sherri

[Snoopy]

The purpose is to get a view of what your pressure will be when in a familiar environment. It is not supposed to be an opportunity to "cheat" the system. If you fabricate a relaxing no stress day so that your blood pressure may be on the lower end, you will just be a hypertensive patient you happened to have had a 24 hour blood pressure monitor that did not represent their usual blood pressure. The idea of all these tests is to make sure it is safe for you to donate so that your future health is not compromised, and that the entire donor process of screening donors remains rigorous and valid for the safety of transplant medicine.

      Sherri, Thank you for your response.  You are quite right, naturally, about taking this test seriously, and not trying to cheat the system.  As written, my post may have given the wrong impression.  Personally, I am convinced that my occasionally higher (near borderline, not hypertensive) readings are caused by tension about the test, rather than any actual problem.  But, obviously, if I actually am tending towards high BP, we've got to know.
     I already am pretty good about low salt, although I also have to watch my weight and cholesterol.  I read food labels routinely.  Have you ever noticed how hard it is to find things that are low in salt, fat, and calories all at the same time? :-)
     I will increase my walking, and practice deep breathing.  And, no, not to "game the test", but to get used to doing it routinely, as I age, post-donation (hopefully), etc. To reduce stress, I'll, uh, stop reading the newspaper....
     Meanwhile, thanks again! Snoopy