Question: Dear Doctor,

I'm a 36 year old mail, 5'11", 242 lbs. (down from 250 lbs.) with prehypertension. My blood pressure is variable but the vast majority of the time is in the prehypertensive range. Sometimes, in the mornings, it is at or below 120/80, with most of the rest of the time itbeing somewhere in the prehypertensive range (sometimes low, sometimes high). Very rarely I will see a 140+ or 90+ reading, but that tends to always go away with a second reading. I do have heart disease in my family as my father died of a heart attack at 53, so it's always a worry for me. I also have anxiety about taking my blood pressure, so it often makes the first readings higher.

I exercise regularly (5 times a week+), try to eat healthy foods, drink a lot of water, take some heart healthy supplements (garlic, CoQ10, fish oil, grape seed extract, K2, D, etc.) and generally try to live a fairly healthy lifestyle. I also don't smoke, but I do drink (moderately most of the time). I've recently changed up my exercise due to my difficulties with weight loss and am having some more success the last few weeks with some interval training mixed with circuit training, which seems to be giving me more results than I was seeing with more steady exercise.

3 years ago, I had an echo to check my heart because of my prehypertension. It came back as normal and my doctor was fairly pleased with it. A few factors, specifically left ventricle, was at the upper limit, but still normal (1.1 cm).

We just repeated this test, and my doctor was still fairly pleased with the echo (good chamber size, good valve function, good ejection fraction [though a few percent down from 3 years ago]), but my left ventricle was 1.2cm, so there is a mild concentric left ventricular hypertrophy. This worried me greatly, but she's assured me at this time it's not exceedingly risky - it's just that we don't want it to get bigger and would prefer to reverse it if possible.

Because of the prehypertension and LVH, she decided to try me on a beta-blocker called Bystolic, which was supposed to have very few side effects. I took the first 5mg pill yesterday, and while it did bring down my blood pressure, I feel terrible on it. I've been foggy, unable to concentrate, cold, and just don't feel at all myself. I see her in another month and have decided not to continue taking it because of how bad it makes me feel, despite the results. I know there are other blood pressure medications to try, but all have some serious potential side effects that worry me. My other concern with this medication is I've noticed my resting heart rate has fallen from the 60's and 70's to the 50's, which will make any heart training for the exercises I'm doing difficult (since I won't have a reliable exercise upper limit for my heart rate, and I'm not extremely comfortable with using perceived exertion).

Onto my questions:

1.) I've read that obese people (and even athletes, though for different reasons) sometimes do have mild LVH, regardless of blood pressure. Is a 1.2cm reading given my size especially risky, or should I try not to worry that much and just try to live as healthily as I can?

2.) Does the fact that I've moved from 1.1cm to 1.2cm over 3 years mean I will continue going that way if there aren't significant changes, or could that be as far as it goes?

2.) In your opinion, do I absolutely need medication at this time, or would I be better off to continue with my attempts at getting more fit and losing weight? Wouldn't doing both lower my BP as well as possibly regress LV changes?

Thank you very much for your help. I'm really trying to make the right decisions here, but I feel like, at least with *this* medication, my quality of life would be much lower.

Warmly,
xxxxx

Hi Doctor Makode,

Thank you very much for the kind and helpful response.

So you're not overly concerned with my 1.2cm concentric measurement (let's assume it's not a measurement error for now)? Is it true that at 1.2 I'm not at significant increased risk for heart attack or stroke? Do you feel like if I keep my BP under control (prehypertensive or lower) and lower my weight, it could regress?

Generally a few days before a doctor's appointment, I get several readings of blood pressure a day, multiple times like you suggest. The average for systolic is never over 140, and for diastolic the average is never over 90. I *might* get a reading or two over each once in a while, but it always goes away. Average is probably somewhere in the neighborhood of 130/86 or possibly less.

I will focus on weight loss and hope I can reverse all this. Thank you for your help and the followups!

Thanks, Dr. XXXXXXX Makode!

Last followup, and I appreciate your patience and very thorough answers!

Yes, lipid profile is fairly good (low cholesterol in general...low HDL as well, but it's not a problem with my total cholesterol, which is only around 100). Similarly, no problems as far as sugar.

I will continue with my exercise, eating healthy, and goal of weight loss and fitness and try not to worry too much as far as that echo reading. It's good to know 1.2cm doesn't significantly increase my risk (and that I don't have to worry too much til 1.5).

I know there's both concentric and eccentric LVH; I do do some bicep exercises, though with fairly light weights (10 lbs.) and things like pushups. Most of my exercise, however, is running/interval training/etc. So this could still explain the concentric version?

Thanks again for helping ease my fears.

Warmly,
xxxxxx