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Cardiovascular System - Blood Pressure

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Please can you advise me on my medication as I am going diving on 15th November in Oban. I started on ramipril 2.5 increasing to 10mg. I have been on the 10mg for just over a week. I take it at bedtime. Last week after taking the first of the 10mg I woke up regurgatating acid and felt very dizzy with strange feelings down the left hand side of my face. Since then at the weekend I felt nausea and dizzy. Will it safe for me to dive or will I have to wait until I have been taking medication a little longer.

A - Whooa, this sounds like quite a side effect, and I hope you have gotten rid of it by now, if not, go see your regular GP for an immediate assessment of your blood pressure. When you up a dose like that there are chances it can drop your BP too much, hence nausea and dizzy. And strange feelings on one side of your face really need a neurological assessment, to make sure there’s no strokey sort of things going on. So, assuming this is still present, do NOT dive.

If it does settle and it’s simply a transient problem with the dose increase and now gone, this is how you dive. High blood pressure does need to be assessed by a dive doc before diving. You need an ECG to make sure there’s no damage to the heart, and a general once over. But these meds are dive friendly, few side effects like the dreaded beta blockers or diuretics. I reckon your chances are good, as long as all this side effect malarky has gone for good.

Q - Kitty at Dive Solutions has given me your name. I have been discussing with Kitty the possibility of buying my father some diving lessons for his 70th birthday. He is generally fit and healthy. There are a couple of questions on the health form which I am not sure about (and because it's a surprise, do not want to ask him what the position is). These are the questions relating to high cholesterol and high blood pressure. I believe that he does or, at least, has in the reasonably recent past, taken Lipitor (or something similar) but I am not aware (nor is my mother) of any problems and his cholesterol is in check.

Kitty thought that you would be able to "sign him off" so that I can purchase the lessons for him. Is this correct? Do you need any further information?

A - I think we can work round this one, before it gets in to “Carry On” proportions of comedy as you try to hide the secret as he walks into a docs office with pictures of divers everywhere. If it was just high cholesterol, then this has never stopped anyone form diving. But he will need a medical. I suggest remotely certing him for the pool and theory, but before the open water dives, where he would have clicked by then, seeing me. Of course there are no guarantees he will pass the medical, but you get a feel for people and he should be OK.

Q - My employer is calling me from Hawaii, she wants to scuba dive for the first time but she is being treated for high blood pressure. She is in otherwise good health, only an abnormal eye exam recently related to the blood pressure. There were other references to blood pressure on the dive site, but nothing specifically related to an angiotensin receptor blocker, only beta blockers. Can you advise whether she should dive? She is in her early 40's.

A - I’m trying to get my head round this. Your boss is in Hawaii, needs a medical question answered, and instead of asking the dive shops dive doc, calls you. I hope you don’t have to wipe her…you know what I mean!

Anyways up, she will need to get seen before diving, to check what the hypertension has done to her, but the good news is that the meds she is taking are the best with diving. So she should be ok to learn. Hey, you could even do her PADI exam for her too.

Q - I am a 51 year male and my LDL cholesterol is a little high. My Doctor has just put me on a daily dose 20 mg of statins to try to get the level down. My blood pressure is normal and I am otherwise healthy. Is there anything he or I should be aware of that would inhibit my taking diving lessons?

A - This is going to get more and more common, as NHS GP’s are paid to put people onto these sort of meds at the soonest instance. 250 G’s a year!! They’re having a laugh, and it’s our taxes. And they whinge about over-work. Try running a proper business, I say.

Anyways, as long as you are not a coronary risk, and it sounds you are not, then you are fine to dive.

Q - My dear wife (49 years of age) uses atenolol for high blood pressure which she hopes to come off from, and as we are going to Egypt soon on a liveaboard. Can you suggest any other alternatives?

We have also been informed that a supplement of B1 will keep the flies away, is this true?

We have had Hepatitis, tetanus and typhoid are there any other jabs needed?

Do you have any other health tips?

A - Dear wife, yes I agree they can be expensive! Atenolol is a beta blocker and as I have pointed out before in previous issues this drug has a risk of causing a build up of fluid in the lungs if she were to exercise more than she was used to. This is called "pulmonary oedema" and results when the heart, which is slowed by the medication, not coping with the amount of blood returning to it, which then oozes out of the capillaries of the lungs into the tissues of the lungs itself. You can recognise someone with this as they are classically short of breath and cough up frothy blood stained sputum rather like the head of a glass of strawberry Cresta if you can remember popular 1970's soft drinks. Atenolol is the most commonly used of the antihypertensives as its cheap and pretty effective, but I've got to advise that she try a non beta blocker, and the best of these for a diver is probably Losartan. So try to get her medication switched afore she goes.

Now the question of what best to keep the flies off. Traditionally one of the Vitamin B subtypes, either B1, B6 or B12 works to keep off mosquitoes rather than flies, but to tell the truth I'm not sure which one it is exactly. But by no means is this to be relied on instead of antimalarials if that occurs where you are. I think the theory is that it makes the skin smell bad to these bugs and wards them off like garlic is also supposed to. But flies are a different matter, bigger and bolder. I guess the key is not to smell like what flies like, or make someone else an attractive proposition. I'll leave that to you! Your shots seem fine as long as its Hep A you've had. As for health tips…plenty.

The most important is to stay well hydrated as this is the biggest contributor to DCS in divers out there. This includes not getting diarrhoea, so watch what you eat there.

Remember the sunscreen and from my experience never be the first to get rigged up before a dive if there's a real slowcoach, standing in 35 degree heat with a wetsuit on for 20 minutes if someone's still in the loo can exhaust you to the point of collapse.

Enjoy the trip.

Q - I hope you can advise me on the following ?

During a full and very comprehensive annual medical from my usual G.P. of many years, he finds, at present I have mild hypertension. Under normal everyday conditions he stated "He would monitor my Blood Pressure again in 6 months time" within the PADI "Guidelines for Recreational Scuba Divers Physical Examination" there are no limits for relating to hypertension level which my G.P. can assess if my condition is of any concern and therefore sign my "Medical Statement" document.

Are you able to provide any advice which I can pass to my G.P. to enable my Medical Statement to be completed .

I am 45 years old, have been diving for 18 years, currently a PADI A/I, complete over 100 pleasure dives per year and teach one night per week. Health generally good and a reasonably normal level of fitness.

A - The guidelines are fairly straightforward as regards high blood pressure and diving. In the UK if you are an established diver, with a BP of under 160/100 you are allowed to dive, but if you are new to the sport and you have a BP of over 150/90 then you need to see a medical referee before you are allowed to dive.

Now before you get too worried you need to understand something. The pressure that your doctor checks is a variable thing. It may be high when he or she checks it, but it may be low later when you are at home. So in my practise I never go on a single reading that I take. I always suggest that a patient with borderline high BP either buys a machine to check it themselves at home on a regular basis which I think is a far more accurate way, or even better, has a 24 hour BP monitor. This gives the most accurate reading for your BP and quite often shows that it was normal anyway.

However, if it is raised enough to stop you diving then hypertension is very easy to treat and can be under control within a week or two with a choice of medication that won't interfere with diving.

So, get it properly checked firstly and then get it controlled and you can be diving sooner than you think.

Q - In October last year I experienced unusual chest pains and was checked out in Hospital. I underwent a range of tests including an exercise ECG on the treadmill. My problems were diagnosed as Stress / Anxiety as all the tests came back clear, no medication was prescribed. The nurse who carried out my exercise ECG said my BP was too high. My own GP checked me out after and said my Blood Pressure was raised 145/95 and prescribed Propanolol as this would help both BP and anxiety. After this I must say I felt awful and eventually in December I managed to persuade him to stop the medication and let me settle down.

My Blood Pressure when checked by the nurse last week was 130/90. He has agreed to let me go diving again but seems insistent that we get the 90 down to 80 and I believe he will be prescribing more drugs next time I see him.

Please could you comment on whether my BP is high and if so what medication is ok to take when diving. Diving is important to me in enabling me to cope with stress.

A - So diving makes you less stressed, and the problem was stress in the first place. Sounds like we need to re-open Mr Cousteau’s Sudanese underwater world for you. Your BP is actually OK to dive with, anything below 150/100 in an existing diver can be considered fine. If you are going to go onto meds, my recommendation is any drug ending in “-sartan”.

(other dive medical questions)



   


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