high Blood pressure and diving

Discussion in 'Divers with Disabilities' started by Savaaha, May 4, 2010.

  1. Savaaha

    Savaaha Angel Fish

    # of Dives: 0 - 24
    Location: Hattiesburg,MS
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    I was wondering how many others have high blood pressure and dive. Are you on any specific meds for it?

    I was told at one point some medications are not compatible with diving. I'm made to wonder if this was the doc trying to sell a new drug or if he was telling the truth. I was told I HAD to take Diovan. I am currently on Lisinopril as its cheaper than the other medication. I switched to it after last diving season.
     
  2. Bubbletrubble

    Bubbletrubble Regular of the Pub

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    Lisinopril is an ACE inhibitor. One of the common side effects of ACE inhibitors is a cough. A more serious side effect is inflammation of the lining of the respiratory tract. Such pulmonary side effects are not good for a diver. If you have these side effects, then it would be best to change to a different class of anti-hypertensive med. That being said, physicians often prescribe ACE inhibitors to divers. ACE inhibitors are a much better choice than beta-blockers, which decrease exercise tolerance.

    Diovan is the brand name for valsartan, an angiotensin receptor blocker (ARB). I'm not aware of any side effects that would make ARBs inappropriate for scuba divers. Common side effects for valsartan include headache and dizziness. FYI, there's a combo formulation of Diovan with the loop diuretic HCTZ. Divers on HCTZ should take care to stay well-hydrated, as the loop diuretic can cause dehydration if fluids aren't replaced.

    Yeah, I can see why Diovan would cost more than lisinopril for you. I think a reasonable approach is to stick with lisinopril for now, assuming that it controls your hypertension without any of the previously mentioned side effects. You don't really need to take Diovan. If that's what your physician told you, did he/she give an explanation as to why?
     
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  3. Savaaha

    Savaaha Angel Fish

    # of Dives: 0 - 24
    Location: Hattiesburg,MS
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    I had a huge problem with the Lisinopril cough in the beginning, I've been on it a while now and the only time I cough is at night usually as I lay in the bed reading or on the computer before bed. I rarely cough during the day anymore.
     
  4. Bubbletrubble

    Bubbletrubble Regular of the Pub

    # of Dives: 200 - 499
    Location: Seussville
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    Hmmm. Is the night cough the reason your physician wanted to move you away from the ACE inhibitor? FWIW, it's pretty standard to move a patient to an ARB if the ACE inhibitor elicits coughing. It sounds to me like your physician was being pretty reasonable. As you found out, though, the downside is that ARBs are much more expensive than ACE inhibitors.

    Have you tested whether breathing dry scuba tank air elicits coughing? I would definitely do a test-dive in my living room prior to attempting any real diving while on lisinopril.
     
  5. Savaaha

    Savaaha Angel Fish

    # of Dives: 0 - 24
    Location: Hattiesburg,MS
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    I was on the Diovan last dive season, and to save money switched to lisonopril. When I was 1st on it I coughed like hell but he told me with in 3-4 months the cough would stop. It has for the most part, only and rarely at that do I have a coughing spell at night.

    I did some pool time on saturday and had no problem breathing the tanked air. I think this Sherwood reg I have now will also help and according to the LDS it has a pair of metal pieces in it to help prevent drying out of my mouth.
     
  6. Troutmaster

    Troutmaster Single Diver

    # of Dives: I just don't log dives
    Location: Southern Michigan, USA
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    I have high blood pressure (really high actually). I have been taking Cardizim and Benicar HCTZ for a few years now (one AM and one PM) and have not had any problems. I am carefull about hydration, but I was before the HCTZ. I tried lisinipril but the cough drove me nuts. There are alot of BP meds out there, many have been arround long enough to be less expensive generics. You are getting some good advice here, hopefully TSandM will chime in, or you should PM her. She is a doctor and very experienced diver, she won't lead you astray.
     
  7. Savaaha

    Savaaha Angel Fish

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    Location: Hattiesburg,MS
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    Ive been on both Carizim and Benecar in fact was on benecar before the doc put me on diovan.

    I may give her a PM if she doesn't post here. Im feeling better about staying on what Im on since I don't have the cough like I did before. Generic for this is only 4.00 so its very cost effective.
     
  8. Bubbletrubble

    Bubbletrubble Regular of the Pub

    # of Dives: 200 - 499
    Location: Seussville
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    That's encouraging should you insist to stay on lisinopril.

    It sounds like this is going to be an informed decision on your part. You know what is at risk. If you have a coughing fit underwater, how manageable do you think the situation will be?

    I realize that you are saving a significant amount of money by going with the ACE inhibitor...but you are assuming a greater amount of risk. I'm assuming that you had no cough and good blood pressure control while on Diovan.

    Sorry I couldn't be more helpful. IMO, I think your physician is giving you good advice.

    FWIW, management of hypertension is very much an art. Side effects help physicians rule out the use of certain classes of drugs in a given patient. The patient might also have another medical condition that influences drug choice, e.g., hypertensive Type II diabetic on ACE inhibitor (may slow progression of kidney disease).
     
  9. Savaaha

    Savaaha Angel Fish

    # of Dives: 0 - 24
    Location: Hattiesburg,MS
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    Bubble, you have been a great help. Its good to have people to bounce things off of.

    If need be I am more than willing to switch. When it comes to health stuff I definitely have experience. I am 17 yrs post liver transplant and have had HBP the entire time. Ive stayed alive and in fair shape because I do listen to my doctors. I posted to see if anyone else dove while on lisinopril and to see if there was a possibility it was feasible. The doc who said I should be on it never really explained the why, just said it was a better choice if I was going to be diving. Hes no longer at my clinic so I cannot ask him.

    If I stayed on the lisinopril I think I could handle a coughing spell should one happen, I cant imagine it being worse than vomiting at depth, which I happened twice in 1 day and was able to deal with without surfacing(Really bad day at the destin jetties).
    I may go ahead and be on the safe side and go back to Diovan for the diving season, Im just hating the idea if readjusting to lisinopril a 2nd time.
     
  10. Bubbletrubble

    Bubbletrubble Regular of the Pub

    # of Dives: 200 - 499
    Location: Seussville
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    Why did your doctor switch you from Benicar to Diovan? They both belong to the same drug class (ARBs) but likely have different drug kinetic profiles.

    Did you mean to write Cardizem instead of "Carizim"?
    The side effect profile for ARBs appears to be better than other anti-hypertensive meds, particularly ACE inhibitors. The whole airway issue with ACE inhibitor-induced coughing is troubling. That's probably what the doctor was referring to. I know for a fact, however, that there are divers who successfully take ACE inhibitors...but AFAIK they don't fall into the minority population who get the cough.

    In the 1990s, there were a handful (not many at all) of published cases of liver toxicity in patients taking ACE inhibitors. Obviously, this isn't an issue for you or else you would have been symptomatic and your bloodwork would have shown increased liver enzymes. Just something to be aware of.
    Yeah. I can imagine that it would be tough to deal with all of that coughing all over again when dive season was over. I am also aware of the significant cost difference in the two meds. In a perfect world, we wouldn't have to choose between personal safety and saving money. It's a difficult situation.
     
  11. Savaaha

    Savaaha Angel Fish

    # of Dives: 0 - 24
    Location: Hattiesburg,MS
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    Cardazim.But its been a long while since I was on it.
    I don't know his reasoning for switching me. If they are of the same family. I remember being very leery about the switch tho.
     
  12. Savaaha

    Savaaha Angel Fish

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    Location: Hattiesburg,MS
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    I think Ill probably go ahead and talk to my doc next trip down there. Our dive prospects are slowly diminishing as the oil slick in the gulf advances so this post may not needed at all.

    I have figured out diving with all the medical issues I have and so far this is the only one that leaves me with questions. I was lucky the doc I had when I got my medical clearance form from the dive club was a diver and thought diving would benefit me greatly.
     
  13. Bubbletrubble

    Bubbletrubble Regular of the Pub

    # of Dives: 200 - 499
    Location: Seussville
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    It sounds like you're pretty good about communicating with your medical team. That's very important. If you need a referral to a physician in your local area who has knowledge of dive medicine, Divers Alert Network can be helpful. Give 'em a ring even if you aren't a DAN member. For non-emergent medical questions, call 800-446-2671 or 919-684-2948, Mon-Fri, 8:30am-5:00pm (ET) .

    You should also consider PMing TSandM. She's an ER doc and medical moderator here on SB.

    Too bad about the oil slick. Perhaps you could plan a dive vacation elsewhere. :cool2:

    Good luck with everything.
     
  14. pasley

    pasley Scuba Instructor

    # of Dives: 500 - 999
    Location: Lakewood, CA
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    Bubbletrouble has spoken well with some good advice that I would echo here.

    Your physician is of course the expert on medical things. The following is just my observations on life and not medical advice, or even knowledgeable discussion, and may not be relevant to your situation. Number one killer of SCUBA divers - Heart Attack. High Blood pressure increases the risk of coronary artery disease and with that comes an increased risk of heart attack and blood clots.

    Medication may be effective at controlling high blood pressure and is a good tool in the doctors arsenal for managing it, but does not address the cause, just the symptom. There are many causes of high blood pressure including genetics, age, stress, lack of exercise, weight, diet etc. Most commonly in the USA high blood pressure comes from poor diet, too much salt, poor exercise habits and the resulting weight gain. Improving on the exercise front and the stress front by SCUBA diving more and doing other aerobic exercise (with doctors agreement) between dives (swimming, bicycling, running) and on the diet front by just eating healthier will normally lower the weight and with it the blood pressure. I know of several SCUBA divers who use to take blood pressure medicine before they started SCUBA diving weekly (or more often). Not saying that would work for you, just saying if your doctor clears you for aerobic exercise you may eventually reduce or eliminate your needs for the meds. I will also point out that you can be stick thin, exercise like a demon and still have high blood pressure and/or cholesterol due to other factors (stress, genetics etc). As always follow your doctors advice, but SCUBA diving can be an active part of your aerobic exercise program and blood pressure management regimen.

    Example: Age 56, Height 6Ft., weight 145, BP 101/60 (it has gone up with age, I was 98/58). Ran marathons when I was 28 and yes I have genetics on my side). Dive most weeks, conditions permitting, often twice a week. Don't diet, just eat healthy, limit the junk food to once in a while and don't eat out too often. When I eat out I request they put half my meal in a to-go container before they serve me. Most restaurants give you way too much food (and we patronize restaurants that give you larger servings over those that give you smaller ones) and we tend to eat it because we were told to clean our plates. Side note, Burger King's Whopper Jr, the size hamburgers use to be in 1960, taste good and only cost $1.00 and it is all you need for lunch once you start eating right sized meals and adjust to it. I add a Value Meal (aka Kids) milk shake for $1.25 and have lunch for under $3.00 that fills me up, has a treat (milk shake) and is not too expensive either in the wallet or calories/fats (630 Total Calories Vs Whopper & Medium Shake 1190 Calories) department.
     
  15. Savaaha

    Savaaha Angel Fish

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    Location: Hattiesburg,MS
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    Hi Pasley,
    My HB started after my liver transplant. Im sure its caused partly by my weight and partly because of the meds used for the post transplant care. I also have nerve damage in my fafe from trigeminal neuralgia and the drg I take for that causes weight gain. I am over weight but am working on that. I used to be 295 and am now 250. As for my diet I am a vegetarian(I do not eat meat,fish or eggs) My junk food intake is minimum, I do not eat fried foods. The only fast food joints I do eat at is taco bell(1 7layer burrito fills me up) and occasionally Wendys(burger without the meat).
    Right now we are also working on getting the processed foods out of our diet(the boxed foods) and am eating more baked veggies. I also no longer cook with the veg oil , sparingly with canola and more so with light olive oil.
    Exercise consists mostly of laps in the pool due to arthritis and fibromyalgia.

    I am working on getting on getting the weight off. I need to readjust my eating tho as I had dipped down to 235 and was doing well, but during a shift in my husbands work, we moved we did end up living in a hotel for a bit and ate out too much. Im confident I can get that off tho.
     
  16. TSandM

    TSandM Missed and loved by many.

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    I really don't have much to add to what Bubbletrubble has already said. If your cough is minor on the lisinopril, I suspect there won't be any particular problem with diving on it. It is quite possible to have a coughing fit through a regulator (I have done it) but it doesn't sound as though your cough is related to exertion at all.

    As long as your symptoms are occasion coughing at night, I would stay on the same medication, rather than switch back and forth.

    I'm assuming the physicians who are monitoring your immunosuppression have been fine with the idea of diving?
     
  17. Savaaha

    Savaaha Angel Fish

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    Location: Hattiesburg,MS
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    TSandM,
    Yes they are. In fact the doc said it would be a good form of excerise for me so long as I did not over do in carrying the gear. The transplant and the immunosupressives for that are well in hand :) over 17yrs and no rejection. The only way it hampers my diving is I cannot lift/carry the BCD/tanks/weights out of the water due to a hernia. We have that worked out as I get my mask and fins on and get in the water, my husband passes the gear to me and I put it on in the water. If we have alot of chop, I put the gear on on the boat and he supports the tank for me as I walk to the edge and do my stepoff.
    I do think Ill be ok as far as the coughing, it is not brought on with exertion at all. I stay well hydrated as well to avoid drying my mouth out and that also helps.
     
  18. warmwaterturner

    warmwaterturner Dive Con

    # of Dives: I'm a Fish!
    Location: Houston, Texas
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    Been using Diovan for about 3 years. No side effects for me and no problems assoicated with diving.
     
  19. pasley

    pasley Scuba Instructor

    # of Dives: 500 - 999
    Location: Lakewood, CA
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    As I said there are many causes for both the BP and any weight issues. When medication are the cause it can be tough. It sounds like you are working on it. Not sure about the vegan thing. I confess to being a carnivore, but to each their own.

    If your diet is mostly vegetables and fruits that rather than grains that may be fine. But as you know grains (breads, pasta etc) are easily stored by the body for future use.

    It sounds like you are doing what you need to be doing. Keep up the good work and if the doctor clears you SCUBA dive often.
     
  20. Savaaha

    Savaaha Angel Fish

    # of Dives: 0 - 24
    Location: Hattiesburg,MS
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    I've been cleared for diving for several years :D .Sadly have not dove as much as I like but now that I have my own reg(got it friday) I can at least put in some pool time when ever I like.

    I am getting away from the pasta and processed stuff, and am cooking(baking) more veggies now. Im not quite a vegan and don't think I ever could be. I love my milk and cheeses :)
     

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