AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question QUESTION: I have had Hypertension since my early 20's. I am now 64.
The first 30 years, I would go to the doctor and be told that my BP of 145/95 was too high and had to take medication. Then I would try the medication which made me feel bad and just stop taking them. Recently, I have had instances of 230/130.
Anyhow, I read an article titled
Individualizing the Treatment of Hypertension
In the article, it was stated that ICG was capable of identifying which of the various reasons an individual has hypertension.
Impedance cardiography is one way of individualizing the approach to controlling blood pressure based on which factors are most likely causing the hypertension in the individual patients.
Could you comment on this?
I am familiar with the BioZ machine sold by CardioDynamics. I was pleased to find out that my cardiologists had a BioZ. When I asked him about using it on me, he said "It is not used for this". I gathered up information detailing its use to diagnose my HBP problems and gave it to him. I like this doctor as a person, he is always jolly and in good humor, but I can't imagine that he would spend $35,000 on a BioZ in 2005 and still not know that it can be used for diagnosing potential causes of hypertension.
IGC may not be a magic bullet, but it is a tool that should be available in any doctors office.
By the way, I have seen older models of the BioZ for sale on Ebay for as little as $900.00. I am even considering buying one and donating it to my local free clinic.
ANSWER: Impedance cardiography has yet to take hold in the treatment of hypertension. Interpreting the results from its use requires some considerable experience with it and thereafter medication changes. Many of these same changes can be made empirically by a skilled clinician without the benefit of impedance cardiography and blood pressure successfully controlled. Your blood pressure pattern sounds unusual with values as high as 230/130. If this truly a spiking blood pressure pattern then something like impedance cardiography offers no benefit/insight into mechanisms. A careful history and physical examination is the best answer to spiking blood pressure patterns. I do not have the full details of your case so I can at best surmise things from what you have stated/
Best regards,
Domenic Sica, M.D.
---------- FOLLOW-UP ----------
QUESTION: When I said I had readings as high as 230/130, I should have said that for a 3 week period, my blood pressure was ranging between 175/110 to 230/130.
I was NOT saying that my blood pressure spiked to 230/130.
I am aware that Impedance Cardiography is used for fine tuning treatment for patientw with congestive heart failure.
If Impedance cardiography hasn't taken hold in the tratment of hypertension, it is because of lack of education. My cardiologists who owns a BioZ machine didn't know it could be used for fine tuning treatments for resistive hypertension. The BioZ machine
is just one tool that can be used, but it is sad that even cardiologists who own the machine don't use it for dealing with hypertension.
I take my medications at 7AM and 7PM. About 2 hours after taking my meds, my BP is around 140/75 which is great. About 8 hours after taking my medications, my BP is around 165/100.
The recent addition of AZOR has been a definite improvement. I have never ( not even when I was in my 20s) had a dystolic reading of under 85 and since taking AZOR I do. The problem I have is that it stops having an effect after about 8 hours.
Answer Your thoughts on impedance cardiography are reasonable. As to your blood pressure I wish I could offer more meaningful comments but unfortunately this forum does not allow me to obtain detailed histories and thus my answers are oftentimes incomplete. As to the AZOR effect waning after 8 hours two logical solutions are an increased dose or its being used twice daily.
