What is your BP? Have you had issues with hypertension (HTN) in the past? Have you been having BP issues while on cycle and/or off cycle? Have you had any BW done recently?

In either case, if you’re showing any concern, I'd have your BP checked by someone who KNOWS how to take one correctly. In a pinch, you can purchase an at home device that you can self-operate. However, these units are known to be somewhat inaccurate and should be compared to a manual reading taken in mmHg to "calibrate" the unit. While you're at it, it's also a great idea to calculate your pulse pressure. Having a narrow pulse pressure is often a sign of CHF, cardiac tamponade, stenosis, ect...bad news.

Pulse Pressure

In case you don't know...Pulse Pressure is defined as the difference between the systolic and diastolic pressure readings. In short, it represents the exertion that the heart generates each time it contracts. If resting blood pressure is 120/80mmHg (systolic/diastolic), pulse pressure is 40. A person with normal blood pressure (120/80) will have a pulse pressure of 40 (120-80). But that doesn’t mean that a person with a pulse pressure of 40 has normal blood pressure. Check it out: Clearly, a blood pressure of 140/100 is much different than 120/80….right? These examples demonstrate that pulse pressure, by itself, can’t be used to make treatment decisions when other information is unavailable. Pulse pressure, as you can see, is a sign but not a diagnosis. Many different diagnoses can account for changes, so it's only one piece of the puzzle.

Types of hypertension

I guess I should explain secondary vs primary hypertension real quick. Primary hypertension aka “essential hypertension”, is a disorder which is associated with elevated blood pressure whose causes are not readily identifiable. Its prevalence tends to rise with age and genetic factors in most populations. Secondary hypertension causes are usually medical disorders such as diabetes, kidney disease and liver disease, drugs….in our case AAS. Unlike primary essential hypertension, secondary hypertension is curable simply by resolving the underlying medical causes. Once the underlying disorders are treated in a secondary hypertension patient, the high blood pressure quickly disappears. Elevations in systolic BP while on cycle, or “secondary HTN” are almost a given when on AAS, its the diastolic reading that should really raise concern. Not to say that you should dismiss elevated systolic BP readings simply because you’re on cycle

How to take BP?

Before you delve into this a whole lot, I'd take your BP orthostatically/posturally. Laying down, sitting and standing. In between the readings, take a minute or so before taking the next reading. Be sure to note all three readings.

Then, I'd have someone who knows how to accurately take a BP by hand (stethoscope and sphagnomometer) and compare your findings.

What about BP meds?

I’m certainly not an MD, but I’ve worked closely with MDs my whole career and often do patient teaching concerning their prescribed BP meds. Don't confide in hawthorne berries or celery seed extract. Those "may" help with very very minor hypertension. In most cases, I'm willing to bet they'll do absolutely nothing. You're better off with a PDE-5 inhibitor (Cialis!!), arginine and L-citrulline. If you doubt a PDE-5’s efficacy in causing vasodilation……believe it or not, I work with a surgeon who actually still uses boluses of Sildenafil (Viagra) during some open heart procedures. After all, that what its original role in pharmacy. If you really do have primary HTN as a lot of us do, a low dose Hydrochlorothiazide/antihypertensive drug is more likely what will be in play if there are no adherent findings with BP assessment techniques and medical intervention is needed.

Drinking water to lower BP?

Drinking water; although great for you, actually expands blood volume and raises BP. You should still obviously be drinking lots of water though. When someone presents in the ER with any sign of fluid volume deficit or hypotension, the first move is IV NS or D5 H20. Why? To increase blood volume and ultimately raise systolic blood pressure and mean arterial pressure. Hammering IV fluids has a faster but similar effect as drinking water. Drinking water is bad-ass and we gotta do it a lot! However, it won’t lower your BP…sorry.

Should I donate blood?

Of course! If blood work indicates that your RBC count is beyond normal limits, a trip to the community blood center is a great idea. Besides, think of the people you can potentially save by donating blood. AAs are well known to cause erythrogeneis either through stimulating renal production of EPO and/or by stimulating bone marrow to release more RBCs. Polycythemia (elevated RBC count) can be dangerous for the following reasons: The relationship between BP and viscosity is such that, given a constant systolic BP, if blood viscosity increases, then the total peripheral resistance (TPR) will necessarily increase, thereby reducing blood flow. Conversely, when viscosity decreases, blood flow and perfusion will increase. Because of the dependence of systemic arterial BP on cardiac output and TPR, if blood viscosity and TPR rise, systolic BP must then increase for cardiac output to be maintained. Consequently, blood viscosity has been established as a major determinant of the work of the heart and tissue perfusion. Since increased viscosity requires a higher BP to ensure the same circulating volume of blood, both the burden on the heart and the forces acting on the vessel wall are directly modulated by changes in blood viscosity. In a nutshell, the thicker your blood is, the harder your heart has to work to keep it moving.

I know I probably went overboard. I've just seen a ton of people who had dangerously high BP come through the ER not even know because it was never checked.

As always…if anyone finds anything incorrect or has anything to add, please speak up! I value and appreciate everyone’s input!