Suggest Treatment For Pre-hypertension, Varicose Veins And Prolonged Periods

Question : Hi there,

I'm seeing my personal doctor fairly regularly, but had some followup questions (my next appointment is not until April), and I know she's busy, so I wanted to get your input. A bit of history, and I apologize of the length of this inquiry, but I want to be thorough with my question.

I'm a 36 year old male, obese at around 5'11" and 248 pounds (though working out regularly [most days of the week] and really trying to lose). I don't smoke, do drink (moderately most of the time), my cholesterol numbers are pretty good (bizarre in that they're quite low all around with total cholesterol only being 100, but that's supposed to be good), and otherwise healthy. I do have prehypertension most of the time with readings occasionally (but not regularly) in the Stage 1 range, but only just. Most of the time the readings are only prehypertensive, and sometimes below. I do have white coat hypertension where I get anxiety about readings when taken by doctors, so I try to get some readings at home where this doesn't have as much of an effect. I also take supplements to help, including garlic, fish oil, grape seed extract, fish peptides, celery seed, hibiscus, and magnesium (all of which my doctor is aware of).

My father (of Eastern XXXXXXX descent) passed away at 53 from a heart attack while exercising. According to my mother, he had fainting spells many times during times of stress or physical exertion (ie. while they were dancing and quite regularly). Unfortunately, as they were divorced later in life, detailed information about his cause of death is not known. I recall hearing my mother say someone was 90% blocked near the carotid, but she now does not recall whether this was him or not (though she is having memory issues), and I can't guarantee this was him. Given his history of fainting and early death from heart attack, I have begun to wonder if it was hypetrophic cardiomyopathy, but not enough history is available to me to know. I am especially concerned because I know if it WAS hypetrophic cardiomyopathy, this gives me a 50% chance of inheriting the gene and an increased risk of long-term problems or even sudden death.

I had an echocardiogram/doppler in early 2014, and everything came back normal. However, two values (Interventricular Septal Thickness and LV Wall Thickness) were both at 1.1cm, which is the upper limit of normal (but still normal). All other heart function was considered grossly normal and from what she said good. We're doing another echo since it's been just over 3 years due to the concerns over my father's history.

So, to my questions:

1.) I understand inherited genetic hypetrophic cardiomyopathy often shows up in adolescence or early 20's. Given that I had a healthy (even if at upper limits) echo in 2014 at the age of 33, does that make hypertrophic cardiomyopathy due to genetic factors unlikely?

2.) Related to #1, I understand people who are susceptible to this, and especially those susceptible to the sudden death concern, generally have some risk factors/symptoms pointing to that. One is a parent who died suddenly from a cardiac event, which I would have because of my dad, and that's the only one I'm sure I have. Others, though, like a fast resting pulse (mine's usually 60's-80's), fainting, exercise intolerance, arrhythmias, and chest pains are things I haven't had any issues with. Occasionally I can feel my heartbeat, say, in bed, but I'm told that could be attributed to anxiety and is in some people normal anyway.

3.) Related to #2, another risk factor often listed is an abnormal blood pressure response to exercise. How would I know? Would this be something I would be aware of? My doctor has elected not to do a stress test as she feels (with some merit) that the anxiety caused by the test could throw off the results and that with my current health, it's unnecessary to put me through that. So is there a way to rule this out? If I can exercise for long periods (~45 minutes) at 60-85% of my maximum heart rate comfortably (I'm tired but a good tired), does that mean I'm okay?

4.) Finally, and unrelatedly, I have some very minor varicose veins starting in the ankles of my feet (primarily the right one). My doctor isn't at all concerned and thinks it's from all the walking/running I've been doing (and the excess weight), but recommended I wear some copper compression socks. I've started to do that during cardio workouts. I wanted to know if these socks increase blood pressure at all (and if there's any risk because of it) since they do compress, and also if it's okay to only wear them during workouts that are intense on my feet for prolonged periods (such as running or the ellipticals, but not for, say, situps or free weights)?

Thank you very much for your time in considering and answering these questions!

Warmly,
XXXX

Thanks so much for your helpful response!

I'm working on trying to get the weight off. Hopefully that will allow my heart to remodel with slightly less thickness, and it should help with the BP too.

You've reassured me that genetic hypertrophic cardiomyopathy is quite unlikely in my case from my history so far. I would assume this means there's no extra sudden death risk in relation to anybody else without this condition.

Understood re the treadmill stress test. I'll go ahead and bring this up to my doctor at my next visit once we have the new echo results and see what she thinks. So, from what you're saying, without a stress test, there's no way to know if my blood pressure response to exercise is normal or abnormal? (But given my concern was because of hypetrophic cardiomyopathy, hopefully that makes an abnormal result more unlikely?)

Also understood re compression stockings. I'm glad there are no blood pressure concerns. Is it correct to wear these only when doing intense aerobic episode that stresses the feet/ankles?

Thanks again - your responses are very helpful.