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What should I be asking the doctors to do for me next?

By Anonymous June 22, 2010 - 7:38pm
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I am 44 years old. Mother of 2 children ages 19 and 16. Up until this past February 2010 I would have considered myself to be fairly healthy, active always on the go type of person. In September 2009 my husband suffered a major stroke and was hospitalized for 3 months. In February he was doing his routine blood pressure with our machine that we purchased for home. On this particular evening I thought I'd check mine too. I thought the machine was broken or maybe the cuff was the wrong size but after checking it 3 times the average reading was 210/141 pulse 110.

I went to my family doctor who immediately referred me to a Cardiologist. I was put on 2-1mg. Mavik, 1 Spirozene 25/25 and a low dose aspirin. I was so sick the first two weeks with dizzy spells and so sleepy could not keep my eyes open after only being awake for a few hours at a time. All of my bloodwork came back normal, cholesteral good, triglycerides good , white and red cell count good, thyroid good, creatinine good. My iron was very low and am taking iron supplements. It has now been 5 months since this all started. I have been to the Cardiogist for 8 visits. At each visit my meds have been changed either a pill added or a dosage changed. I am currently on 1 mavik, 1-120mg of Dilthazen, 1/2 spirozen 25/25, 1 iron pill and 1 low dose aspirin. The ultrasound of my heart showed no significant signs of the valve walls thickening yet. So far my high blood pressure has not shown damage to my heart yet. On my last visit (4 days ago) I asked my cardiologist if I could please have an ultra sound of the veins in my neck. She said that could be arranged. My blood pressure is still very high right now as I sit here my blood pressure is 143/98 pulse 98 if walk from the bathroom to the kitchen my bloodpressure goes up around 154/101. I understand that she is trying to get my bloodpressure under control but shouldn't she be finding the cause of this? Maybe I have a blockage somewhere? I am starting to get very frustrated and I don't feel very well at all. I am not used to not moving around. What am I suppose to be asking next?

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Dear Anonymous,

You have good reason to be frustrated but I commend you for being an active patient and asking very good questions. You are in good company. Up to 70% of patients with hypertension (high blood pressure) ARE NOT adequately controlled. The target blood pressures have been defined by the American Heart Association as a systolic (upper number) < 140, preferably <130 and a diastolic (lower number) < 90. On the other hand, given the number of anti-hypertensive drugs available, nearly all patients SHOULD be able to eventually achieve good control. That said, it often requires a lot of trial and error and up to 3-4 drugs. Obviously lifestyle changes are very important as well, including lowering your intake of salt (sodium), exercising and controlling your weight. As difficult as it might be in some patients, getting good control of one’s blood pressure is critical to protect you from the risk of stroke, heart disease and other serious conditions.

There are several categories of drugs to treat hypertension, each acts in a different way and may be more or less effective in a given person. Some drugs are more or less effective by race. Each drug has a range of dosages. The most common types of drugs are:

ACE Inhibitors (ACEI)
ARB’s (similar to ACEI)
Beta Blockers (BB)
Calcium Channel Blockers (CCB)
Diuretics (water pills)
Alpha Blockers

You are on a low dose of an ACEI (Mavik 1mg, typical range 1-4 mg), a low to medium dose of a CCB (Diltiazem 120, typical range 120-240 mg) and a low dose of a double diuretic (Spirozine 12.5/12.5, typical range 25/25 to 50/50). So, overall, you are on a low dose of three types of drugs. There is room to increase each, there are many alternatives within each category and there are other categories, (e.g. BB’s), that you are not on. I recommend that you continue to work with your doctors on increasing doses and trying different combinations of medications until your blood pressure is consistently under 140/90 and preferably under 130/85. It is absolutely critical to get things under control so don’t be satisfied until you are consistently in range.

Some people simply have different reactions to different drugs. You were initially without symptoms despite a blood pressure of 210 so it is reasonable for you to wonder if your not feeling well may partly be related to the specific drugs you are on. If your blood pressure is better but you still feel lousy don’t assume you have to live that way. Ask your doctor to consider further adjustments to your medication.

Finally, there is a condition known as REFRACTORY HYPERTENSION. It is defined as a blood pressure of >140/90 despite the maximum dose of at least 2-3 drugs. As frustrated as you are, you don’t qualify yet because you are still on relatively low doses of the medications. If after further work you find that your blood pressure is still high on high doses of at least 2-3 drugs then you need be evaluated further for a variety of unusual conditions that can cause refractory hypertension. These include renal artery stenosis, several hormonal conditions, sleep apnea, etc. Each has specific testing and treatment regimens.

Hope that helps.

August 3, 2010 - 8:47pm
EmpowHER Guest

I was wondering you've received any information regarding my question. I hope to hear from you soon.
Thank you

July 16, 2010 - 1:02am
(reply to Anonymous)

Hi, I'm not the medical expert they are contacting, but blood pressure can be tricky to get under control at first. One question I have is whether they have checked out your kidney function. Kidney problems often cause hypertension. There are many meds that can help with blood pressure, so if the ones they have put you on are making you feel crummy, they can try something else in most cases.

Honestly, you may want to get a second opinion. It is always appropriate when you have something big going on, especially if you aren't getting any relief. Mayo has a nice information section that may help you: http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=causes.

Good luck.

July 16, 2010 - 7:01am
EmpowHER Guest
Anonymous (reply to Cary Cook BSN RN)

Thank you so much for responding to my post. To answer your question regarding kidney, my blood test showed that Creatinin levels are good. No other kidney tests have been done. I was notified that I will go for my Carotic Artery Ultrasound at the end of September. The dosage of meds I am currently trying is starting to level out for me a bit. I now experience only slight dizzy spells periodically and it seems to be keeping my blood pressure lower than before. I no longer feel when my bloodpressure is rising throughout my body. Instead when that happens in the afternoons when I move around the most I can now feel it only around my neck and face. It feels like there is lots of pressure in my head and I can feel my heartbeating in my face. I don't appear to be red faced or flushed though but that is how I know and feel my bloodpressure is rising sure enough when doing my BP it is. Thank you for the website address. I will check that out right now.

July 16, 2010 - 3:05pm
(reply to Anonymous)

Please let us know if you come up with any further questions.

July 16, 2010 - 5:22pm
Expert HERWriter Guide Blogger

Anon - Thanks for sharing your situation. I've contacted a medical expert to seek additional information for you. It may take a day or two to get a response, but we will get back to you.
Thank you,

June 24, 2010 - 4:51pm
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