60 Y/o Male With Chronic Hypertensive Disease Especially During Stress

Posted on Tue, 12 Feb 2019

Question: 60 y/o male with chronic hypertensive disease especially during stress also with GERD and OSA not properly treated- had afib x4 at 45 50 52 and 55- rate control with atenolol 25-50 mg/day dependant on felt PAC%E2%80%99s - no complications- recently been getting excessive and severe headaches had neuro workup ct cta initially mri mra LP one week later all negative - noticed when my BP remains high avg 150/90 HA%E2%80%99s can persist for a month straight- diamox was added now on 250 mg po tid with bp at 130-140/ 80-85 after 2 days of treatment mild acidosis noted- HA%E2%80%99s have improved but are still there- Ativan was added at 0.5 mg po qid to bring down anxiety response to HA%E2%80%99s- clonidine 0.1 prn if BP over 180/100 at anytime. i purchased an auto CPAP and will start using it tonight- my concern is I have overlooked this condition for a long time and when i initially presented to the ER 3 weeks ago my BP was 200 /105 with a horrible horrible headache- should i be concerned i had a bleed or just continue on this course or make other changes- ty very mich for your time- XXXXXXX

Answered by Dr. Bhanu Partap (1 hour later)

Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello

After going through the medical details provided by you I can very well understand your concern for your health and well being and I would like to tell you that the chances of having a bleed is very unlikely because you didn’t had any neurological symptoms.

As of now because your BP is holding well so it’s advisable that you should continue the ongoing treatment without making any modifications. Also I would like to tell you that along with regular medicine intake lifestyle modifications are also very important in a proper BP control regime. You have to avoid excessive intake of caffeine containing drinks like coffee, smoking should be completely stopped and salt intake should be minimised.

Also it’s advisable to relax and keep yourself calm because anxiety is one of the important causes of fluctuating or high blood pressure.

I hope this information will answer you query and relieve your worries.

Kind regards
Dr Bhanu Partap

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhanu Partap (11 hours later)

i dontSmoke or drink I do have one cup of green tea once a week I was concerned about staying on the Diamox for too long secondary to the acidosis do you have any suggestions for alternatives when this occurs looking back at my history my average blood pressure for the last 40 years was probably somewhere around 150/90 to 95- with Intermittent severe bouts of accelerated hypertension thank you for your response XXXXXXX

Answered by Dr. Bhanu Partap (1 hour later)

Brief Answer:
Hello again

Detailed Answer:
Is it possible for you to send me that blood electrolytes reports showing acidosis so that I can review it and then advise accordingly.

Regards
Dr Bhanu Partap

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj