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Have Resistant High Blood Pressure . Cardiologist Over 2yrs Hasn't
Question: Have resistant High Blood Pressure. Cardiologist over 2yrs hasn't pinpointed cause or has been unable to prescribe a medication to lower it. Best is 170/90 will rise to 190/105. Was in hospital 3 months back when changing meds it shot up to 225/110 they treated me Intravenously with 10mg Hydralazine which lowered it to 160/70. Went to Cardio Dr afterwards and he put me on it 25mg 3x daily. BP now 170/95. Still high. Been high all my life even when I was running marathons in my 20's weighing 145lbs. Mother had I all her life. She died @87 in an accident. She had no heart problems at all.
Brief Answer:
I would recommend peforming further tests:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I reviewed carefully your blood lab test reports and it seems that the renal function and the renal blood perfusion are OK, so their implication is excluded.
But, there are other tests that need to be done in order to find the possible cause underlying your resistant high blood pressure. In this regard, I would recommend checking thyroid hormone levels in order to exclude a possible thyroid gland dysfunction.
Another point to check would be your adrenal gland function. In this regard, I would recommend performing:
- aldosterone blood levels
- cortisol plasma and urine levels
- renine plasma activity
- urinary metaphrines for possible pheochromocytoma.
It is also advisable an angio CT scan or MRI of your aortic arch in order to exclude possible aortic coarctation, which can lead to resistant high blood pressure values.
You should discuss with your doctor on the above tests.
I remain at your disposal for any further questions whenever you need!
Kind regards,
Dr. Ilir Sharka, Cardiologist
I would recommend peforming further tests:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I reviewed carefully your blood lab test reports and it seems that the renal function and the renal blood perfusion are OK, so their implication is excluded.
But, there are other tests that need to be done in order to find the possible cause underlying your resistant high blood pressure. In this regard, I would recommend checking thyroid hormone levels in order to exclude a possible thyroid gland dysfunction.
Another point to check would be your adrenal gland function. In this regard, I would recommend performing:
- aldosterone blood levels
- cortisol plasma and urine levels
- renine plasma activity
- urinary metaphrines for possible pheochromocytoma.
It is also advisable an angio CT scan or MRI of your aortic arch in order to exclude possible aortic coarctation, which can lead to resistant high blood pressure values.
You should discuss with your doctor on the above tests.
I remain at your disposal for any further questions whenever you need!
Kind regards,
Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had also seen an endocrinologist who I believe performed these test
- aldosterone blood levels
- cortisol plasma and urine levels
- renine plasma activity
- urinary metaphrines for possible pheochromocytoma.
through blood and 24hour urine collection. All were negative. I will show my Cardio Dr these test and ask him if indeed they were done
However the aortic arch test is something I will pursue. I did have Echo Cardiograms done and an MRI which wouldn't these tests detected an irregular aortic arch.
I know BP is a silent killer but would I have any physical symptoms from the aortic arch irregularity. I do run 15 miles per week along with weight exercise and find no out-of-breath symptoms. I do get worked up and suffer from panic attacks after I take my BP and realize its high and get fearful to wonder outside the perimeter of a nearby hospital.
I eat right, exercise, don't' drink alcohol, never smoked and just cant get a handle on this high BP even with medications. Been this way for most of my life from mid 20's. Are their many people like me having this problem and is it solvable.
- aldosterone blood levels
- cortisol plasma and urine levels
- renine plasma activity
- urinary metaphrines for possible pheochromocytoma.
through blood and 24hour urine collection. All were negative. I will show my Cardio Dr these test and ask him if indeed they were done
However the aortic arch test is something I will pursue. I did have Echo Cardiograms done and an MRI which wouldn't these tests detected an irregular aortic arch.
I know BP is a silent killer but would I have any physical symptoms from the aortic arch irregularity. I do run 15 miles per week along with weight exercise and find no out-of-breath symptoms. I do get worked up and suffer from panic attacks after I take my BP and realize its high and get fearful to wonder outside the perimeter of a nearby hospital.
I eat right, exercise, don't' drink alcohol, never smoked and just cant get a handle on this high BP even with medications. Been this way for most of my life from mid 20's. Are their many people like me having this problem and is it solvable.
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again, dear Steven!
As you have performed almost all the recommended test, the major traditional causes of secondary hypertension are excluded.
Anyway you should review your tests names with your cardiologist just to be sure that thyroid, adrenal functions are OK.
A careful echocardiogram and thorax MRI would detect any potential aortic abnormality.
So, what it remains to do is therapy optimization (daily dose adjustment and an appropriate drugs combination) as well as following your actual healthy life-style and diet.
Outdoor recreational activities would be helpful to reduce your anxiety episodes and further lower your blood pressure values.
Your health issue is quite manageable, but close BP values follow up is required.
Wishing you good health!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again, dear Steven!
As you have performed almost all the recommended test, the major traditional causes of secondary hypertension are excluded.
Anyway you should review your tests names with your cardiologist just to be sure that thyroid, adrenal functions are OK.
A careful echocardiogram and thorax MRI would detect any potential aortic abnormality.
So, what it remains to do is therapy optimization (daily dose adjustment and an appropriate drugs combination) as well as following your actual healthy life-style and diet.
Outdoor recreational activities would be helpful to reduce your anxiety episodes and further lower your blood pressure values.
Your health issue is quite manageable, but close BP values follow up is required.
Wishing you good health!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I thank you for your factual and pointed responses. Its been more than direct and intellectual than I have received from my Doctors. One last question. In the arsenal of medications for BP are there any you would have me consider to ask my Cardio Dr about. This more than anything else is really important to me. He seems to be throwing darts at the wall and causing at times my BP to spike. I have been told I metabolize drugs quickly if that's any help. One other note. I have taken Amlodipine (Norvasc) nearly 30 years. It started making me feeling quite (suicidal) depressed. Those symptoms disappeared once he took me off it. Right now on 25mg Hydralazine 3x dly and Valsartan/HCZ 320/25. Not lowering BP enough. Any suggestions would be appreciated. I do understand your recommendations are only suggestions. Thank you.
Brief Answer:
I would suggest:
Detailed Answer:
Hello!
As there are no superior predefined schemes when treating hypertension, it is necessary to try getting the most from therapy and avoiding at the same time potential adverse effects.
You may actually combine your actual therapy with other medications like Doxazosin 1-2 mg/day, or Methyldopa (starting 250 mg x3/day).
You should discuss with your doctor on the above alternatives.
Best regards,
Dr. Iliri
I would suggest:
Detailed Answer:
Hello!
As there are no superior predefined schemes when treating hypertension, it is necessary to try getting the most from therapy and avoiding at the same time potential adverse effects.
You may actually combine your actual therapy with other medications like Doxazosin 1-2 mg/day, or Methyldopa (starting 250 mg x3/day).
You should discuss with your doctor on the above alternatives.
Best regards,
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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