I Have Had Hypertension For The Last 25 Years. It

Posted on Mon, 28 Oct 2019

Question: I have had hypertension for the last 25 years. It has always been hard to control. For the last 3 months I’ve had very high pressures for a week or two at a time and I am on 5 different blood pressure medicines but it still shoots up too high. I have readings as high as 215/ 120 and they don’t respond to the hydralazine I was given for times when these spells occur. It may go down for an hour or so then it goes back up. The doctor added an anti anxiety medicine, Buspar, to see if it would make the medicines more effective. I have diarrhea 3-4 days a week. I don’t know if it’s caused by high bp or if the medicine is causing it. The doctor told me the high bp is caused by autonomic dysfunction. Sometimes I will have extremely low blood pressure (70/46) but it happens sporadically and I can’t relate it to a specific cause. I have had “drop” attacks when it has been low. I fall without losing consciousness. I have extreme vertigo when it’s high. I am so frustrated with these extremes and it’s very disabling. Is there any better treatment plan than what I am on?

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on - Ask a Doctor - service!

I passed carefully through your concern and would explain that considering your persistently high blood pressure values it is necessary to follow further clinical investigation towards secondary causes of hypertension. like thyroid gland dysfunction, pheocromocytoma, aortic coarctation, XXXXXXX syndrome, renal dysfunction, etc.

Coming to this point, additional medical tests should be performed (urinary metanephrines, thyroid hormones, aldosterone and cortisol levels, urea and creatinine, cardiac ultrasound, blood electrolytes level, etc.)

In addition, close blood pressure monitoring is necessary for a couple of days up to a week for a better optimization of the current anti-hypertensive therapy.

You should discuss with your doctor on the above mentioned issues.

Hope to have been helpful to you!

In case of any further questions, feel free to ask em again.

Kind regards,

Dr. ilir Sharka
cardiologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (13 minutes later)

I’ve had multiple tests done repeatedly. No other cause is found. It was after all other possibilities were ruled out that I was diagnosed with autonomic dysfunction. It’s my understanding there’s no treatment for this other than treating the symptoms. But I hoped there may be something new that could be done. Thank you for your help.

Answered by Dr. Ilir Sharka (9 hours later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

I would recommend avoiding strainding physical activity and reducing salt and caffeine intake, in order to avoid spikes in blood pressure values.

I would also recommend checking urinary metanephrines, if you have not checked them yet.

A brain MRI and nerve conduction studies, would help investigate for the possible causes underlying autonomic dysfunction.

A head Up Tilt test would help investigate for orthostatic hypotension, which is commonly association to autonomic dysfunction.

Hope you will find this answer helpful!

Wishing all the best,

Dr. Iliri

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar