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Suggest Treatment For Continued High BP When On Medication
Question: five years ago had anatomical anyrism 73mm been repaired since doc have been trying to get BP down was on adalat oros 20x2 per day now have reduced to 10mg per night . ata cand was on 32mg now taken back to 8mg at night. here at moment summer 30to 40* Celceus and finding that as temp goes up BP goes low about 100/60 as temp goes cold bp 150/70 if cold taking hot drink lowers and vice versa. overnight pressuer can be 200/100 depending if I sleep with mno sheet or 140/70if sheet and blanket but too hot XXXXXXX YYYY@YYYY have you any thoughts as it has my G.P.Stumped
Brief Answer:
Immediate modification of BP medications requirred
Detailed Answer:
Hi XXXXXXX as I have understood from what you have written so far is that you had been suffering from aortic aneurysm for which you had initially undergone a surgical repair and you are now on two medications, namely Candesartan (Atacand) and Nifedipine (Adalat) and the dosage and release formulation of the medications have been changed recently.
Now you have been facing a problem that you have high blood pressure at cold and low at hot climate and they also change accordingly as the temperature varies at different time of the day or whether you use a blanket or not.
Now, the point is that blood pressure can increase in cold climate due to selective narrowing of some blood vessels in the body and functioning of sympathetic nervous system.
In your case, the change or increase has been abrupt and that I think is due to sympathetic hyperactivity.
Now, you have been prescribed medication which mostly look at the renal contribution to hypertension. Another medication (Nifedipine) is a short acting one and its formulation has been changed from a long acting extended release one to a short acting one. Now, all of them have contributed to this disproportionate and abrupt increase in blood pressure.
So, now I think you have received the answer for your query that "what thoughts" I have regarding the problem.
Now, the solution part.
I think a beta blocker group of antihypertensive should be added to the current regimen. For that, you should consult your local cardiologist.
Secondly, a blood pressure of 200/110 mmHg is too high for home based treatment. If you have noticed such pressure, you need to get admitted in a local hospital for monitoring and intensive control of blood pressure.
Lastly, restriction of salt in diet and walking are essential for proper control of blood pressure. Therefore, you should maintain a fat and salt restricted diet and perform regular walking.
If you find this answer helpful, please close the thread and rate my answer.
Regards
Dr. Kaushik Sarkar
Immediate modification of BP medications requirred
Detailed Answer:
Hi XXXXXXX as I have understood from what you have written so far is that you had been suffering from aortic aneurysm for which you had initially undergone a surgical repair and you are now on two medications, namely Candesartan (Atacand) and Nifedipine (Adalat) and the dosage and release formulation of the medications have been changed recently.
Now you have been facing a problem that you have high blood pressure at cold and low at hot climate and they also change accordingly as the temperature varies at different time of the day or whether you use a blanket or not.
Now, the point is that blood pressure can increase in cold climate due to selective narrowing of some blood vessels in the body and functioning of sympathetic nervous system.
In your case, the change or increase has been abrupt and that I think is due to sympathetic hyperactivity.
Now, you have been prescribed medication which mostly look at the renal contribution to hypertension. Another medication (Nifedipine) is a short acting one and its formulation has been changed from a long acting extended release one to a short acting one. Now, all of them have contributed to this disproportionate and abrupt increase in blood pressure.
So, now I think you have received the answer for your query that "what thoughts" I have regarding the problem.
Now, the solution part.
I think a beta blocker group of antihypertensive should be added to the current regimen. For that, you should consult your local cardiologist.
Secondly, a blood pressure of 200/110 mmHg is too high for home based treatment. If you have noticed such pressure, you need to get admitted in a local hospital for monitoring and intensive control of blood pressure.
Lastly, restriction of salt in diet and walking are essential for proper control of blood pressure. Therefore, you should maintain a fat and salt restricted diet and perform regular walking.
If you find this answer helpful, please close the thread and rate my answer.
Regards
Dr. Kaushik Sarkar
Above answer was peer-reviewed by :
Dr. Shanthi.E
THANK YOUI FOR YOUR ANSWER i WILL FOLLOW UP.
HAVE ENCLOSED A CHART OF BLOOD PRESSURE READING OVER LAST FEW WEEKS NOTE THE WIDE VARIATION PER DAY XXXXXXX
HAVE ENCLOSED A CHART OF BLOOD PRESSURE READING OVER LAST FEW WEEKS NOTE THE WIDE VARIATION PER DAY XXXXXXX
Brief Answer:
Revision of antihypertensive regimen
Detailed Answer:
Hi XXXXXXX thanks for the wonderful chart provided.
As I can see here, you truly have a wide range of fluctuations in blood pressure and often a low diastolic blood pressure as well. On the other hand the systolic blood pressure is often taking a peak.
As I had suggested earlier, nifedipine is not a wise choice as antihypertensive at this scenario and beta blocker should be added to the regimen instead, particularly because your heart rate is good.
So, please consult your local cardiologist regarding the same.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr Kaushik Sarkar
Revision of antihypertensive regimen
Detailed Answer:
Hi XXXXXXX thanks for the wonderful chart provided.
As I can see here, you truly have a wide range of fluctuations in blood pressure and often a low diastolic blood pressure as well. On the other hand the systolic blood pressure is often taking a peak.
As I had suggested earlier, nifedipine is not a wise choice as antihypertensive at this scenario and beta blocker should be added to the regimen instead, particularly because your heart rate is good.
So, please consult your local cardiologist regarding the same.
If you find this answer helpful, please close the thread and rate my answer.
Regards,
Dr Kaushik Sarkar
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Prasad
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