Brief Answer: Many factors influence blood pressure readings... Detailed Answer: Hi, Thank you for sharing with us your concern. You are saying to be on amlodipine and bystolic, and had a BP of 118/64 when you got home from work. Then, it raised to 158/100 when you were at home. Please bare in mind that blood pressure does flunctuate during the day, especially when working, after eating, or taking coffee, etc. So, I'd want to ask when did you measure your BP which came out 158/100: - right after eating? - have you taken coffee before? - what other activities you had done? - were you sit and calm? There are many factors leading to increased BP. However, a reading of 158/100 is not that high to be considered worrisome. I'd suggest to repeat the measuring of BP : - stay sit and calm and have eaten at least for 30 min - if you took a coffee or any caffeine drink, please wait for 2 hours before measuring BP. All the best! Dr.Alba

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Brief Answer: Advise to relax,monitor BP,consult cardiologist... Detailed Answer: Hi back, Thank you for following up. I will try to answer to your questions hoping to put peace in your mind. Please bare in mind that if you are not having severe headache nor chest pain or shortness in breathing or numbness/tingling in any part of your body; then, it could be because of anxiety you got for getting high bp results. 1. The bp readings of 160/100 is considered high, but as mentioned earlier, your anxiety could have played a role together with the accuracy of the bp monitor you use. 2. It is normal for the bp to fluctuate especially if stressed or being anxious apart doing physical activity. As the high bp reading was after eating, then, the medications you are taking are not as effective as they should. I'd suggest to keep monitoring your bp before eating, at bedtime and early in the morning, record the results and report them to your cardiologist for further evaluation. 3. The bp readings called "emergency" are above 180/110; yours is high but not an emergency. Furthermore, you are also having your pills regularly. 4. Once again, I'd suggest to schedule an appointment with your cardiologist/physician and to run further cardiac tests : - ECG - cardiac echo - Holter monitoring - ECG stress test to evaluate your hearth and general health status. Depending on the results, it could be judged over changing pills or dosage. To my opinion, such elevation in BP could be because of the work/stress you had all the day and anxiety you get when your bp reading resulted high. Have chamomile tea and have a good sleeping until you see your doctor. Hope it helped! Dr.Alba Feel free to ask me other questions you might have. I'd be happy to answer them back and alleviate your worries.

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Brief Answer: Please refer to the answer below... Detailed Answer: Hi XXXX, Thank you for following up. Our work as medical practitioners is very "delicate"; we try to help our patients to resolve their health issues, but at the same time, we care for their emotional/psychological well-being. If one patient is emotionally/psychologically tranquilized, it will much more easier to understand and overcome the health issues together. With regards to your case, I have seen that your last consultation was on October last year where I have noticed trace of protein in urine and low HDL. Otherwise, everything else is ok. You are worried about vit.B12 and D levels. They are within normal levels although earlier slight decrease. This means that your diet is not rich in foods high in Vit.D and vit.B12. It is true that deficiencies in vit.D can increase chances for hypertension; while the vit.D supplementation can help decrease high BP. Meanwhile, vit.b12 deficiencies indirectly contribute to high blood pressure and heart disease. In your case, I'd suggest to eat more foods high in vit.D and vit.B12 and start multivitamin supplementation. I'd suggest to repeat urine analysis to identify if you still have trace of protein. If still trace, you should talk to your physician to identify why you have it: - kidney infection or uti - damages to the kidney from hypertension At the end, I'd suggest to get an appointment with your cardiologist to get your heart status re-checked. I noted that your last appointment was October 2012. I have noticed that your carotid layers (intima) is thickened, which might partially explain such elevations in your high blood pressure. This is one more reason I'd ask to get your heart and carotid re-evaluated. Furthermore, you report to be taking bystolic; while, I have noticed that cardiologist advised not to take it. At that time, (the reports on 10/26/2013), the cardiologist has written in the treatment paragraph to wean bystolic until discontinued. While the next follow up was after 2 months. Low heart rate caused by bystolic could be another reason for such high blood pressure. Once again, I ask to consult with cardiologist for further evaluation and to clarify this. Thank you for following. Dr.Alba Happy to assist you further!

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Brief Answer: Pleased to know I'd helped you! Detailed Answer: Hi back XXXX, You're most welcome Looking forward to have your feedback soon! Thank you! Dr.Alba

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