Brief Answer:
please provide more details.

Detailed Answer:
Dear Sir
Thanks for your query.
1. Yes, BP is a continuous variable and changes with time to time (almost continuously). It increases with any mental /physical stress and decreases with relaxation like sleep.
2. I have seen the pictures of her ECG. I could not find lead III tracing in them. Please upload the same. There is some suggestion of high blood pressure in these tracings in the form of high voltage in AvL. Otherwise in absence of symptoms, there is no significant change.
3. Please also mention if she has any complaints like shortness of breath on exertion or chest discomfort on exertion? If she has got any blood tests or ultrasound of kidneys done?
Sincerely
Sukhvinder

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Brief Answer:
please tell about work-up

Detailed Answer:
Dear Sir
Perhaps the tracing which should have shown lead III is absent and the marked LEAD III is not actual lead III.
You did not mention about her hypertensive work-up. If she has got her Ultrasound of kidneys and kidney function tests done. Beside if she has undergone other blood tests for high blood pressure?
If you will record blood pressure at periods of stress, you will find the BP high. These may be a respiratory tract infection, flu, common cold, episodes of cough , exertion or psychological stress.
If her shortness of breath is persistent, a cardiac ultrasound is warranted. If there is no shortness of breath on daily walk, likelihood of these episodes due to respiratory problem are high.
Sincerely
Sukhvinder

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Brief Answer:
please upload the reports.

Detailed Answer:
Dear Sir
I was talking about WORK-UP and not WORK-OUT. That means investigations only.
When we see a newly diagnosed patient of high BP, we normally advise him Blood sugar, hemoglobin, HbA1c, serum creatinine, BUN, urine examination, serum sodium and potassium, ultrasound of kidneys, ECG and xray-chest. Even if they are 6 months old, they will work for us. Please upload all these reports.
Waiting for her reports.
Sincerely
Sukhvinder

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Brief Answer:
need some tests, life style modification,medicines

Detailed Answer:
Dear Sir
1. The ECG, Lipid profile and urea/creatinine levels are within normal limits.
2. We normally get the other tests also as I mentioned to look for reasons and complications of hypertension. Kidney disease may cause high BP and high BP may damage kidneys. The remaining tests are blood sugar, HbA1c, urine examination, ultrasound of kidneys, serum sodium & potassium, Hemoglobin and x-ray chest. They tell us about damage to any of the end-organs and also help us to ascertain overall cardio-vascular risk. At times, although not commonly, there are tumors around kidneys which can contribute to high blood pressure.
3. Life style modifications for any hypertensive patient include maintaining optimal weight (body mass index ~23), Daily supervised exercise, low salt diet rich in nuts/legumes/vegetables & fruits, relaxation exercise/ meditation and avoiding alcohol/smoking (if using them).
Hope this helps.
Sincerely
Sukhvinder

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Brief Answer:
please see details.

Detailed Answer:
Dear Sir

1. The hemogram, urine examination, serum electrolytes, fresh urea/creatinine levels, random blood sugar are within normal limits.

2. X-ray chest report says that cardiac shadow is normal.

3. Ultrasound of kidneys is important investigation and needs to be done despite all other normal reports. As yet the other reports do not point to a secondary cause for high blood pressure.

4. Chillies, tamarind and other spices are not prohibited. They can be taken in normal quantity.

5. I already enumerated the required life style modifications.

6. I hope the correct name of medication is STAMLO and not STAMOL. STAMLO contains amlodipine. It is a calcium channel blocker and decreases blood pressure. Amlozaar is a combination of amlodipine and losartan. Losartan is an angiotensin receptor blocker and reduces blood pressure by a different mechanism.

7. Do not think that once a drug is prescribed it is forever. Especially the requirement of BP lowering drugs decreases in summer and increases in winters. It is not advisable to change the medicines without strict supervision of patient. You should continue to take prescribed medicines and if you feel that a very good control has been achieved with medicines you can discuss with your physician about reducing dosage slowly and in small amounts with strict supervision. But this should never be attempted on your own. Even it must not be changed after an online advise because of obvious limitations.

Hope this helps. Feel free to discuss further.
Sincerely
Sukhvinder

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