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Have blood pressure 225/125. Had TIA. Suggest proper medications?

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Internal Medicine Specialist
Practicing since : 1986
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hypertension - my wife has had episodes with her blood pressures of approx. 225/125.
She also had a TIA.
What is the best strategy to finding the proper medications? She's been in the hospital twice and the cause/treatment has not been found. I watch her on a daily basis.
Posted Tue, 13 Aug 2013 in General Health
Answered by Dr. Akhilesh Dubey 48 minutes later
Thanks for using XXXXXXX
In case of Hypertension cause may not be know and this is >90% called Essential Hypertension. It can be controlled in most cases.

She has already suffered TIA (Transient Ischemic attack), hence we should be very careful to keep her blood pressure under control preferably 130/80 mm of Hg.

She should be investigated by Complete blood count, Blood sugar, Kidney function test, Electrolytes, EKG, x XXXXXXX chest, Ultrasonography of abdomen and Echocardiography. I am sure these tests must have been done as she was hospitalized.

We have to adjust dose of drugs she is taking when it is difficult to control blood pressure it is best to use combinations of 2 or 3 drugs. She should use less salt < 2.5 gm/day.

I would like to know what treatment she is taking at present and if you can upload her reports it will help. We should try to find any cause of failure to respond to treatment.

Hope this information helps, please provide above details to answer in detail.

Dr. Akhilesh Dubey M.D
Above answer was peer-reviewed by
Follow-up: Have blood pressure 225/125. Had TIA. Suggest proper medications? 15 hours later
She is now taking 20mg lisinopril, and clonidine 0.1mg as needed.
For the clonidine, it is taken for when her blood pressure exceeds 120 systolic.
Typically it's been taken in the morning as soon as BP > 120 mmHg, and then in afternoon. Sometimes another time in the evening.

Originally the clonidine was to be taken > 160 mmHg, but after a visit to the ER(her BP was 227/127), after the two hospital visits, the intern at hospital revised it to 120 to get ahead of the blood pressure rises. This has worked better since she has been taking it at the lower pressure.

You are correct in assuming she had all of the tests you mentioned. I don't have the charts, but wanted to get this back to you. When she has a high BP event, she shakes almost uncontrollably. She's been over 220 mmHg at least 5 times, and I am extremely fearful of a stroke and subsequent damage.

She was originally on 3 blood pressure medicines after her 1st hospital visit, lisinopril 40 mg, hydrochlorothiazide and can't remember the 3rd. The hydrochlorothiazide was taken away as it's a diuretic, and her 2nd hospital visit was due to a sodium blood level of 109. She was also drinking tons of water before her 2nd visit.

I realize having the charts would be best - but I feel I need to move fast.
Answered by Dr. Akhilesh Dubey 10 hours later
Thanks for follow up,

She is taking Lisinopril and Clonidine both are good drugs please continue them, I would suggest to use Clonidine regularly to avoid fluctuations in blood pressure twice or thrice daily after consulting your treating doctor.

If you can up load reports it will help to analyze and plan to investigate further.
She should take rest and take less salt if her serum sodium has returned to normal.

Please let me also know if she is taking any analgesic or any other drug, by chance there is history of smoking or tobacco use and alcohol.

If episodic high blood pressure is there then we need to investigate for Pheochromocytoma. Once I get reports will be able to elaborate on this.

Hope this helps, if you have any doubt, I will be available to clarify.

Dr. Akhilesh Dubey M.D.
Above answer was peer-reviewed by
Follow-up: Have blood pressure 225/125. Had TIA. Suggest proper medications? 41 hours later
I wrote a reply but think I got timed-out.
My wife does have history of alcohol and smoking.
She's quit alcohol, smoking electronic cigarettes.
She takes 325mg aspirin twice a day.

I'm attaching some labs.
She started taking Xanax yesterday. It has made a big difference, the blood pressure fluctuations have narrowed. Still ranging 140 to 100 mmHg systolic.
Answered by Dr. Akhilesh Dubey 5 hours later
Thanks for follow up,
I am glad to know she has decided to quit smoking and alcohol, this will definitely help her.
I think she is responding to the treatment, anti anxiety drug (Alprazolam) should help her, please continue as per prescription. We should maintain her blood pressure 130/80 mm of Hg.

I have seen all her investigations, her Haemoglobin is on lower side, Liver enzymes (AST & ALT) are mildly raised and even calcium is low.

I think liver enzymes may be related to her alcohol use and at her age calcium and vitamin D supplementation will be useful. You can discuss with your treating Physician and take proper prescription.

Hope I am able to address all your concerns, please feel free to ask any doubt, I will be happy to help. If there is nothing please rate my answer with good review before closing this discussion.

Dr. Akhilesh Dubey M.D.
Above answer was peer-reviewed by
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