Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Thank you for asking on HCM!

I carefully passed through your question and would explain that high blood pressure is a caredio-vascular risk for stroke or coronary artery disease.

The fact that she has dizzy spells with loss of balance, may be a sign of vertebro-basilary insufficiency which is caused by low blood flow in the vertebral arteries.

From the other hand blood pressure crises could lead to intracranial hemorrhage, with a dark prognosis. Anyway this is not her case, as she feels better now.

I would recommend performing some tests to evaluate the blood flow to the brain and investigate for possible vessel narrowing:

- Blood lipid profile to evaluate for possible dyslipidemia
- A Doppler ultrasound of the cervical vessels
- Another more informative test of the intracranial and cervical vessels would be angio-MRI (or MRA) which can evaluate more carefully the blood flow in the brain vessels and posterior circulation (vertebral and basillary artery) and also give more information on her brain, investigating for possible small strokes.

Further lab tests to investigate for secondary causes of uncontrolled high blood pressure would be necessary:

- a resting ECG
- a chest X ray study
- other blood lab tests (fasting glucose, blood electrolytes, kidney and liver function tests, thyroid hormone levels)

Meanwhile, I would recommend consulting with her doctor in order to optimize her actual therapy in order to control better her blood pressure.

I would also recommend taking aspirin and a statin (atorvastatin, simvastatin, etc.), in order to reduce her possible risk for stroke, as her symptoms are suggestive of a high risk. Anyway it would be better performing the above mentioned tests before.

I would also recommend some lifestyle modifications in order to help her manage better her blood pressure and also reduce her cardio-vascular risk:

- Diet modifications (avoid salt and caffeine intake). From the other hand a Mediterranian diet would be recommended.
- Perform a lot of physical activity (walking, aerobics, etc.).
- Reduce weight if she is overweight.

Hope you will find this answer informative and helpful!

Kind regards,

Dr. Iliri

---