Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

126 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Sudden episodes of BP hikes. Plasma renin, renal color doppler study and VMA are within normal range

Answered by
Dr.
Dr. Sukhvinder Singh

Cardiologist

Practicing since :1998

Answered : 1306 Questions

default
Posted on Fri, 15 Nov 2013 in Hypertension and Heart Disease
Question: Hi
My wife ,62 years old,weight 59,height 5.4ft,gets sudden episodes of BP hikes for the last 2-3 months.She starts feeling something in her tummy and asks me to check her BP and it rises to 220/120,heart rate goes to 95 to 110.I showed her to MD physian cum cardiologist here and ECg,ECO cardiogram were normal.Her Plasma renin,renal color doppler study,VMA ( Venyl mendalic acid study) all were done and everything is within normal range.The doctor here feels she has reactive hypertension.She was given T Nicardia R 10mg,T Rivotril 5 mg whenever she gets the episodes. She was shown to a phychiatrist and prescribed T Nexito 10 mg as they feel she has got depression but she is very active,cheerful,lively lady and no symptoms of depression.She is oversensitive to any sudden accidents,hearing seeing death news etc.Her BP goes up in 5 to 10 minutes and after taking Rivotril,it comes down to normal 130/80 level in 30 to 40 minutes ,sometimes in between shoots up and down but it lasts for about 30 minutes afterwards she gets good sleep.BP medicine T Olmesartan was tried and she gets sweating,BP goes down below 100 and so.She and I am reluctant to put her on Nexito due to lots of its side effects.
I am giving her homoetahic medicine now and if badly necessary,then give T Rivotril and T Nicardia 10 mg.
I am in a totally helpless position now where to go and wat to do to find out the root cause of these episodes as all reports are normal.She is also T2DM and on T Galvasmet 50/500 and sugars are under control.
Can u please help me and guide us in the matter and i shall be thankful for ur help.
Regards
XXXX
doctor
Answered by Dr. Sukhvinder Singh 9 hours later
Brief Answer:
please see below

Detailed Answer:
Dear Sir
1. The basic causes for large fluctuationepisodic /rise in blood pressure (BP) include stress at time of measuring BP, pheochromocytoma (PCC), neuropathies, alcohol, improper drug dosing etc.
2. Our BP varies as per our physical or mental stress. Exercise, simple running or calculating a mathematical problem or exposure to cold weather or a bad news , all increase our BP albeit for short period of time. Hence whenever we take BP we should be free of stress, should not be in pain, should not have taken coffee, tea or exercise in last one hour. Else the BP measurement will not reflect the actual control. I recommend measuring her BP daily at almost same time in such circumstances to know her actual status.
3. VMA has been done to rule out PCC. Was her Ultrasound of kidneys and suprerenal region done? Beside pain in tummy does she has anything else?
4. I am not a proponent of this SOS Nicardia R therapy. Instead I would prefer to give a low dose Beta-blocker to my patients in such scenario (after ruling out PCC) and carefully up-titrate them. Rivotril therapy is a decision of psychiatrist.
She should be counselled for adopting appropriate response mechanism to various episodes in life. She needs to be evaluated for diabetic neuropathy also.
Hope this gives some insight. I am waiting for your follow up query with details.
Sincerely
Sukhvinder

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Sukhvinder Singh 13 hours later
Hi Doctor
Thanks for ur quick reply. I agree with your views when BP should be monitored and when it can go up. In my wife,s case Bp shoots up to 220/120,herat rate 95
any time which i cannot be predicted ,it happened at 1.00am,at 4 am and rest of the time it is always in the range of 130/80.
As regards USG studies ,i give below the details for ur kind inf
1 B Mode and Bilateral color doppler study of Aorta,both main & renal arteries,intra renal branches in the upper,middle ,lower pole calyes done and the result is Renal Disease Gr 1,no R A Stenosis.
2 Plasma Renin 6.70 ( n range 4.4 to 46.1)
3 Sr creat 0.60
4 BUN 8.0
5 Blood Sugar FBBS 103,PPBS 154 & HBA1C 7.3
6 TSH 3.61,T3 102,T4 8.5
Eco Cardio Normal
ECG Normal

As regards BP medicine,Olmesartan lowest dose was tried for a week and her pressure started going downward ,so it was stopped and she is not on any BP medicine now.
Tummy issue,she has got acidity problem . When her BP episode begins,she tells
something happening in the stomach(no pain),sometimes gets loose motion and BP starts rising for 30 to 45 minutes or so and with Rivotril or Nicardia ,it gets normal. It happened 6-7 times in two weeks time.No investigations of stomach etc advised by doctors here.Shehas got anxiety problem and BP episodes once in 2-3 months and used Alprax 0.25 as SOS only when it happens.Now it takes place more often and worsened .
I dont mind giving her Nexito but want to make doubly sure whether it is heart related prob ,anxiety /depression or any thing else because nexito has got its own problem and she is very active,lively,social person otherwise and do not look depressive.She became a type of lethargic,dull with a few days nexito intake which was discontinued a month ago without any withdrawal symptoms.
Is it ok to give BETA Blocker for a diabetic and can suggest some names and i can
discuss that with doctors here in mumbai.
I am extremely sorry for this long mail which can give total picture of the case.
Kindly give ur expert advice for which i shall be indebted to you
Kind regards
XXXX
doctor
Answered by Dr. Sukhvinder Singh 9 hours later
Brief Answer:
please see below.

Detailed Answer:
Dear Sir
1. I agree people do not use beta blockers on preference in diabetics. But since the mechanism of hypertension seems to be related to sympathetic stimulation/ catecholamines, beta-blocker would stop the rise most effectively, but only after definitely ruling out PCC. This involves a pain ultrasound of kidneys and further bio-chemical testing if required. Your report does not talk of plain ultrasound of kidneys. It only tells about the doppler interrogation. She should also be evaluated for diabetic neuropathy.
2. There are a number of beta-blockers like metoprolol, bisoprolol etc which are relatively selective and interfere less with diabetes. However you should never start them on your own. You must discuss the whole case with internist and then do according to his advise.
3. It is important to understand the behavior of BP (without any drugs) as i suggested in last answer. This will help us understanding that if she has only reactionary rise in BP or she has basal high BP over which reactionary rise occur.
4. I would recommend counselling by professional psychologist rather than Nexito to fine tune her responses to sudden unexpected episodes in life. Drug therapy should be a second option, even if she has anxiety disorder.
5. Any inciting cause like dyspepsia should be promptly tackled and your internist can help her.
6. Her other investigations are fine except for renal disease grade I (diabetic nephropathy) and a bit higher HbA1C.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,   ,   ,   ,  
Drug/Medication ,  

Recent questions on  Withdrawal symptoms?

doctor1 MD

My Implanon expired in June of this year and now I'm experiencing pregnancy symptoms such as fatigue nausea sore breast acne headaches weight gain and made swings I am aware that birth-control withdrawal can mimic the symptoms I would only be for five weeks if I am in fact pregnant my periods resumed in August should I get a blood test or is this just withdrawal symptoms?

doctor1 MD

I have been taking 0.5 mg of Klonopin BID for 22yrs. Dr wants me to get off so decreased my PM med to 0.25 Had some trouble sleeping at first, some vague side effects, then after 2 months, was decreased to 0.25 AM also. Foggy head, lethargic, not able to think straight. Saw him today & he said withdrawal from small dose would not have these effects & advised blood work with Internist for thyroid or anemia. I feel crazy. Don t the Dr know the withdrawal symptoms?

doctor1 MD

Hi there. I have recently stopped using Citalopram . I was on it for 9 months and tapered off slowly over a period of 5 months. I am getting the usual withdrawal symptoms ....dizzy, brain zaps, low mood and low motivation. The most troubling is...

doctor1 MD

Hi. I am a bit concerned about the dose of lorazepam that i take. 1mg split in 0.5 morning and evening. It's been 1 month since i started this treatment, along with 10 mg of Cipralex . My psychiatrist said to stay another month on lorazepam due to...

doctor1 MD

I am a 68 year old woman who has been taking 40 mg of Vyvanse once a day for ADD for about 5 years now. A few months ago I began to experience elevated blood pressure, a tic of lip-smacking and lip sucking, and intermittant whiteness of my fingertips. I have researced on line and seen that all of these symptoms may be caused by this drug, although the last 2 are very rare. I have learned that my age and the long duration of my taking Vyvanse may be a big factor in these symptoms appearing now. I have been trying to find an appropriate doctor who can answer my questions about how to go about safely stopping the taking of this drug. To date 4 doctors (neurologists of various types) have told me that they do not treat this problem. My primary care doctor has recommended 2 of the 4 that have turned me down. He did however give me a 1 month prescription for a lowered dosage of Vyvanse @ 20 mg and I have been taking that now for 5 days. I am experiencing withdrawal symptoms which I expected and am very willing to endure to get this drug out of my system and hopefully get the unpleasant side effects to diminish and even more hopefuly to go away entirely. Can you tell me if I am on a good course of action and if I am going about this transition in a safe manner?

doctor1 MD

Hi there. I have been on an SSRI( Citalopram ) for 9 months. My highest dose was 20mg per day. I have tapered off slowly over a period of 5 months. I quit entirely one week ago and my withdrawal side effects include some anxiety , tiredness(lack...

doctor1 MD

For the past couple of months i've had a lung and breathing problem, bad wheezing, unable to get air - not sure if it is allergies or asthma, symptoms are worsened at night, sometimes producing phlem when coughing (bright yellow / some brown) but generally not much mucus production, just clogged airways.

In the past couple of days it's been a lot worse
Last night it was very bad, I got panicky and went to an urgent care center

The doctor after listening to my lungs said they thought i most likely had an asthma attack

They then prescribed 60mg daily of prednisone for one week, and an albutoral inhaler.

Yesterday I started amoxicillin (500mg capsules). I took one in the morning, and one at about 7PM before i went to the urgent care center, but did not take a dose last night as advised by the doctor.

The doctor there told me (after prescribing the prednisone and inhaler) to discontinue the amoxicillin completely

I said i was coughing up bright yellow mucus with some brown, they said that doesn't mean infection, and just stop taking the amoxicillin, and start the prednisone and inhaler

I am not sure if i should discontinue the antiobiotics, and if I will need to ween myself off of the prednisone, as i've heard there can be withdrawal symptoms.

I currently have no insurance and don't have a doctor, and am very confused to what to do .. I just want to get better, and am not sure what the wisest decision is

thanks for taking time out to read this