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    Suggest treatment for high blood pressure and terrible headaches

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Posted on Mon, 24 Jul 2017 in Hypertension and Heart Disease
Question: On April 13, 2017 I was prescribed Fludrocort for low blood pressure. It worked so well until about a 10 days ago and I started having headaches . I went to my pcp 6/30/17 and he was shocked that my blood pressure was at 190/98, they took my pressure 5 times while i was there and Dr. lowest systolic was in the 170's. I came home and ate dinner, a few hours later felt very nauseous and went to bed, spent time in the bathroom with vomiting thinking I had contracted a bug and had the flu....yesterday I felt fine when I woke up however in 3 hours I was in bed with exhaustion! Unusual for me as I do not nap. I thought it was the flu. my BP at 8:30am was 142/77 P 61 at 10:15 was 121/73 at 2:30 122/88 9PM 153/74 and this morning 1663/87. I called my heart Dr. on 6/30 after returning from my PCP and they said to stop the medication, which I did. They are not available now and I was concerned that the BP is rising and I am again not feeling well and woke up with a terrible headache. I also do not have headaches....maybe 1 every other year!! I am a young 80 year old, in good physical condition 5'9", weigh 149 and a busy lady with friends, belong to toastmasters and church volunteer. I have never had hi blood pressure before and am anxious. Thank You.
doctor
Answered by Dr. Panagiotis Zografakis 1 hour later
Brief Answer:
the cause of the headaches has to be identified

Detailed Answer:
Hello,

I've read your text... your case sounds a little complex. I believe we should focus on the headaches first. Do you have the headache all day or does it come and go? Are there pain-free periods during the day? Is there anything that provokes the headache or makes it worse or better? Do you have other symptoms when you have headaches? Does this nausea accompany the headache or is it irrelevant? How intense is the headache and how fast did it start? Was it like a hammer blow (abrupt very intense headache) ? Do you have fever?

The high blood pressure may sometimes be caused by pain. Painful stimuli raise the blood pressure and when the pain subsides so does the high blood pressure. So one thing to check is whether your blood pressure is low when the pain is gone (if it is).

Another thing to notice is that fludrocortisone should be stopped gradually. The dose should be tapered over a few weeks.

If this blood pressure elevation is not related to the pain then there are 3 scenarios that sound realistic in a case like yours:
- blood pressure raised due to the mineralocorticoid effects of fludrocortisone
- blood pressure raised due to renal artery stenosis
- a new stroke despite the lack of serious neurological symptoms

In a patient like you I would have started from the headache issue. A CT scan of the brain would exclude hemorrhage and would detect some non-hemorrhagic cases of stroke. The CT-scan would be particularly useful if your doctor detects neurological deficits on clinical examination.

Then the blood pressure can be checked closely for at least a week and perhaps also do a 24-hour Holter measurement.

If your blood pressure is consistently high the fludrocortisone should be gradually tapered and an antihypertensive medication initiated.

I can't be more specific than that (like suggest medications ,etc) because I'm not your doctor. Your doctor knows your complete medical history, has seen your test reports and can examine you, so your doctor is the most appropriate person to suggest treatment.

I hope you find my comments helpful!
Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 4 hours later
1. Headaches...They are bad enough to wake me up at night. I can hear my heart beating in my head. I have never had headaches like this but I don't have experience in headaches other than a few times. like when I had Viral Encephalitis in the 80's. Last night the headache and nausea were together when the headache was bad, when the headache subsides I feel better. After writing to you I went back to bed, made sure I was hydrated and again woke up with a headache and listening to my heart beat!! 7:30am my BP was 148/95. it hurts in the front forehead even down my nose bone! I feel only slightly nauseated and am functioning well around the house. I do not feel like myself. I believe anxiety from this "new me" is causing some forgetfulness and anxiety. Actually it frightens me!! Calm down ol girl.

I know the HBP came first then the nausea, as that was a few hours later.

From April to just over a week ago my BP on the Fludicortisone was always below 125/85 I felt wonderful.

On Thursday, July 7, I have an appointment with my neurologist and will discuss this with him and on Tuesday will get in touch with my PCP.

I will look up renal artery stenosis, I do not know what that is.

Thank you for replying.
doctor
Answered by Dr. Panagiotis Zografakis 5 hours later
Brief Answer:
your headache is a little worrisome

Detailed Answer:
You're welcome!

Any headache that wakes the patient (actually any symptom) requires investigation. The investigation should start with a CT scan of the brain.
If the brain is OK then other secondary causes of hypertension would have to be excluded like pheochromocytoma (which may cause headache, orthostatic hypotension, hypertensive crisis, a loud heartbeat, etc). Renal artery stenosis means the narrowing of the lumen of the arteries that bring blood to the kidneys. When the kidneys receive less blood than they expected, they raise the blood pressure. Renal artery stenosis may occur due to atherosclerosis in older individuals. Other causes may apply for younger patients.

It's a good idea to discuss your headaches with the neurologist!

Best wishes!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3691 Questions

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