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Suggest Treatment For Persistent Hypertension Despite Medication

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Posted on Mon, 19 Dec 2016
Question: We are checking BP for last 5 days, and it is constantly 150/96 or 160/98. Also , we are traveling to a planned vacation today, I am scared what all precautions shall we take or if it very alarming , shall we cancel our trip?
doctor
Answered by Dr. Remy Koshy (21 minutes later)
Brief Answer:
I would like to know a few more details

Detailed Answer:
Hello XXXXXXX
Thanks for posting your query,

I have read through your query and I can understand your concern,,
Before I can guide you any further, I would like to know a few more details related:
- any particular reason for checking your BP readings, like headaches, vision disturbances etc?
- any recent history of exposure to undue stress?
- is it the first time that you have been detected with high BP?
- are you on any other medications?
- any other history like diabetes, high cholesterol levels?

Let me point out that your levels clearly require medical aid. You need to start on anti hypertensives, on which I would guide you on once you revert back with your answers.

Regards,

Above answer was peer-reviewed by : Dr. REMY KOSHY
doctor
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Follow up: Dr. Remy Koshy (3 hours later)
Hello Sir/Madam,
Here are my replies to your queries:
any particular reason for checking your BP readings, like headaches, vision disturbances etc?
Last Saturday, reported severe headache and dizziness, we took him to hospital where his BP detected was 170/115, immediately we had an ECG, which was fortunately normal. Then a local doctor gave him an injection and advised to chart his BP for a week. Since then I have noticed his BP remains constant to be 150/96 or 160/98.
- any recent history of exposure to undue stress?
we had a family problem very recently, may be he is under that stress, but upon asking many times, if he tensed he says no I am fine, even when his BP is 160.98 he feels very normal.
- is it the first time that you have been detected with high BP?
yes for the very first time
- are you on any other medications?
no not on any other medications
- any other history like diabetes, high cholesterol levels?
no

Please guide me what shall we do.
doctor
Answered by Dr. Remy Koshy (17 minutes later)
Brief Answer:
he requires medical treatment.

Detailed Answer:
Hi XXXXXXX
Thanks for the detailed reply,

Since it is the first time that he has been detected with high BP levels, and also since he has no other co-morbidities, the main reason behind this is due to the undue exposure to stress.

If I were your treating physician, I would start him on Tab. Amlodipine 10mg and then monitor his bp levels for a week or two and then slowly taper it down if he is found responding to the treatment. As this is a prescription drug, I would suggest you to consult with an Internal Medicine Specialist in your area and see if he agrees with me, so that you can get it prescribed for you.

Meanwhile, I would also suggest you to do the following:
- confront him on the topic of stress, so that he may open up and relieve his tension.
- avoid foods which does not contain much salt like papads, pickle, salted nuts etc.
- a daily minimum exercise for about 45 mins is a must
- maintain a healthy weight if he is overweight
- also look out for his cholesterol levels.

Hope I have answered to your query,
Please feel free to discuss further or else kindly close and give your feedback.

Thanks and regards
Above answer was peer-reviewed by : Dr. REMY KOSHY
doctor
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Follow up: Dr. Remy Koshy (10 minutes later)
Thanks a lot Dr. Remy. Are you based out of Delhi/NCR.
doctor
Answered by Dr. Remy Koshy (5 minutes later)
Brief Answer:
Thanks for the response

Detailed Answer:
Hello again,
Thanks for the response,


No, I'm presently located in XXXXXXX
I will be pleased to assist you further.

Wishing you good health
Thanks and regards
Above answer was peer-reviewed by : Dr. REMY KOSHY
doctor
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Follow up: Dr. Remy Koshy (6 minutes later)
If I am traveling today, shall I keep this medicine with me ?
As I will be out of town for 4-5 days, and will be staying in a hotel may be we cannot get good and less salted food. Can you please suggest few precautionary measures which I have to keep in mind.
I am very tensed doctor, is there something alarming?
doctor
Answered by Dr. Remy Koshy (17 minutes later)
Brief Answer:
it is good to start his medication today itself

Detailed Answer:
Hi XXXXXXX
Thanks for reverting back dear,

Please do not become tensed. Any normal person may find a rise in his bp levels when exposed to 'undue' stress. Likewise, it has happened in your case. Also like you have said, fortunately, his ECG has come out to be normal. So I would like to reassure you to relax and be strong.

Since you would be travelling today, it is good to start his medication today itself. would not recommend him travelling with this high levels. So you can get this medication prescribed and give him one ASAP.

You must make it a point to check his bp after one hour so as to see if he is responding to it. I would suggest he start with 10mg per day ie, 5mg twice daily and if he is found to get lower levels on a constant basis, it can be tapered to 5mg per day and then 2.5mg per day likewise.

Here are the precautionary measures you need to look for:

1. in case his BP levels rises:
- constant headache
- dizziness
- nose bleeds
- breathing difficulty
- black out (in severe cases)

2. in case his bp drops
- dizziness
- tiredness, fatigue
- loss of concentration
- fainting

As for food, he can take any food but just be conscious enough to avoid salty packed foods, roadside chats, avoid drinks and smoking if any.

Hope I have answered to your query,
Thanks and regards
Above answer was peer-reviewed by : Dr. REMY KOSHY
doctor
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Follow up: Dr. Remy Koshy (29 minutes later)
Thanks a lot doctor. It was great discussing with you.
Thanks again
doctor
Answered by Dr. Remy Koshy (6 minutes later)
Brief Answer:
You are most welcome

Detailed Answer:
Hi XXXXXXX

You are most welcome,
It was my pleasure discussing with you too,

You can get back to me directly in future here if desirable.

If I have answered to all your queries, kindly close and give your feedback.

Warm regards
Above answer was peer-reviewed by : Dr. REMY KOSHY
doctor
Answered by
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Dr. Remy Koshy

General & Family Physician

Practicing since :2014

Answered : 476 Questions

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Suggest Treatment For Persistent Hypertension Despite Medication

Brief Answer: I would like to know a few more details Detailed Answer: Hello XXXXXXX Thanks for posting your query, I have read through your query and I can understand your concern,, Before I can guide you any further, I would like to know a few more details related: - any particular reason for checking your BP readings, like headaches, vision disturbances etc? - any recent history of exposure to undue stress? - is it the first time that you have been detected with high BP? - are you on any other medications? - any other history like diabetes, high cholesterol levels? Let me point out that your levels clearly require medical aid. You need to start on anti hypertensives, on which I would guide you on once you revert back with your answers. Regards,