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Dr. Andrew Rynne

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What causes fluctuating BP readings in a hypertensive person diagnosed with pharyngitis?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5761 Questions

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Posted on Mon, 21 May 2018 in Hypertension and Heart Disease
Question: Recently had a very bad respiratory infection several weeks ago and also developed pharyngitis from GERD, that I have suffered for the last several years. Since then I have a very slight cough a few times a day which produces a little phlegm. So I decided to check my blood pressure today, which I have not done for several months. It was going between 155/93 to 180/100 just moments apart and depending on the arm I attached the monitor. I take Losartan 50 mg for high blood pressure and historically it is usually 142/85, and I have both Graves Disease and Diabetes. So, I am concerned. Please advise.
xxxx XXXXXXX
000-000-0000
doctor
Answered by Dr. Ilir Sharka 23 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would explain that these high blood pressure values could be related to different possible causes:

1- As you are taking Advil frequently, it could raise your blood pressure values.
2- A thyroid hormonal imbalance (considering the fact that you are taking levothyroxine), could lead to increased blood pressure values. For this reason, it is necessary checking your thyroid hormone levels and make the proper dose adjustements to your actual therapy if necessary.
3- As you are diabetic, it is necessary also to exclude a possible kidney dysfunction, which could lead to increase blood pressure values too. That is why I would recommend checking your kidney function tests too.

If these blood pressure values persist, I would recommend increasing the dose of Losartan up to 100mg daily.

Adding a beta-blocker (like carvedilol) would be advisable too, considering the fact that you are taking levothyroxine.

You should discuss with your doctor on the above issues.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Dr. - Could the increased blood pressure values be something unrelated to my thyroid and diabetic condition, such as a form of cancer, or heart disease? Because, I feel great, sleeping normally and not feeling any fatigue.

With my pharyngitis, it is only slightly abating since taking Omeparasole 40mg for two weeks. Should I move over to a more powerful med, such as Dexilant 60 mg, which worked for me when I had GERD very badly in 2011 and swallowing was most uncomfortable?
doctor
Answered by Dr. Ilir Sharka 34 minutes later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again, dear xxx!

I would explain that high blood pressure may be multi-factorial; several potential causes may be blamed and each of them should be excluded when a secondary hypertension is suspected.

But, most commonly it is the primary or idiopathic hypertension that we find more frequently. In such case no organ dysfunctions could be responsible for uncontrolled high blood pressure.

Now, coming to your medical history, it is advisable first to explore your current thyroid, kidney and adrenal glands function, exclude anemia and check your BP values after avoiding the potentially adverse effects of Advil (all anti-inflammatory drugs has the potential to increase blood pressure level).

The following medical tests are necessary to be done:

- complete blood count,
- thyroid hormone level,
- BUN & creatinine,
- blood electrolytes level,
- fasting blood glucose level,
- glycosylated hemoglobin (HbA1C)

There is no reason to think about cancer or additional cardiac disorders.

Regarding pharyngitis etiology, as you have suffered from a recent respiratory infection, an inflammatory cause seems to be the most probable reason.

But this should be checked by performing a careful physical exam by your attending physician (GP or internist) and performing some inflammatory tests like:

- PCR & ESR,
- throat microbiological culture,

Meanwhile, as you have a history of GERD, a PPI drug (like Omeprazole, etc.) is encouraged and if an inflammatory reason is excluded, then the treatment should be guided by the ongoing symptomatic relief.

If you have any further questions, feel free to ask me again.

Regards,

Dr. Iliri



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 2 hours later
Thank you, Dr. Iliri. It is a pity that you don't live close to me in Las Vegas, as your responses tell me that you're a fantastic doctor, and I need a new GP.

I will get the blood tests done on Tuesday and send you my results.

You can also reach me at YYYY@YYYY . My real name is XXXXXXX and I protect it, for obvious reason.

Best regards.

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Follow up: Dr. Ilir Sharka 3 minutes later
I meant to say a new GP/Cardiologist.
doctor
Answered by Dr. Ilir Sharka 9 hours later
Brief Answer:
You are welcome!

Detailed Answer:
I would be glad to review your medical reports whenever they are available and help you with a second professional medical opinion.

I remain at your disposal for any further discussions.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 18 hours later
Thank you, Dr. Iliri. I should have the results back by Thursday.

Regards,
XXXXXXX
doctor
Answered by Dr. Ilir Sharka 6 hours later
Brief Answer:
You are welcome!

Detailed Answer:
Dear XXXXXXX

I am glad to have been helpful to you!

Let me know about everything!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 36 hours later
Hi Dr. Iliri –
Just received my blood test results. Everything was normal except the following, which were high:
               Result     Normal for me (lest 5 years)
Eosinophils       7.48
Glucose       144           115 - 135
Triglycerides      296           150 - 292
VLDL Cholesterol 59           30 - 58          
LDL Direct      141           103 - 167
A1c                6.8           6.4 - 6.9

The following represents results better, or slightly worse, than previously:
Creatinine was 1.22… BUN/Creatinine Ratio was 15.90.
Cholesterol was 234
Cholesterol/HDL Ratio was 3.94 (much lower than usual… it has been as high as 6.2)
HDL was 60 (higher than normal 36 - 59)
LDL/HDL Ratio was 2.37 (much better than usual 3.3 - 4.4)
Urine PH was 5.5 (6.0 is usual)
EGFR is 60 (better than usual 49)

I have a constant minor stiff neck on the left side and continue to feel a very small sensation on my left side of throat when I swallow, which is less intense than what I have experienced when suffering from GERD repercussions previously in the throat. A minor throat clearing cough happens a couple of times day with medium level clear phlegm.

Regards,
XXXXXXX
doctor
Answered by Dr. Ilir Sharka 17 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

I carefully reviewed your blood lab tests and would explain as follow:

- Increased eosinophils could be related to an allergic reaction or a fungal infection. Anyway, it is quite normal to have increased esosinophils in alergic persons. An upper airway viral infection can also mimic these changes in the complete blood count report.

- The increased fasting glucose and HbA1C show a little uncontrolled diabetes. Anyway, such mild increase in HbA1C is not really concerning. I would just recommend being more careful with your diet.

- Your blood lipid profile is excellent. This means that you are not at any increased cardio-vascular risk related to dyslipidemia. You should know that Total cholesterol /HDL ratio should be below 4.5 and LDL/HDL ratio should be below 3.5. You in your case, I should say that they are normal. There is nothing to worry about it.

- Your kidney function tests are normal.

Coming to this point, I would say that there is not any metabolic cause underlying your increased blood pressure values.

It could be related to Advil intake.

I would also recommend checking your thyroid hormone levels, in order to make the proper dose adjustments to levothyroxine if necessary.

I would also recommend increasing the dose of Losartan to 100mg daily, as above recommended in order to help maintain a normal blood pressure. If high blood pressure values persist, despite the raise in the dose of losartan, I would recommend adding a betablocker (like carvedilol).

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 10 hours later
Hi Dr. Iliri –

Thank you for the detailed response… and for the time, effort and consideration towards my ailment(s).

My AIc was a little high that day due to it being taken a few hours after rising. It is back down to 115 today. The thyroid hormone levels were very good – TSH was 1.62 and Free T4 was 1.16.

The increased blood pressure is still a mystery and I will take your recommendation and increase Losartan to 100mg a day, and purchase Carvedilol if it remains high.

My pharyngitis seems to be abating today and also the stiff neck. If they continue into January, I will see my ENT for an exam, but I am hoping to avoid that visit, because the scope up the nose and down the throat is not a pleasant experience.

I have always been fairly fit… 45 years ago I played semi-professional soccer in my native England and had an open trial for Man Utd, but my father wanted me to go into business as there was no money in professional soccer in those days. Today, I am a retired business executive who comes out of retirement next year to bring about a new social network that I intend to sell to Facebook or Google, as it supersedes what they are doing, So, I need to be in my best possible health.

If you come to Vegas for a visit, let me know as I will probably be able to help you with discounted hotel rooms and direct you on the local environment for the best possible enjoyment. My surrogate father built and controlled Vegas for 50 years and I was his business confidant. So, my contacts are pretty good. Unfortunately, the doctors in Vegas are dreadful, so my being in contact with you. Please send me your direct contact points as you may be able to help me medically again, for which I will gladly pay.

Wishing you and your family a very Merry Christmas and a Happy, Healthy and Prosperous 2018.
XXXXXXX
000-000-0000
YYYY@YYYY
doctor
Answered by Dr. Ilir Sharka 14 hours later
Brief Answer:
You are welcome!

Detailed Answer:
Dear XXXXXXX

I am glad to have been helpful to you!

Your appreciation for my work means so much to me!

Regarding your pharyngitis, I would also recommend using an antiseptic spry, which you can find over the counter in the drug store.

If you have any other questions, please feel free to ask me again directly on Healthcaremagic!

You can write "Question direct for Dr. Ilir Sharka" when starting your question and I will try to answer to all of your questions as soon as possible.

Let me know about everything!

Wishing all the best for this coming New Year! Merry Christmas to you and your family!

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 11 minutes later
Thank you, Dr. Iliri.

You have my contact points, should you need them.
XXXXXXX
doctor
Answered by Dr. Ilir Sharka 20 minutes later
Brief Answer:
You can contact me easily at any time.

Detailed Answer:
Dear xxx!

You can contact me directly on HCM!

You can now contact me directly through my email, as well.

I would be glad to help you with a second professional opinion whenever you will need.

Best wishes,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 45 minutes later
Unless I've become completely stupid in the last hour, I can't see or find your direct email.
doctor
Answered by Dr. Ilir Sharka 9 minutes later
Brief Answer:
My answer:

Detailed Answer:
Hello!

Please check your email!

Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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