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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes fluctuating BP?

Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 6574 Questions

Posted on Sat, 11 Mar 2017 in Hypertension and Heart Disease
Question: My mother is 92. One kidney. Last Friday morning about 2 am mom got up from chair to go to bed . She said she felt hot , but she had no fever, and said just felt bad. Her bp was 180/70 / 87 in right arm but
154/ 64/80 in left. She also was having a problem forming words. She took one clonidine 0.2mg. (Cardiologist said to do this previosly)...she Slept. Sat am at 1030 bp was 135/53/53.( normal for her). She was normal untill Last night Mon night at about 8 pm she got that hot feeling again... no fever. But flushed looking a little. BP was 187/58/70 in right but only 155/61/69 in left! She was due her metoprolol 50 mg and a few more blood pressure pills so took them. At 10 pm last night bp was 161/56/59 in right and 139/55/59 in left. She Slept.No clonidine taken . Her regular bp Meds are metoprolol 50.....Diovan 320...nefedipine 60....Hctz 25....multaq 800....( afib drug) .... she told me she thinks urine output is less recently. Im worried about this . Can you give me your thoughts .
Answered by Dr. Ilir Sharka 58 minutes later
Brief Answer:
I would explain as follows;

Detailed Answer:

Welcome back on HCM!

I passed carefully through your concern and would like to explain that some key points to consider regarding your mother's health:

- recently your mother is suffering from unstable high blood pressure values. Those high systolic blood pressure values (180 mmHg, 187 mmHg) demonstrate that.

As she has exaggerated BP values differences, probably due to peripheral artheropathy, it is necessary to consider the highest detected BP values (so the right arm values).

Coming to this point it is important to reveal potential causes of this recently found high BP imbalance. As your mother is actually with only one functional kidney and is also complaining of decreased urine output, it is necessary to review her actual overall kidney function.

If an impaired renal function is detected (which could explain why the blood pressure is getting too high), then some preliminary arrangements on her chronic therapy should be done. Probalby HCTZ could be substituted by a loop diuretic drug such as Torasemide (5 - 10 mg or Furosemide (20 - 40 mg daily).

Also, if abnormally high creatinine values are detected (abnormal renal function), then a critical review on Diovan continuation should be done (as ARBs may further deteriorate renal function).

- regarding her recent complaint of difficulty in words formulation, it is necessary an actual review of her neurological status, by consulting a neurologist (to perform a careful history review and neurological status examination), to rule in/out any possible transient ischemic attack (transitory cerebral ischemia). This recommendation is further supported by her previous history of atrial fibrillation (which is a risk factor for cardio-embolic events).

Also, some additional medical tests are advisable, facing her hypertension imbalance:

- complete blood count,
- BUN & creatinine,
- blood electrolytes level,
- thyroid hormones level,
- level function tests,
- fasting blood glucose,
- resting ECG,
- cardiac ultrasound

You should discuss with your attending doctor on the above mentioned issues.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 13 hours later
Creatinine is 1.5....its normal for her... hasone kidney....bun is 46.... quite common for her ...... she doesnt drink asmuch as she should!
Answered by Dr. Ilir Sharka 13 hours later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

You should know that ARB drugs (like Valsartan) can worsen the kidney function and also cause hyperkalemia (high potassium levels) in patients with altered kidney function.

Coming to this point, I would recommend discussing with her doctor on the possibility of gradually reducing the dose of Valsartan until stopping and switching to another drug like an alfa-blocker (Terazosin or Doxazosin), in order to avoid further worsening of her kidney function.

A close monitoring of her potassium levels is also necessary to exclude high potassium levels, which can be even life-threatening.

I would also recommend stopping Hydrochlorothiazide, which can cause aggravation of her kidney function and switch to a loop diuretic like
Furosemide or Torasemide.

You should discuss with her doctor on the above issues.

Hope to have been helpful!

Wishing all the best,

Dr. Iliri

p.s: I am sorry for the delay on answering! It was a busy day at the hospital! Hope you can understand!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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