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What Causes Fluctuations In BP Readings?
Question: Hello. I have been treated for high blood pressure with the drug losartan potassium. It worked fairly well for a month or so, but then I suffered from "crashes" almost every day where my blood pressure dropped and I felt faint and had to lie down for at least a half hour. Normal sunlight was unbearably intense at these times. The dose was reduced, but this pattern continued. The dose was reduced again. Finally I stopped the pills entirely. I have a blood pressure monitoring machine and I monitor daily. My blood pressure (without medication) ranges widely, from 150/87 to 91/56 at the extremes. I am worried about the risk of stroke. I am 67 years old and live in Bolivia where health care is spotty. I have reduced sodium intake and caffeine. I would appreciate your advice.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello XXXXXXX
Welcome on HCM!
I understand your concern and would like to explain that when dealing with high blood pressure it is necessary to find the right therapeutic scheme for each individual, as no prearranged scheme could properly work in every patient.
High BP therapy is a matter of change, depending on many factors (including hot and cold weather).
First of all, a close BP values follow-up would reveal if really hypertension exists.
Those wide BP variations (150/87 mmHg to 91/56 mmHg) need to be further investigated. Close BP monitoring for a couple of days (several times daily) is recommended to ascertain the average BP value.
(1) If your average BP is lower than 140/90 mmHg, you don't need to be treated with drugs (though some higher values [like150/87 mmHg] may be registered).
In such case only some preventive measures of possible triggering factors would be sufficient (like lowering body weight if you are overweight, avoiding excessive caffeine intake and other stimulating drinks as you have already done, avoiding close smoking contacts, following a healthy life-style and especially diet [avoiding spicy and fatty foods], a daily physically active profile with lots of physical exercises [walking daily at least 4 km]. This latter would improve the entire blood circulation and also promote a better humor [remember anxiety may be an important triggering factor for those high BP bouts you are experiencing], etc)
(2) But if you suffer from an increased average high BP (>140 and/or 90 mmHg) then besides the above mentioned measures it is necessary to continue medical therapy.
Before starting therapy, secondary hypertension should be excluded (any dysfunctional responsible body organ).
Coming to this point, I would recommend to perform some medical tests (I believe you have performed as least some of them):
- complete blood count (to rule out possible anemia),
- BUN and creatinine (to avoid renal dysfunction),
- thyroid function tests (a possible triggering factor - thyroid dysfunction),
- blood electrolytes level (for investigating adrenal glands),
- liver function tests (important metabolizing site for many drugs)
- resting ECG and cardiac ultrasound (for excluding possible effects of long-standing hypertension),
- fasting blood glucose,
- blood lipid profile,
All the above tests are necessary before planning a therapeutic modulation. If any disorder is detected, once the responsible triggering factor treated, those high BP bouts will disappear.
At the end, I would like to remember that the most important issue when planning a strategy against hypertension, is reviewing BP values for at least a couple of days (1-2 weeks).
Please let me know about your average BP value and also your performed tests.
Hope to have been helpful to you!
In case of further uncertainties, feel free to ask me at any time.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello XXXXXXX
Welcome on HCM!
I understand your concern and would like to explain that when dealing with high blood pressure it is necessary to find the right therapeutic scheme for each individual, as no prearranged scheme could properly work in every patient.
High BP therapy is a matter of change, depending on many factors (including hot and cold weather).
First of all, a close BP values follow-up would reveal if really hypertension exists.
Those wide BP variations (150/87 mmHg to 91/56 mmHg) need to be further investigated. Close BP monitoring for a couple of days (several times daily) is recommended to ascertain the average BP value.
(1) If your average BP is lower than 140/90 mmHg, you don't need to be treated with drugs (though some higher values [like150/87 mmHg] may be registered).
In such case only some preventive measures of possible triggering factors would be sufficient (like lowering body weight if you are overweight, avoiding excessive caffeine intake and other stimulating drinks as you have already done, avoiding close smoking contacts, following a healthy life-style and especially diet [avoiding spicy and fatty foods], a daily physically active profile with lots of physical exercises [walking daily at least 4 km]. This latter would improve the entire blood circulation and also promote a better humor [remember anxiety may be an important triggering factor for those high BP bouts you are experiencing], etc)
(2) But if you suffer from an increased average high BP (>140 and/or 90 mmHg) then besides the above mentioned measures it is necessary to continue medical therapy.
Before starting therapy, secondary hypertension should be excluded (any dysfunctional responsible body organ).
Coming to this point, I would recommend to perform some medical tests (I believe you have performed as least some of them):
- complete blood count (to rule out possible anemia),
- BUN and creatinine (to avoid renal dysfunction),
- thyroid function tests (a possible triggering factor - thyroid dysfunction),
- blood electrolytes level (for investigating adrenal glands),
- liver function tests (important metabolizing site for many drugs)
- resting ECG and cardiac ultrasound (for excluding possible effects of long-standing hypertension),
- fasting blood glucose,
- blood lipid profile,
All the above tests are necessary before planning a therapeutic modulation. If any disorder is detected, once the responsible triggering factor treated, those high BP bouts will disappear.
At the end, I would like to remember that the most important issue when planning a strategy against hypertension, is reviewing BP values for at least a couple of days (1-2 weeks).
Please let me know about your average BP value and also your performed tests.
Hope to have been helpful to you!
In case of further uncertainties, feel free to ask me at any time.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Illiri,
I will monitor my BP several times per day today and tomorrow and send you the averages for each day. The message on my screen says that our discussion will automatically close in 3 days, so it looks like a longer period will be problematic. I will check my test results (already performed) and send them along to you as well. I haven't had the whole list, but it is useful information for me if my averages are too high and I need medication.
One of my concerns is that once our discussion is closed, will I have access to you in the future? I would prefer not to have to repeat our discussion with a new doctor, if possible.
Thanks again,
XXXX
I will monitor my BP several times per day today and tomorrow and send you the averages for each day. The message on my screen says that our discussion will automatically close in 3 days, so it looks like a longer period will be problematic. I will check my test results (already performed) and send them along to you as well. I haven't had the whole list, but it is useful information for me if my averages are too high and I need medication.
One of my concerns is that once our discussion is closed, will I have access to you in the future? I would prefer not to have to repeat our discussion with a new doctor, if possible.
Thanks again,
XXXX
Brief Answer:
You are welcome!
Detailed Answer:
Hello again, dear XXXXXXX
I will be at your disposal for further discussion whenever you will provide me with the required available information.
You can contact me directly even after those days through the following link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Hope everything will be OK!
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again, dear XXXXXXX
I will be at your disposal for further discussion whenever you will provide me with the required available information.
You can contact me directly even after those days through the following link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Hope everything will be OK!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Illiri,
I have taken BP readings yesterday and today (6 times yesterday, 5 times today) and have averaged the readings. They are 130/77 and 128/79. The lowest reading was 105/66 and the highest 146/75.
I have translated the test results I have had from Spanish into English, and I will try to attach the document to this follow-up (fingers crossed). If it doesn't work, I will cut and paste into the next follow-up. It's called test results.pdf
Thanks again, XXXX
I have taken BP readings yesterday and today (6 times yesterday, 5 times today) and have averaged the readings. They are 130/77 and 128/79. The lowest reading was 105/66 and the highest 146/75.
I have translated the test results I have had from Spanish into English, and I will try to attach the document to this follow-up (fingers crossed). If it doesn't work, I will cut and paste into the next follow-up. It's called test results.pdf
Thanks again, XXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
I carefully reviewed all your tests and would conclude that your total cholesterol levels and fasting glucose are slightly elevated.
Nevertheless, your total cholesterol/HDL cholesterol ratio is within the normal ranges, which means that you are not at a higher cardiovascular risk, related to your blood lipid profile.
Regarding your blood pressure values, they are most of the time below the normal ranges. So you don't need to worry about that!
You do not need any medical treatment, but some modifications to your lifestyle would help reduce cholesterol levels and also maintain a normal blood pressure.
Some tips would help modify your blood pressure and blood lipid profile:
-modify your diet (low salt and caffeine intake, low fat and sugar food, high omega 3 rich food)
-perform a lot of physical exercise
-try to loose weight, especially if you are overweight.
Regarding your blood fasting glucose, I would recommend repeating the test and perform a glucose tolerance test and a HbA1C to exclude possible glucose intolerance which would be the initial stage of diabetes.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
I carefully reviewed all your tests and would conclude that your total cholesterol levels and fasting glucose are slightly elevated.
Nevertheless, your total cholesterol/HDL cholesterol ratio is within the normal ranges, which means that you are not at a higher cardiovascular risk, related to your blood lipid profile.
Regarding your blood pressure values, they are most of the time below the normal ranges. So you don't need to worry about that!
You do not need any medical treatment, but some modifications to your lifestyle would help reduce cholesterol levels and also maintain a normal blood pressure.
Some tips would help modify your blood pressure and blood lipid profile:
-modify your diet (low salt and caffeine intake, low fat and sugar food, high omega 3 rich food)
-perform a lot of physical exercise
-try to loose weight, especially if you are overweight.
Regarding your blood fasting glucose, I would recommend repeating the test and perform a glucose tolerance test and a HbA1C to exclude possible glucose intolerance which would be the initial stage of diabetes.
Hope you will find this answer helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Illiri!
I am relieved about the blood pressure, and will follow your advice with respect to more exercise (beginning with morning walks) and dietary changes. I have already started on these (since the tests), and will pay more attention to the omega 3 rich foods and fats. My weight is in the normal range (61 kg. with a height of 162 cm.). I put on a few pounds after I quit smoking about three years ago, and it's been difficult to lose them.
I will follow up on the glucose tolerance test, and I am wondering about a thyroid test. You mentioned thyroid problems as a possible contributor to high blood pressure, and my mother suffered from an under-active thyroid when she was young. I have lost my eyebrows and most body hair, and someone told me that this could be a symptom of thyroid problems. I had never considered this (thinking it was just the aging process) and wonder if you would recommend that this be looked into as well?
Thanking you again, XXXX
I am relieved about the blood pressure, and will follow your advice with respect to more exercise (beginning with morning walks) and dietary changes. I have already started on these (since the tests), and will pay more attention to the omega 3 rich foods and fats. My weight is in the normal range (61 kg. with a height of 162 cm.). I put on a few pounds after I quit smoking about three years ago, and it's been difficult to lose them.
I will follow up on the glucose tolerance test, and I am wondering about a thyroid test. You mentioned thyroid problems as a possible contributor to high blood pressure, and my mother suffered from an under-active thyroid when she was young. I have lost my eyebrows and most body hair, and someone told me that this could be a symptom of thyroid problems. I had never considered this (thinking it was just the aging process) and wonder if you would recommend that this be looked into as well?
Thanking you again, XXXX
Brief Answer:
Thyroid dysfunction could be related to a similar symptomatology
Detailed Answer:
Dear XXXXXXX
I am glad to have been helpful!
Regarding thyroid dysfunction, you should know that it can alter your blood pressure, fasting glucose and blood lipid profile.
So thyroid function tests (hormone levels) would help rule in/out this possible disorder, which could be related to your symptomatology.
Please, feel free to ask me directly at any time for any other uncertainties at the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Wishing you the best,
Dr. Iliri
Thyroid dysfunction could be related to a similar symptomatology
Detailed Answer:
Dear XXXXXXX
I am glad to have been helpful!
Regarding thyroid dysfunction, you should know that it can alter your blood pressure, fasting glucose and blood lipid profile.
So thyroid function tests (hormone levels) would help rule in/out this possible disorder, which could be related to your symptomatology.
Please, feel free to ask me directly at any time for any other uncertainties at the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Wishing you the best,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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