Doctors Lounge - Cardiology Answers
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Forum Name: Ischemic Heart Disease
|stuart.wroe - Thu Sep 11, 2008 2:37 am|
I am a 50 year old man with a long history of 'normal' blood pressure when tested.
At the beginning of August, as part of my work (I am a senior youth worker for the international YMCA movement), I spent 10 manic days managing a stage area working exceedingly hard and working excessively long hours from early morning until way past midnight at an international YMCA Festival in Prague, Czech Republic, with few breaks, missed meals and insufficient/unsuitable food and insufficient hydration.
At the end of the Festival just as I was preparing to relax for a couple of days when POP! the left side of my face went numb. I was taken to the hospital and underwent a CT Scan and carotid ultrasound, MRI, ECG and other tests. My blood pressure was 170/110. I was diagnosed as having had a TIA.
Back home in the UK I am in the system and in the care of the stroke medicine team at my local hospital and (one month later) on a regime of aspirin 75mg, Ramipril 2.5mg (increased dosage), Diprydamole 200mg(x2), Simvastatin 40mg.
My blood pressure is remaining stubbornly elevated.
My question is
Now that I am back home, and given my history of normal blood pressure, why hasn't my blood pressure come down naturally now that I am out of the extremely stressful environment of the Festival?
|John Kenyon, CNA - Tue Sep 30, 2008 8:11 pm|
Sometimes some event serves as a trigger to set off or aggravate an underlying condition which can cause the blood pressure to become and remain elevated. This seems to be what happened with you. It can be something as simple as overwork which flips that "switch." The literal switch is called a barostat, and we all come equipped with a pair of them. They can be "reset" sometimes by prolonged stress. You also could have an adrenal tumor, which simply means there is more adrenaline going into your bloodstream at any given time, and this could have been "switched" on by the stressful period. These are not readily reversible things. Sometimes, over time and with proper medication, the problem will resolve, at least for a while. If it is due to a tumor it can sometimes be corrected by surgery. The baroreceptor problem may soon be able to be corrected in some patients by a device not unlike a pacemaker. Then again, you may just have developed essential hypertension that was programmed into your future by your genes. That would mean medication to control it.
Meanwhile,the first order of business is to control the blood pressure so as to avoid any future full-blown stroke, and to also manage the stress which may have triggered the hypertension. One thing at a time, and first order of business is to prevent a stroke, which means controlling the hypertension. Then there is time to work on the "why".
I hope this has been helpful.
|stuart.wroe - Wed Oct 01, 2008 2:25 am|
Very helpful, thanks John....
|dallyn - Mon Dec 22, 2008 8:56 pm|
I am a 44 year old female. I have also had a past history of normal to a little below normal blood pressure readings. However, I was injured at work a few days ago and while at the hospital my blood pressure was 166/?. I don't remember what the bottom reading was. I thought it may have just been the trauma but today I went to the Dr for a follow-up visit and while my blood pressure had gone down, the top number was still at 133. My last annual checkup was in september and my blood pressure was fine. My cholesterol is fantastic, says my dr. At that time she told me that with my blood pressure and chol. that I had a very low risk of heart disease. I do smoke and that is a big negative. I have no family history of blood pressure problems. I do not drink and I am on no medications.
My question is, why has my blood pressure gone up so fast and so high. I tried to call my dr today to ask but I coudnt reach her. Should I be alarmed by this?
|John Kenyon, CNA - Tue Dec 23, 2008 12:20 pm|
Hi Dailyn -
The most likely explanation is something that's buried in my answer to the previous poster. Many people, when in the ER or otherwise involved in an unexpected emergency (or just painful) situation may note a marked increase in blood pressure. Most people have some rather dramatic variations in pressure during the course of a day, depending upon what's going on at the time, and most of these go unnoticed because most people aren't checking their blood pressure on a regular basis. You're right to check yours since you got a high reading at the hospital, but hospitals are often very stressful places to be, and those who's bodies react to stress with increased cardiac output are sometimes called "hot reactors." This same phenomenon is what's at work in "white coat syndrome." While you apparently don't have this problem, you may still have been feeling a little bit "energized" by being in a clinical setting. In both cases the attending personnel (or doctor in the second case) should have rechecked multiple times to see if your BP settled down over the course of each visit. When a pressure appears that's inconsistent with a known patient (as in the case of you at your doctor's office) or a higher-than-acceptable pressure shows up (as with your hospital visit) the standard practice is, at the doctor's office, to recheck later in the visit to see if the pressure has dropped to a more "friendly" level. In the ER setting the standard of care is to check a patient's BP at a certain set interval (one is usually there a couple hours at least, usually longer) and record those readings. Early ER readings are often quite high in people with no problem, due to the trauma, as you mentioned.
Smoking, by the way, will eventually cause a slow but progressive increase in BP, and can cause spikes as well. That's all the sermon you'll get from me on that. :)
Sometimes when something like this happens it seems to flip a "switch" in the regulating system (as I think I mentioned in replying to the earlier poster) and this may sometimes stay "on" for a while. In a few it winds us marking the onset of a diagnosable blood pressure problem, but in your case it would seem your doctor (or you) should probably just recheck your pressure a few times, at random intervals, to see if it's normalized. It takes three consecutive resting readings higher than 140/90 on different occasions to even start thinking seriously about possible medical treatment. Since your history has been pretty much spotless, and since your doctor's office reading was only marginally high ("normal" would be anywhere from 140/90 on down to the point where you'd be suffering from low BP symptoms). It should have be rechecked, but probably due to that excellent history it was taken as within normal limits (WNL) and will be compared with a reading the next time you happen to be there. If you have the opportunity to check yours (at home or on a drugstore machine) you may find, depending on your level of relaxation, prior activity, state of mind, etc., it may be closer to what's normal for you (generally that would run between 100 - 120/60 - 88).
I hope this helps. Please bear in mind that if you're the least bit anxiety prone, concern about this could cause it to be higher than in the past every time you have it checked because you'll be thinking about it specifically. This isn't an "all in your head" answer, it's just the way our regulating mechanism works.
Good luck to you. Please follow up with us as needed.
|dallyn - Tue Dec 23, 2008 1:39 pm|
thank you and i intend to call my dr as soon as she is back to work and talk to her about the smoking thing. its high time i stopped. thanks again
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