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Date of last update: 10/20/2017.

Forum Name: Hypertension

Question: Should a diastolic pressure of over 100 be a concern?

 sunshine36 - Sun Jan 25, 2009 3:24 pm

About five months ago I began having days when I would be at work when I would begin to feel like I was going to pass out. Also, for about the past ten years I have had times where I feel like I have butterflies in my chest. One day the light-headedness was particularly bad and the feeling lasted for longer than normal. I had my blood pressure checked and it was 150/120. It was checked three times over the next half hour and never went below 148/118. I was sent home and went to the doctor. They did a bunch of tests on my blood to check for Thyroid issues, electrolytes, potassium, a whole chemical work up, and an EKG and everything came back normal. They sent me home, and asked me to come back in a week to see if it was just a fluke, because before all this began my blood pressure was normally between 90-115/60-70. I went back and it was still high. So, I was put on Metoprolol and sent to see a cardiologist. On the Metoprolol my blood pressure stayed around 130-140/108-110 on most days. When I went to see the cardiologist they did another EKG, and a stress test, an Echo, and a CT Angiogram. The only thing they found was that I possibly have a bicuspid aortic valve. They saw that the Metoprolol is not working and put me on Sular. Again, this medicine did not lower my BP. The only time of the day that my BP is usually normal is in the morning when I first wake up. They now have me taking Cardizem CD. I have not been diagnosed with Hypertension. Because of my age (28) they feel there is something else going on, and for now they are saying it is not my heart.
I am concerned because I have days where my blood pressure rises really quickly. One day before I left work I checked it and it was 120/93. A half hour later I was walking somewhere when suddenly everything seemed to be floaty (if that makes sense), and I suddenly felt really weird. I went and checked my blood pressure and it was 142/102 and it is staying around that even on medication. I have been getting a lot of headaches. I just wonder if there is something more that I should be making sure my doctor checks, and whether or not this is something I should be really concerned about (my diastolic blood pressure).
 John Kenyon, CNA - Thu Jan 29, 2009 1:04 am

User avatar Hello -

First, yes, a diastolic pressure consistently above 100 is a concern. It's just not supposed to be that high very often (not even during vigorous exercise). So this needs to be resolved.

Your doctor is very likely right regarding your age. While blood pressure does tend (or at least historically it has) to increase with age, at 28 there's no innocent reason for your pressure to suddenly step up that way, and the underlying cause should be discovered if at all possible.

It's not always possible -- this is then called "essential" hypertension -- but many times the cause can be found and corrected. It's woth a try to avoid having to be on BP meds for an extended period of time.

One thing that should be rule out due to the sudden onset of this problem is pheochromocytoma -- a generally benign adrenal tumor. These tumors are often found right on the adrenal gland or glands, as one might expect -- but not always. This is why they are such a problem to discover: they're not always where they'd be expected. They can actually turn up anywhere inside the thorax, and the main problem with them is that they produce adrenaline, just like the adrenal glands. I suppose it goes without saying that when these are present, so is too much adrenaline, which can cause a sudden spike in blood pressure which may be chronic.

There are both blood and urine tests to determine if there is excess adrenaline in the body. If this is the case, the hunt starts for the tumors (which can be very tiny at times, and difficult to identify via usual imaging techniques). If this is the problem, it is usually quite fixable, and tests to rule this out or in should be done for sure.

Also, since there is a history of thyroid disease in your family, and since it doesn't matter whether it was hyper or hypo (since the disease can transpose from one generation to the next and even between siblings), hyperthyroidism needs to be ruled out as well. This is neither as complicated to diagnose nor correct, but it definitely should be done, and quickly.

If these two possibilities are eliminated and there is not other evidence of kidney disease, then you'll probably be classifed as having "essential" hypertension, at least for the time being, and treated symptomatically -- to control the blood pressure first and foremost. This is necessary anyway, and hopefully, eventually, the underlying cause will be discovered. Ideally it would turn up in the course of trying to rule out the disorders mentioned above.

I hope this is helpful to you. The bicuspid aortic valve (BAV) may have some obscure relationship with elevated blood pressure also, but there's no clear cause and effect. Still, if you do have a BAV you'll also need to be followed for possible development of an ascending aortic aneurysm. Since you currently have high blood pressure, and since this is a risk factor for aortic aneurysm independent of BAV, this is especially important to watch as well, so the diagnosis of BAV needs to be clarified and, if present, followed with at least an annual echocardiogram.

Good luck to you. Please follow up with us as needed.
 sunshine36 - Thu Jan 29, 2009 2:29 am

Thank you so much for your reply. I have been tested for thyroid issues since I previously had problems with it, but all of my levels came back normal.

I know that you said that sometimes if you have pheochromocytoma it can be hard to detect sometimes. Would it not show up on a CT Angiogram scan? The only thing they saw was a possible cyst in my liver and something to do with my lungs that was harmless.

Also, you mentioned about my BAV. You said it needed to be clarified. I already had an echo, and I am not sure why my doctor is not sure whether or not I have one. Is there another test that can tell us for sure?

Thanks so much for your help already.
 John Kenyon, CNA - Thu Jan 29, 2009 12:33 pm

User avatar Early pheochromocytomas can sometimes be very difficult to visualize because they can be so tiny. This is where the 24-hour urine test comes in handy, as it can show excess adrenaline and lead to a more thorough exploration (via imaging) to try and locate the source, assuming there is one.

For some reason there seems to be an occasional problem being certain if an aortic valve is bicuspid. The best thing is to have the echo repeated, hopefully using a different tech. A better method for "seeing" this area is a transesophageal echocardiogram (TEE), which is done by sedating the patient and dropping the transducer down the throat, into the esophagus, behind the heart. This puts it in very close proximity to the area in question, doesn't take very long, and gets the most accurate result. Otherwise, it seems to me if there's any doubt about BAV it's probably best to err on the side of caution and take an annual look, until or unless it's positively ruled out. While it doesn't seem to have any particular issues in and of itself, it is strongly associated with ascending aortic aneurysm, and that's also fairly easy to check for periodically, maybe at the same time as an annual echo.

Hope this is helpful. Stay in touch.
 sunshine36 - Wed Feb 11, 2009 10:07 pm

I have gone to see a new doctor, but he did not have my records yet and he decided to put me back on Metoprolol. I had the same problem when I took it before that it made me gain a lot of weight and also caused me to have pain in my chest. It is pain that is increased when pressed upon. Is this a normal side effect? I do not think it is pain in my heart because the last time I told them this they did an EKG and it came back normal.
 Dr. E Asis - Mon Feb 16, 2009 2:13 am

User avatar Hi! It seems that the pain you are experiencing when you pressed upon your chest is a typical musculoskeletal pain, not a pain originating from the heart. But I usually request for an ECG if the pain persists just to rule out an impending heart attack. I haven't heard about chest pain as a side effect of metoprolol or any other beta blocker.
 sunshine36 - Tue Mar 10, 2009 8:05 pm

I am sorry I have so many questions, but I experienced something new today that I have never had a problem with before. Often when I am flying or driving for a long period of time my legs begin to feel tight, like they have swollen up. Today I was standing on my feet for a while and I began to feel that feeling. Could this be caused by my blood pressure problems?
My doctor basically dismissed my blood pressure as more than likely being stress related, if not herditary. They think it is stress related because more often than not my blood pressure is okay when I am at home, and high when I am at work. I am hardly ever home, and when I am I am not being active. When I begin to go places and am standing on my feet for long periods of time, this is when I more often notice symptoms of my blood pressure going up.
Today I took my medicine like normal, which has been working most days, but I have also been sitting more. Today at my job I did not have the choice of sitting down for about two hours. I had to stand and walk around the entire time. When I got done I felt off and had a headache along with the tight feeling in my legs. I had my blood pressure checked and it was 140 over 103. I was wondering if this can cause the feeling I felt in my legs?
 abbas73 - Tue May 19, 2009 8:00 pm

diastolic blood pressure persistanly higher than 90 is considered hypertention and should be treated.

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