Sudden High Blood Pressure: Risks and Next Steps

Sudden spike in blood pressure?

Hello, doctor.
My family member's blood pressure suddenly spiked to 168/118 in the morning, accompanied by severe dizziness and nausea.
Since it was a holiday, the hospital outpatient services and clinics were closed, so we quickly took medication and rested to alleviate the symptoms.
They have a history of hypertension and hyperlipidemia and have been taking antihypertensive medication regularly, specifically one tablet of Valsartan per day.
There have been a few instances of forgetting to take the medication, but they did not experience any discomfort and would remember to take the medication the following day.
Is this spike in blood pressure due to forgetting to take the medication the previous day? I am concerned that the sudden increase in blood pressure could be a precursor to a stroke or other cardiovascular issues.
May I ask: 1.
Is there a need to go to the hospital for a chest X-ray or echocardiogram? 2.
Given the severe dizziness and nausea, could there be an increase in intracranial pressure, and should a brain examination be conducted to check for potential cerebrovascular issues? Thank you.

Miss Jiang, 20~29 year old female. Ask Date: 2018/10/06

Dr. Bai Xiyan reply Cardiology

Hello Ms.
Jiang, regarding the issue of your family member's unstable blood pressure, it is important to note that hypertension is typically a chronic condition and often coexists with diabetes and hyperlipidemia, all of which are risk factors for cardiovascular diseases.
Therefore, regular outpatient visits and adherence to medication are essential.
In case of any emergencies, you can visit our emergency department, which is available 24 hours a day.
In response to your two questions: first, blood tests and imaging studies are both indicated examinations that can help in the early detection of complications.
Second, the most common cause of sudden increases in blood pressure is non-compliance with medication, or acute factors such as stress, cold weather, or even a stroke.
Emergency physicians will arrange necessary examinations based on the condition, and it is crucial to seek medical attention promptly for appropriate management.
The medical staff at Chiayi Hospital are dedicated to serving you!

Reply Date: 2018/10/06

More Info

Sudden spikes in blood pressure, such as the reading of 168/118 mmHg experienced by your family member, can indeed be alarming, especially when accompanied by symptoms like severe dizziness and nausea. Given the history of hypertension and hyperlipidemia, it is crucial to understand the potential risks and appropriate next steps.

Understanding the Risks
1. Hypertensive Crisis: A blood pressure reading above 180/120 mmHg is classified as a hypertensive crisis, which can lead to serious complications such as stroke, heart attack, or kidney damage. The symptoms of severe headache, dizziness, and nausea can indicate that the body is reacting to the elevated blood pressure.

2. Medication Non-Adherence: It appears that your family member has a history of forgetting to take their antihypertensive medication, Valsartan. Missing doses can lead to a rebound effect, where blood pressure rises significantly after periods of non-adherence. This can explain the sudden spike in blood pressure.

3. Potential for Stroke: Sudden increases in blood pressure can indeed be a precursor to a stroke, particularly if there are accompanying neurological symptoms. The risk is heightened in individuals with pre-existing hypertension and other cardiovascular risk factors.

Next Steps
1. Immediate Medical Attention: Given the symptoms of severe dizziness and nausea, it is advisable to seek medical attention as soon as possible. While it may be a holiday and outpatient services are closed, consider visiting an emergency room. They can perform necessary evaluations and provide immediate treatment.

2. Diagnostic Tests:
- Chest X-ray: This may not be immediately necessary unless there are respiratory symptoms or signs of heart failure. However, it can help rule out any acute cardiac issues.

- Echocardiogram: This test can assess heart function and structure, especially if there are concerns about heart failure or other cardiac conditions.

- Brain Imaging: If there are ongoing symptoms of dizziness and nausea, a CT or MRI of the brain may be warranted to rule out any cerebrovascular events, especially if there are concerns about elevated intracranial pressure or stroke.

3. Monitoring and Follow-Up: After the immediate situation is addressed, it is crucial to establish a plan for regular monitoring of blood pressure and adherence to medication. Consider setting reminders for medication intake or discussing with a healthcare provider about alternative treatment options if adherence continues to be an issue.

4. Lifestyle Modifications: Encourage lifestyle changes that can help manage blood pressure, such as a heart-healthy diet (low in sodium and saturated fats), regular physical activity, stress management techniques, and avoiding tobacco and excessive alcohol consumption.

Conclusion
In summary, the sudden spike in blood pressure and accompanying symptoms warrant immediate medical evaluation to rule out serious complications. It is essential to address medication adherence and consider lifestyle modifications to manage hypertension effectively. Regular follow-up with a healthcare provider is crucial for ongoing management and to prevent future episodes.

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