Should You Seek Further Evaluation for Persistent High Blood Pressure?

Is it necessary to go to a major hospital for further examination?

Hello Doctor: My father (approximately 57 years old) is currently undergoing hypertension monitoring at a clinic and is taking antihypertensive medication.
However, his daily blood pressure readings at home are still around 145.
Is this normal, or does he need to go to a larger hospital for further examination? Additional information: My father has mentioned experiencing dizziness in the morning upon waking up.

Meng, 20~29 year old female. Ask Date: 2019/05/08

Dr. Hong Yuanbin reply Internal Medicine

Hello, it is recommended to measure your blood pressure regularly 3-4 times a day.
Before each measurement, make sure to rest for at least 15 minutes to obtain more accurate readings.
If you are measuring your blood pressure only once a day or even less, and it exceeds 140 mmHg, it may indicate that a few readings could be influenced by external factors, leading to temporarily elevated blood pressure.
In such cases, adjusting blood pressure medication may not be necessary.
However, if your blood pressure exceeds 140 mmHg more than twice a day, it is advisable to record these readings and consult your physician to determine if an adjustment in medication is needed.
If you experience chest pain, shortness of breath, or any neurological issues, further evaluation at a larger hospital is required.
Thank you for your inquiry.

Reply Date: 2019/05/08

More Info

When it comes to managing persistent high blood pressure, especially in the context of your father's situation, it is crucial to take a comprehensive approach. Your father's blood pressure readings of around 145 mmHg are concerning, particularly since they are consistently elevated despite being on antihypertensive medication. The presence of symptoms such as dizziness upon waking further complicates the situation and warrants a thorough evaluation.

Understanding Blood Pressure Readings
Blood pressure is categorized into different ranges: normal, elevated, and various stages of hypertension. According to the American College of Cardiology and the American Heart Association, a blood pressure reading of 130-139 systolic or 80-89 diastolic is classified as Stage 1 hypertension. Your father's readings of 145 mmHg fall into this category, indicating that his blood pressure is not well controlled.

Importance of Monitoring
It is essential to monitor blood pressure regularly, as fluctuations can occur due to various factors, including stress, diet, medication adherence, and overall health status. Home monitoring is a valuable tool, but it should be complemented by regular check-ups with a healthcare provider. If your father is experiencing dizziness, this could be a sign of poorly controlled blood pressure or side effects from his medication.

When to Seek Further Evaluation
Given your father's persistent high blood pressure and symptoms of dizziness, it is advisable to seek further evaluation. Here are some reasons why:
1. Assessment of Medication Efficacy: The current antihypertensive regimen may not be effective for your father. A healthcare provider can assess whether the dosage needs adjustment or if a different class of medication should be considered.

2. Evaluation for Secondary Causes: Persistent hypertension can sometimes be due to underlying conditions such as kidney disease, hormonal disorders (like hyperaldosteronism), or sleep apnea. A thorough evaluation can help identify any secondary causes that may require specific treatment.

3. Cardiovascular Risk Assessment: High blood pressure is a significant risk factor for cardiovascular diseases, including heart attack and stroke. An evaluation can help assess your father's overall cardiovascular risk and determine if additional interventions are necessary.

4. Monitoring for Complications: Symptoms like dizziness can indicate potential complications of hypertension, such as orthostatic hypotension or even more serious conditions. A healthcare provider can perform necessary tests to rule out these issues.

Recommendations
1. Schedule an Appointment: It would be prudent to schedule an appointment with a cardiologist or a primary care physician who specializes in hypertension. They can perform a comprehensive evaluation, including blood tests, an electrocardiogram (ECG), and possibly imaging studies.

2. Keep a Blood Pressure Diary: Encourage your father to maintain a diary of his blood pressure readings, noting the time of day and any symptoms experienced. This information can be invaluable for the healthcare provider in assessing his condition.

3. Lifestyle Modifications: Alongside medication, lifestyle changes can significantly impact blood pressure control. Encourage your father to adopt a heart-healthy diet, engage in regular physical activity, manage stress, and avoid excessive salt intake.

4. Medication Review: Discuss with the healthcare provider any potential side effects of the current medications, especially if dizziness is a recurring issue. Adjustments may be necessary to optimize his treatment plan.

Conclusion
In summary, your father's persistent high blood pressure and symptoms of dizziness are significant enough to warrant further evaluation. A thorough assessment by a healthcare professional can help identify the underlying causes of his hypertension, optimize his treatment plan, and reduce the risk of cardiovascular complications. Taking proactive steps now can lead to better management of his condition and improved overall health.

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