Persistent High Blood Pressure: When to Seek Urgent Care

It feels like my blood pressure won't go down?

Hello doctor, I have a question.
For many years, I have experienced fever and discomfort, which led me to visit the emergency room.
At that time, my blood pressure was around 180, and the nurse informed me that it was high, but I didn't pay much attention.
Recently, after feeling unwell due to anger, I checked my blood pressure and found it to be over 200.
After seeing a doctor, I was told I have left ventricular hypertrophy and was prescribed Amlodipine 5/160 mg.
I was advised to monitor my blood pressure morning and night and return for a follow-up in two weeks.
However, after taking the medication for four days, I feel that my blood pressure hasn't decreased significantly; in the morning, it ranges from 160 to 180, and at bedtime, it is between 180 and 200.
I feel very anxious because my blood pressure remains high despite taking the medication.
Should I go to the emergency room, schedule an earlier follow-up, or wait for the two weeks to return?

Mr. Hsu, 40~49 year old female. Ask Date: 2021/10/16

Dr. He Dongjin reply Cardiology

Hello, you seem to be very anxious.
Every time you measure your blood pressure, you get nervous, which causes your blood pressure to remain elevated.
Please take a few days to rest and avoid measuring it for now.
Just continue taking your medication as prescribed.
Let's start measuring again next week, and please return for a follow-up appointment in two weeks.
We care about you at Ping An Changhua Hospital.

Reply Date: 2021/10/16

More Info

It sounds like you are experiencing significant concerns regarding your persistent high blood pressure, especially given your recent readings of 200 mmHg and the diagnosis of left ventricular hypertrophy (heart enlargement). It's understandable to feel anxious when faced with such high blood pressure levels, particularly when you are on medication and not seeing the expected results.
First and foremost, it is crucial to understand that high blood pressure, or hypertension, can lead to serious health complications, including heart disease, stroke, and kidney damage. The fact that your blood pressure readings remain elevated despite medication is a concern that should not be taken lightly.
When it comes to managing high blood pressure, there are several factors to consider:
1. Medication Adherence: It's important to take your medication as prescribed. If you are experiencing side effects or feel that the medication is not working, you should discuss this with your healthcare provider. Sometimes, it may take a few weeks for the full effects of the medication to be realized, or your doctor may need to adjust the dosage or switch you to a different medication.

2. Monitoring Blood Pressure: Regularly monitoring your blood pressure at home can provide valuable information to your healthcare provider. Keep a log of your readings, noting the time of day and any activities or stressors that may have influenced your blood pressure. This information can help your doctor make more informed decisions about your treatment.

3. Lifestyle Modifications: In addition to medication, lifestyle changes can significantly impact blood pressure. These include:
- Diet: Following a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and lean proteins while reducing sodium intake.

- Exercise: Regular physical activity can help lower blood pressure. Aim for at least 150 minutes of moderate aerobic exercise each week.

- Stress Management: Since you mentioned that stress has triggered your high blood pressure, finding effective ways to manage stress, such as mindfulness, yoga, or deep-breathing exercises, can be beneficial.

- Avoiding Tobacco and Limiting Alcohol: Both smoking and excessive alcohol consumption can raise blood pressure.

4. When to Seek Urgent Care: If you experience symptoms such as severe headache, chest pain, shortness of breath, or vision changes, you should seek immediate medical attention. These could be signs of a hypertensive crisis, which requires urgent treatment. Given your current situation, if your blood pressure readings remain consistently high and you feel unwell or anxious, it may be wise to contact your healthcare provider sooner than your scheduled appointment. They may recommend an earlier visit or even an urgent care visit if they deem it necessary.

5. Follow-Up with Your Doctor: Since you have an upcoming appointment in two weeks, it is essential to communicate your concerns to your doctor. If you feel that your blood pressure is not adequately controlled, they may want to reassess your treatment plan sooner.
In summary, while it is essential to give your medication some time to work, it is equally important to remain vigilant about your blood pressure and overall health. If you feel that your situation is worsening or if you are experiencing distressing symptoms, do not hesitate to seek medical attention. Your health and peace of mind are paramount, and your healthcare team is there to support you in managing your hypertension effectively.

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