Managing Uncontrolled Hypertension: Seeking Guidance for My Mother's Health

Distressing Questions

Dear Dr.
He,
I apologize for the lengthy description below.
For the past two years, I have been troubled by a significant issue: my mother experiences episodes of sudden hypertension, which makes her feel unwell.
She is nearly 69 years old.
In April of last year (2022), she suddenly felt palpitations and shortness of breath, with her blood pressure rising to 190.
After taking Amlodipine without effect, she was sent to the emergency room, where blood tests, an electrocardiogram, and a brain CT scan were performed.
Ultimately, she was hospitalized for three days due to elevated cardiac enzyme levels.
During her stay, the cardiology chief performed an echocardiogram and a nuclear medicine myocardial perfusion study, both of which were normal.
The cardiac enzyme levels subsequently decreased to within normal limits, leading the cardiology chief to discharge her with a prescription for Valsartan for long-term use.
However, after about two weeks of taking Valsartan, my mother felt uncomfortable due to side effects and stopped taking the medication, yet surprisingly, she did not experience any further episodes.
About a year passed without incident until March of this year (2023), when my mother again suddenly felt palpitations and shortness of breath at night, with her blood pressure exceeding 200.
She was taken to the emergency room, where she received IV fluids and medication (Labtal), which helped lower her blood pressure.
During this visit, tests were performed, and everything appeared normal, so she was discharged without being admitted.
This time, she was given Labtal as a backup, while continuing to take Valsartan daily.
Strangely, her blood pressure remained unstable in April and May, despite regularly taking Valsartan.
Occasionally, her blood pressure would spike, and she would need to take Labtal to bring it down.
At that time, I consulted you, Dr.
He, and you suggested exploring the possibility of "autonomic nervous system dysfunction." I then took my mother to a neurologist, who prescribed Alpraline for her.
Since starting Alpraline in May, along with a reduced dose of Valsartan (one-third), my mother has not had any further episodes until last Friday (December 8), when she had another major episode.
Labtal was ineffective, and her blood pressure remained at 190, so she had to go to the emergency room again.
The doctor prescribed Cabudan, which lowered her blood pressure to 160, and after confirming there were no significant issues, she was discharged.
However, since her discharge about a week ago, my mother has been experiencing episodes almost daily, either with increased heart rate and elevated blood pressure or headaches accompanied by high blood pressure.
Despite taking various blood pressure medications and Alpraline, she still has episodes triggered by minor discomforts, such as gastrointestinal issues, straining during bowel movements, or changes in posture upon waking.
I cannot help but wonder about the purpose and effectiveness of blood pressure medications.
Aren't they supposed to help patients manage various sudden situations throughout the day? I would like to ask you, Dr.
He:
Q1: My mother has been suffering from this issue daily, and as her family, we feel helpless and heartbroken.
How can we help her live a normal life, and what treatment plan should we consider?
Q2: Today, I took my mother to see a neurologist due to the recent ineffectiveness of her blood pressure medications, as she continues to have episodes.
Even during the consultation, her blood pressure was nearly 170, and she felt unwell.
The doctor prescribed Nifedipine S.R.F.C.
for her to try.
Do you think this medication is suitable for her situation? Additionally, how does Nifedipine S.R.F.C.
compare to Labtal in terms of their differences?
Thank you, Dr.
He.

Kris, 40~49 year old female. Ask Date: 2023/12/16

Dr. He Dongjin reply Cardiology

Hello, we are human and it's inevitable to feel more discomfort during seasonal transitions, especially for older individuals.
Blood pressure merely reflects a person's current condition.
In response to the recent instability of your aunt's autonomic nervous system, the whole family is anxious, which has escalated the situation.
Why is it important to control blood pressure? It's primarily to prevent stroke.
The risk of stroke is more about the severity of hypertension rather than the current blood pressure readings.
Our approach to blood pressure management shouldn't be like stock trading, constantly monitoring fluctuations that only cause anxiety.
I do not recommend taking nifedipine; it merely lowers the blood pressure numbers and calms the family, but it doesn't provide any real benefit to the body.
Latanoprost is sufficient.
Changhua Hospital cares about you.

Reply Date: 2023/12/16

More Info

Managing uncontrolled hypertension, especially in an elderly patient with multiple health issues, can be quite challenging. Your mother’s situation is complex, involving episodes of high blood pressure, heart palpitations, and other symptoms that may be linked to autonomic nervous system dysregulation. Here’s a comprehensive approach to understanding and managing her condition.

Understanding the Symptoms
1. Hypertension and Symptoms: Your mother’s episodes of high blood pressure (e.g., readings of 190 or higher) accompanied by symptoms like heart palpitations, shortness of breath, and headaches are concerning. These symptoms can be indicative of hypertensive crises, which require immediate medical attention. The fact that her blood pressure fluctuates significantly suggests that it may not be adequately controlled with her current medication regimen.

2. Autonomic Nervous System Dysregulation: The symptoms you describe, particularly the sudden onset of palpitations and anxiety, may point to dysregulation of the autonomic nervous system. This can occur due to stress, hormonal changes (especially in post-menopausal women), or other underlying health issues. The introduction of medications like Alpraline (Alprazolam) may help manage anxiety, but it’s crucial to address the root causes of her hypertension.

Treatment Recommendations
1. Medication Review: It’s essential to have a thorough review of all medications your mother is taking. The combination of Amlodipine (脈優), Diovan (得安穩), and Labtal (壓血泰) may not be sufficient alone. Nifedipine (恆脈循) is a calcium channel blocker that can help with blood pressure control, but it’s important to monitor her response to this medication closely. Each medication works differently, and sometimes a combination of different classes (e.g., ACE inhibitors, beta-blockers, diuretics) may be necessary for better control.

2. Lifestyle Modifications: Encourage your mother to adopt lifestyle changes that can help manage her blood pressure. This includes:
- Diet: A heart-healthy diet low in sodium and rich in fruits, vegetables, whole grains, and lean proteins can significantly impact blood pressure.

- Physical Activity: Regular, moderate exercise can help lower blood pressure and improve overall cardiovascular health.

- Stress Management: Techniques such as mindfulness, yoga, or gentle exercise can help reduce stress and anxiety, which may contribute to her symptoms.

3. Regular Monitoring: Keeping a daily log of her blood pressure readings, symptoms, and any potential triggers (like stress or dietary changes) can provide valuable information for her healthcare providers. This data can help in adjusting her treatment plan more effectively.

4. Specialist Consultations: Given the complexity of her symptoms, it may be beneficial for her to see specialists, including a cardiologist for her hypertension and a neurologist for her autonomic symptoms. A psychologist or psychiatrist may also help address any anxiety or stress-related issues.

Addressing Your Concerns
1. Living Normally: The goal of treatment is to stabilize her blood pressure and alleviate her symptoms so she can return to a normal lifestyle. This may take time and require adjustments in her treatment plan. Open communication with her healthcare team about her symptoms and any side effects from medications is crucial.

2. Nifedipine vs. Labtal: Nifedipine is a long-acting calcium channel blocker that can help lower blood pressure by relaxing blood vessels. Labtal, on the other hand, is a beta-blocker that can help reduce heart rate and lower blood pressure. The choice between these medications depends on her specific symptoms and how her body responds to each drug.

Conclusion
Managing your mother’s uncontrolled hypertension requires a multifaceted approach that includes medication management, lifestyle changes, and regular monitoring. It’s essential to work closely with her healthcare providers to tailor her treatment plan to her specific needs. Encourage her to communicate openly about her symptoms and any side effects she experiences, as this will help in making necessary adjustments to her treatment. With the right support and management, it is possible for her to achieve better control over her blood pressure and improve her quality of life.

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