Sudden High Blood Pressure: Causes and Next Steps for Treatment

Sudden elevation of blood pressure for unknown reasons that remains persistently high..?

My father is 75 years old and did not have a habit of regularly monitoring his blood pressure.
He would occasionally check it for fun, and his systolic pressure was around 120-130.
However, his heart rate has consistently been around 90.
Starting in December 2023, he began to experience occasional dizziness, so he visited a neurologist.
The doctor diagnosed him with 18% mild blockage in the cerebral vessels and prescribed Plavix (clopidogrel).
Despite this, he still experiences discomfort in the left back of his head, neck, and shoulders, and feels a sensation in his left eye as if it cannot fully open.
On the evening of December 27, he suddenly felt dizzy, and his blood pressure spiked to 200.
He was taken to the emergency room, where he received an injection to lower his blood pressure and was sent home feeling fine.
However, since then, his blood pressure has remained around 150.
On January 2, he returned to the neurologist to request medication for hypertension, aiming to treat the high blood pressure first.
He was prescribed Concor (bisoprolol) 4 mg to take every morning and evening.
Despite daily monitoring, his blood pressure remains around 150, and although he does not feel unwell, he occasionally experiences dizziness.
On the evening of January 8, he felt dizzy again, and his blood pressure rose above 170.
After taking the blood pressure medication for about a week, his blood pressure still does not reach normal levels.
Aside from the dizziness, he has no other symptoms, and he is unsure about the course of his hypertension.
After researching online, he learned about primary and secondary hypertension.
He is anxious because he suddenly developed high blood pressure within a month or two and does not know which type it is or what the underlying issue might be.
He is also uncertain about how to proceed with testing and treatment.
My father has been feeling down every day, fearing that it may further impact his health.
We kindly ask for your advice on what kind of examinations he should undergo.
Thank you very much.

Hilda, 30~39 year old female. Ask Date: 2024/01/08

Dr. Wu Xueming reply Cardiology

Please take your medication regularly, maintain a normal routine, engage in regular exercise, and control your salt intake.
If your blood pressure remains uncontrolled, please visit the clinic for your physician to adjust your medication.

Reply Date: 2024/01/08

More Info

Sudden high blood pressure, especially in an elderly individual with no prior history of hypertension, can be concerning and warrants thorough investigation. In your father's case, the sudden spike in blood pressure to 200 mmHg, followed by persistent readings around 150 mmHg, suggests that there may be underlying factors contributing to this change. Here’s a comprehensive overview of potential causes, risks, and next steps for treatment.

Potential Causes of Sudden High Blood Pressure
1. Secondary Hypertension: While primary hypertension (essential hypertension) accounts for the majority of cases, secondary hypertension can occur due to identifiable causes. In older adults, common causes include:
- Kidney Disease: Conditions such as chronic kidney disease or renal artery stenosis can lead to elevated blood pressure.

- Endocrine Disorders: Disorders such as hyperaldosteronism, pheochromocytoma, or Cushing's syndrome can cause secondary hypertension.

- Medications: Certain medications, including NSAIDs, decongestants, and some antidepressants, can raise blood pressure.

2. Lifestyle Factors: Changes in diet, increased salt intake, lack of physical activity, or excessive alcohol consumption can contribute to elevated blood pressure.

3. Stress and Anxiety: Emotional stress or anxiety can lead to temporary spikes in blood pressure. Given that your father has experienced discomfort and dizziness, it’s possible that anxiety about his health may be exacerbating his condition.

4. Neurological Factors: Given your father's history of mild cerebrovascular disease, it’s essential to consider that changes in cerebral blood flow or increased intracranial pressure could also influence blood pressure regulation.

Risks of Uncontrolled High Blood Pressure
Persistent high blood pressure can lead to several serious health complications, including:
- Heart Disease: Increased workload on the heart can lead to hypertrophy, heart failure, or coronary artery disease.

- Stroke: Uncontrolled hypertension is a significant risk factor for both ischemic and hemorrhagic strokes.

- Kidney Damage: High blood pressure can damage the blood vessels in the kidneys, leading to chronic kidney disease.

- Vision Loss: Hypertensive retinopathy can occur, leading to vision impairment.

Next Steps for Diagnosis and Treatment
1. Comprehensive Evaluation: It’s crucial to conduct a thorough evaluation to determine the cause of your father's hypertension. This may include:
- Blood Tests: To assess kidney function, electrolyte levels, and hormonal levels.

- Urinalysis: To check for protein or blood in the urine, which can indicate kidney issues.

- Imaging Studies: An ultrasound of the kidneys or CT/MRI of the abdomen may be warranted to assess for structural abnormalities.

- 24-Hour Blood Pressure Monitoring: This can help determine if the high readings are consistent or if they fluctuate significantly.

2. Medication Adjustment: If your father’s blood pressure remains elevated despite medication, it may be necessary to adjust his treatment regimen. This could involve:
- Adding or Changing Antihypertensive Medications: Different classes of medications, such as ACE inhibitors, ARBs, calcium channel blockers, or diuretics, may be more effective.

- Lifestyle Modifications: Encouraging a heart-healthy diet (low in salt and rich in fruits and vegetables), regular physical activity, and stress management techniques can also be beneficial.

3. Regular Monitoring: Continuous monitoring of blood pressure at home can help track changes and assess the effectiveness of treatment.

4. Psychological Support: Given your father's feelings of anxiety and depression, it may be beneficial to involve a mental health professional to address these concerns, as managing stress can positively impact blood pressure control.

Conclusion
In summary, your father's sudden onset of high blood pressure requires a multifaceted approach to identify the underlying cause and implement effective treatment strategies. Regular follow-up with healthcare providers, adherence to prescribed medications, and lifestyle modifications will be essential in managing his condition. Encourage open communication with his healthcare team to ensure that all concerns are addressed and that he feels supported throughout this process.

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