Dizziness and High Blood Pressure in Seniors

Dizziness and discomfort?

Hello Doctor: My father is 70 years old.
Recently, he caught a cold and had difficulty breathing, leading to a diagnosis of "bronchiectasis." His blood pressure has consistently been around 150-170 (he has never taken antihypertensive medication).
The doctor mentioned that this condition would not affect his high blood pressure and recommended that he see a cardiologist.
He underwent blood tests and a portable electrocardiogram; the doctor said the blood test results were normal, but his heart was slightly irregular, and medication was prescribed.
However, he experiences dizziness when he looks up at things, walks forward to grab something, and then returns to his original position.
Although the dizziness does not last long, it is uncomfortable.
He has been taking "Daltens Sustained Release Capsules" and "Tenormin" for a month (he has never taken antihypertensive medication before).

Now, here are my questions: 1.
After taking the medication, his blood pressure has not decreased.
Isn't it expected that blood pressure would lower after taking medication? 2.
The dizziness persists.
Is the dizziness caused by high blood pressure, or is it a separate condition? Which specialty should I consult to address both the dizziness and blood pressure issues? Some people say that certain diseases can cause high blood pressure.
What diseases could lead to elevated blood pressure? 3.
His left arm blood pressure was 173, right arm blood pressure was 145, and pulse was 102 during previous measurements.
I have written a lot; thank you, Doctor, for taking the time to answer my questions.

Sindy, 30~39 year old female. Ask Date: 2012/02/20

Dr. Lan Shengxing reply Neurology

Dear Sindy,
1.
If the medication is unable to lower your blood pressure, you may ask your original cardiologist to change the medication or adjust the dosage.
Some bronchodilators can affect cardiac rhythm, so be sure to bring this up during your appointment for the physician's reference.
2.
Many conditions can cause dizziness, so it may be worthwhile to have a preliminary examination by a neurologist.
It is important to note any significant differences in blood pressure readings between your two arms; this should also be communicated to your cardiologist, as certain large vessel diseases could cause such discrepancies.
Additionally, ensure that the method of measuring blood pressure in both arms is consistent and accurate, as this can affect the readings.
3.
It is recommended to bring your blood pressure monitor to the hospital for a comparison with the readings taken there, which will help clarify the issue.
Best regards,
Lan Shengxing

Reply Date: 2012/02/20

More Info

Hello! Thank you for your detailed inquiry regarding your father's health concerns, particularly his high blood pressure and episodes of dizziness. Let's break down your questions and provide some insights based on medical knowledge.

1. Blood Pressure Management
Your father’s blood pressure readings of 150-170 mmHg are indeed elevated and classify him as having hypertension. It's important to note that high blood pressure can be influenced by various factors, including lifestyle, diet, stress, and underlying medical conditions. The medications he is currently taking, such as "Dahlene Sustained Release Capsules" (likely a form of antihypertensive medication) and "Tenormin" (atenolol), should ideally help lower his blood pressure. However, it can take time for blood pressure medications to show their full effect, and sometimes adjustments in dosage or medication type may be necessary.

If his blood pressure remains high despite medication, it’s crucial to follow up with his healthcare provider. They may consider additional medications or lifestyle changes, such as dietary modifications (reducing salt intake), increasing physical activity, and managing stress levels.

2. Dizziness and Its Causes
Dizziness can be multifactorial. It may stem from high blood pressure, but it can also be due to other reasons such as dehydration, medication side effects, inner ear issues, or even anxiety. The fact that your father experiences dizziness when changing positions (like looking up or moving around) could suggest a vestibular issue or orthostatic hypotension, where blood pressure drops upon standing or changing positions.

Given that he has a history of bronchial dilation and is currently experiencing dizziness, it would be wise to consult a cardiologist or a neurologist. A cardiologist can evaluate the cardiovascular aspects, while a neurologist can assess for any neurological causes of dizziness.

3. Conditions Associated with High Blood Pressure
Several medical conditions can contribute to secondary hypertension (high blood pressure caused by another condition). These include:
- Kidney Disease: Conditions affecting the kidneys can lead to fluid retention and increased blood pressure.

- Endocrine Disorders: Disorders such as hyperthyroidism, Cushing's syndrome, or pheochromocytoma can elevate blood pressure.

- Sleep Apnea: This condition can lead to increased blood pressure due to intermittent hypoxia during sleep.

- Medications: Certain medications, including over-the-counter drugs and supplements, can raise blood pressure.

4. Blood Pressure Variability
The difference in blood pressure readings between the left and right arms (173/102 on the left and 145/102 on the right) can be concerning. A significant difference may indicate vascular issues or other underlying conditions. It's advisable to have this evaluated by a healthcare professional, as they may recommend further testing to understand the cause of this discrepancy.

Conclusion
In summary, your father's situation requires careful monitoring and possibly further evaluation. It’s essential to maintain open communication with his healthcare providers, ensuring that they are aware of all his symptoms and concerns. Regular follow-ups, medication adherence, and lifestyle modifications can significantly improve his quality of life and manage both his blood pressure and dizziness effectively.

Encourage your father to stay hydrated, avoid sudden movements, and report any worsening symptoms to his doctor promptly. Thank you for reaching out, and I wish your father the best in his health journey!

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