Managing High Blood Pressure and Diabetes: Urgent Care Insights for Patients

Hypertension/Diabetes Mellitus

In late February, due to feeling unwell, my mother went to the emergency room and was diagnosed with hypertension (over 200) and diabetes (hyperglycemia).
She is approximately 57 years old and has been consistently following up with outpatient visits and taking medication for both hypertension and diabetes.
Blood tests have also been conducted in between.
However, on the evening of March 9th, she experienced discomfort again, with symptoms including body tremors, difficulty breathing, and needing assistance to stand.
Her blood pressure was measured at 220 upon arrival at the hospital.
My mother lives alone, and this situation is very concerning.
Why is her blood pressure still so high despite ongoing medication? Should we take her to a larger hospital for further evaluation? What tests should be conducted? Thank you.

Xiao Lin, 30~39 year old female. Ask Date: 2012/03/11

Dr. He Dongjin reply Cardiology

Hello, the recent fluctuations in weather may affect blood pressure.
In fact, any changes in internal or external environments can cause blood pressure variations, including sudden temperature changes, anger, poor sleep, menopause, and external stressors.
It is important to address these factors first before managing blood pressure for optimal results.
Generally, medication is intended to stabilize blood pressure most of the time, and occasional fluctuations are reasonable and should not cause excessive concern.
If you are still worried, you may want to keep a complete record of your recent blood sugar and blood pressure readings.
The physicians at several medical centers in Kaohsiung will be able to provide you with the most appropriate management.
Changhua Hospital cares about your well-being.

Reply Date: 2012/03/11

More Info

Managing high blood pressure and diabetes, especially in a patient with a history of severe hypertension and hyperglycemia, requires a comprehensive approach that addresses both immediate concerns and long-term management strategies. Given the alarming situation you've described, where your mother experienced a blood pressure reading of 220 mmHg and symptoms such as shaking and difficulty breathing, it is crucial to take this seriously and seek urgent medical attention.

First and foremost, the fact that your mother has been diagnosed with hypertension (high blood pressure) and diabetes (high blood sugar) indicates that she is at an increased risk for cardiovascular events, including heart attacks and strokes. The elevated blood pressure readings, particularly those exceeding 200 mmHg, suggest that her current medication regimen may not be adequately controlling her blood pressure. This can happen for several reasons, including:
1. Medication Non-Adherence: Sometimes, patients may not take their medications as prescribed due to side effects, forgetfulness, or misunderstanding the importance of their treatment.

2. Medication Resistance: In some cases, the body may become resistant to certain antihypertensive medications, necessitating a change in therapy or dosage.

3. Lifestyle Factors: Factors such as diet, physical inactivity, stress, and other lifestyle choices can significantly impact blood pressure control.

4. Underlying Conditions: Other medical conditions, such as kidney disease or hormonal disorders, can also contribute to poorly controlled hypertension.

Given your mother's current symptoms and the severity of her blood pressure readings, it is advisable to take her to a larger hospital or medical center where she can receive more comprehensive care. In such facilities, she can undergo a thorough evaluation, which may include:
- Blood Tests: To assess kidney function, electrolyte levels, and blood glucose levels, which can provide insights into her diabetes management.

- Electrocardiogram (ECG): To check for any heart-related issues that may be contributing to her symptoms.

- Echocardiogram: To evaluate heart function and structure, especially if there are concerns about heart disease.

- 24-hour Blood Pressure Monitoring: This can help determine if her blood pressure is consistently high and how it fluctuates throughout the day.

- Diabetes Management Assessment: This may include checking HbA1c levels to evaluate long-term blood sugar control and adjusting her diabetes medications accordingly.

In the meantime, it is essential to monitor her blood pressure regularly and keep a record of her readings, along with any symptoms she experiences. This information can be invaluable for her healthcare provider in determining the best course of action.

In terms of long-term management, it is crucial to focus on both lifestyle modifications and medication adherence. Here are some strategies that may help:
1. Diet: Encourage a heart-healthy diet that is low in sodium, saturated fats, and sugars. The DASH (Dietary Approaches to Stop Hypertension) diet is often recommended for managing high blood pressure.

2. Physical Activity: Regular exercise can help lower blood pressure and improve overall health. Aim for at least 150 minutes of moderate-intensity aerobic activity each week, as tolerated.

3. Weight Management: If your mother is overweight, losing even a small amount of weight can significantly impact blood pressure and blood sugar levels.

4. Medication Review: Regularly review her medications with her healthcare provider to ensure they are effective and to make adjustments as necessary.

5. Regular Check-ups: Ensure she has regular follow-ups with her healthcare provider to monitor her blood pressure, blood sugar levels, and overall health.

6. Education: Educate her about the importance of managing both conditions and recognizing symptoms that require immediate medical attention.

In conclusion, your mother's situation is serious, and seeking immediate medical care is the best course of action. Once stabilized, a comprehensive management plan involving lifestyle changes, medication adherence, and regular monitoring will be essential in preventing future crises and improving her overall health.

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