Resistant Hypertension

Posted by ashby1947 @ashby1947, Jul 12 7:14am

Anyone out there dealing with resistant hypertension? In the past 2 months, I have been dx with such. I've completed all kidney/renal studies and advanced BP monitoring, all of which were normal. I'm on 5 different BP meds, and my average daily BP is still 151/80 (as measured by a 24 BP cuff monitor.) I have a long and complex hx of heart issues (all okay now), but this is sudden. I am a 73 yo female, 115lbs, exercise 4x/wk, non-smoker, eat well, no caffeine or BP raising OTC medicine, and 1 drink/day. My Mayo cardiologist says she doesn't know why my BP is not controlled. Any suggestions or experiences to share would be welcome.

Thank you, and wishing you a good day – Sue

Good morning, Sue @ashby1947. I'd like to respond hastily, but helpfully, to your present quandary — writing as a victim of hypertension that I also characterize as "resistant." Quickly, my first observation is that your daily BP is not all that bad for a person of your age. Your systolic 151 is a little high for my taste, but your 80 diastolic is great! Your reliance on 5 different BP meds is worth detailed discussion with a nephrologist as well as your cardiologist (and given your worrying, perhaps an endocrinologist and a psychologist as well). I am taking 3 BP meds daily after having been prescribed a dozen others over the past 20 years — a medical ambivalence attributable to a rare cause of my hypertension, an inherited kidney defect that imposed a Liddle Syndrome (inability of the kidneys to reclaim potassium that is excreted along with sodium). The solution to that is a special diuretic that protects potassium levels. In addition to those factors, I have a 4th med on hand for use "as needed" after experiencing a hypertensive emergency that sent me to the ER about a year ago. I have used this med only twice when my BP spiked above 170/100. Worrisome as all that may be, my medical team is confident that my situation is not especially threatening, given daily readings of about 140/86 most times and lifestyle choices promoting BP stability at levels of lower threat. Martin

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Hi Martin – Thank you for taking the time to respond. I am heartened that you said my average systolic of 151 did not alarm you. I still don't know what to think about all of this. I am waiting for a further response from my Cardiologist. Since all my kidney tests were negative, I doubt that I will see the Nephrologist again. I am on Cardedilol 25 mg TID, Telmisartin 40 mg BID, HCTZ 12.5 mg morning, and Diltiazem 180 mg evening. Clonidine 0.1 mg was my as needed drug until I spiked, controlled it with oral Clonidine, then rebounded to LBP the next day, and very high the day after that. Subsequently, I am on Clonidine patch. It seems to be effective; however, my BP is still high. 3 of these have been added in the past few months. Sorry so much information. I am struggling with an exacerbation of my lumbar back issues right now and in acute pain – which no doubt contributes to the HBP. That will be resolved soon with injections….. until the next time. I think I still have vestiges of 120/80 hovering over me, and the next conversation with my Cardiologist should provide me with a more realistic outlook for someone my age, experience, and medical history. The uncertainly of if/when my BP will be out of control again haunts me, even though I have meds here to deal with it, and I know my way to Mayo ED well. I am trying to keep my focus on this from an academic perspective. How long did it take you come to the stability that you now experience? Was there anything in particular that you found helpful in dealing with your road to feeling confident in your situation? with the doctors? in your own life? I would appreciate anything you care to share. Sue

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I hope you can give me some guidance. When I wake in the mornings my BP is anywhere between 160/100 to 140/90. In the afternoon it drops to 135/90 by bed time its 115/60. I was told not to take blood pressure medicine if it was under 120. When I did, I have woken feeling sick. If I take the medicine in the morning when its high my. Blood pressure does not come down till late in the afternoon when it naturally comes down. I have been on eight different medications with no success. I also have Lupus and post interferon syndrome. Any thoughts?

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@ashby1947

Hi Martin – Thank you for taking the time to respond. I am heartened that you said my average systolic of 151 did not alarm you. I still don't know what to think about all of this. I am waiting for a further response from my Cardiologist. Since all my kidney tests were negative, I doubt that I will see the Nephrologist again. I am on Cardedilol 25 mg TID, Telmisartin 40 mg BID, HCTZ 12.5 mg morning, and Diltiazem 180 mg evening. Clonidine 0.1 mg was my as needed drug until I spiked, controlled it with oral Clonidine, then rebounded to LBP the next day, and very high the day after that. Subsequently, I am on Clonidine patch. It seems to be effective; however, my BP is still high. 3 of these have been added in the past few months. Sorry so much information. I am struggling with an exacerbation of my lumbar back issues right now and in acute pain – which no doubt contributes to the HBP. That will be resolved soon with injections….. until the next time. I think I still have vestiges of 120/80 hovering over me, and the next conversation with my Cardiologist should provide me with a more realistic outlook for someone my age, experience, and medical history. The uncertainly of if/when my BP will be out of control again haunts me, even though I have meds here to deal with it, and I know my way to Mayo ED well. I am trying to keep my focus on this from an academic perspective. How long did it take you come to the stability that you now experience? Was there anything in particular that you found helpful in dealing with your road to feeling confident in your situation? with the doctors? in your own life? I would appreciate anything you care to share. Sue

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Sue (@ashby1947), It's interesting that your medications are numerous and somewhat high dosages. I regard myself as a victim of resistant hypertension, as you know. My meds treating hypertension include Carvedilol (25mg BID), Lisinopril (40mg), and a diuretic Amiloride (10mg BID). My as-needed standby is Hydralazine (25mg). For me, this is heavy stuff. I once forgot Lisinopril at night, took it with Carvedilol in the morning, and wound up in the emergency room after fainting in church! Over the years, I have taken a dozen other hypertension meds, and now my medical team treats most of them as allergens — including Clonidine (a sophisticated brain agent), Diltiazem, and Hydrochlorothiazide on your list and Lasix, which once sent me to the ER for hypokalemia (lacking potassium).

How long have I sought stability? Forty years in Northern Virginia, from an Internist with cardiology credentials, three PCPs in a large clinical practice, three cardiologists, and two nephrologists — the last of which is a genius devoted to finding causes, not just treating symptoms. Her use of an endocrinologist to examine all of my relevant hormones cracked the case! Over the years, I usually felt confident of my medical team, not because they solved my problems, but because they tried alternatives until I reached a stability of sorts. I turned a corner 20 years ago when my new clinic diverted me from Cardiology to diagnosis and treatment by Nephrology. That started a string of second opinions initiated by my doctors with my cooperation, because of the new focus on finding a cause. Diet and exercise changes have cemented the therapies into my outlook which remains positive at age 85. Could you have Mayo provide second opinions on your current medication regimen? Martin

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@ashby1947

Hi Martin – Thank you for taking the time to respond. I am heartened that you said my average systolic of 151 did not alarm you. I still don't know what to think about all of this. I am waiting for a further response from my Cardiologist. Since all my kidney tests were negative, I doubt that I will see the Nephrologist again. I am on Cardedilol 25 mg TID, Telmisartin 40 mg BID, HCTZ 12.5 mg morning, and Diltiazem 180 mg evening. Clonidine 0.1 mg was my as needed drug until I spiked, controlled it with oral Clonidine, then rebounded to LBP the next day, and very high the day after that. Subsequently, I am on Clonidine patch. It seems to be effective; however, my BP is still high. 3 of these have been added in the past few months. Sorry so much information. I am struggling with an exacerbation of my lumbar back issues right now and in acute pain – which no doubt contributes to the HBP. That will be resolved soon with injections….. until the next time. I think I still have vestiges of 120/80 hovering over me, and the next conversation with my Cardiologist should provide me with a more realistic outlook for someone my age, experience, and medical history. The uncertainly of if/when my BP will be out of control again haunts me, even though I have meds here to deal with it, and I know my way to Mayo ED well. I am trying to keep my focus on this from an academic perspective. How long did it take you come to the stability that you now experience? Was there anything in particular that you found helpful in dealing with your road to feeling confident in your situation? with the doctors? in your own life? I would appreciate anything you care to share. Sue

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Interesting that you mention back pain. I had severe back pain (avg pain score steadily climbing to nearly 10) for several years. Had 2 major fusions (now hairline to hips fused, only 3 top vertebrae not fused). Drastic, but BP – which had been similar to yours) is now normal and off BP meds for 2 yrs, despite increasing weight. I’m 70. Only known difference has been pain resolution. Hugs and best wishes!

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