The BP for my Mom (age: around 60) has been around systolic 210 and diastolic 100 since last week. The first doctor she saw gave her "Tenormin". When it proved to be ineffective in reducing the pressure, she was advised by a second doctor to the emergency room of a hospital where she was given "Metoprolol Tartrate" but she was not hospitalised. Today, she felt light-headed. Self-measurement again shows high BP rates. THis time, she went to the same hospital and the doctor (the third one) there told her to stay in the hospital. I just came back home worrying what it is all about.

Can anyone tell me if these rates are very serious? Is there any hope of reducing them? What are the possible causes of such persistent high BP rates? Is it very difficult to find a drug suitable for her? Any knowledge about the medications given? Can the rates be reduced anyway?

I'm rather anxious and would like to hear any of your advice. Many thanks.

ends.

Your mother is having what they call a hypertensive crisis, which is basically any severe or critical sustained elevation in blood pressure. The third doctor was right to hospitalize her when her BP wasn't coming down on Metropolol (which is a beta blocker and very commonly prescribed for hypertension)

There are basically two kinds of hypertensive crisis: hypertensive EMERGENCY and hypertensive URGENCY.

A hypertensive EMERGENCY, is when there is acute or ongoing end-organ damage (i.e. damage to heart or kidneys).

The absence of such complications is known as a HYPERTENSIVE URGENCY.

Hypertensive "emergencies" generally require a reduction in blood pressure within a few hours, if not faster than that, usually using intravenous medications given in an intensive care unit.

Hypertensive "urgencies" also require prompt medical attention, but blood pressure can be lowered over 24 to 48 hours, sometimes in a closely monitored outpatient setting, not necessarily in the hospital.

It appears that because your mom was not hospitalized initially, the first two doctors felt it was an urgent situatuion but not necessarily an emergency.

It's better that she's now in the hospital, where they can monitor her BP closely and can run tests to check her heart and kidneys to see if there are problems there.

The most common causes of hypertensive crisis are:

Several kidney disorders and diseases (both chronic and acute).
Scleroderma and other collagen vascular diseases.
Use of certain drugs, particularly sympathomimetic agents (eg, cocaine, amphetamines, PCP, LSD).
Withdrawal from antihypertensive meds.
Eating tyramine-containing foods.
Taking tricyclic antidepressants, or other sympathomimetics combined with MAO inhibitor therapy (again, certain drugs).
Preeclampsia, eclampsia.
Pheochromocytoma (a tumor of the adrenal glands).
Head injury
Renin-secreting or aldosterone-secreting tumor.
Vasculitis.
Autonomic hyperactivity in presence of Guillain-Barré or other spinal cord syndromes.

Try not to worry too much at this point. There are medications that they can use to stabalize her BP, (she may need more than one) and once under control, they will, as I said, run tests in a controlled environment to find what could have caused this to happen.

But don't let that list scare you.... none of the above are necessarily her problem and she simply might need better BP control than in the past.


zuzu xx

I would add alcohol withdrawal to your list. I had 193/100 after a 4 day binge 1 year ago. Nothing even close since. 116/65 today...

Dear Zuzu and Lilians,

Thank you so much for your very helpful and comprehensive advice. My mother is still in the hospital but her BP has now come down to 138 for systolic. Her doctors have given her new drugs. She looks better now. The doctors would like to see if the situation has stablised before considering discharge. Besides, she has taken some blood tests and is awaiting results. Still not yet known what causes the high blood pressure. Probably it has to do with diet - eating too many cakes. I learn from the web that powder for baking/cooking contains sodium / soda. High BP patients should refrain from taking foods of high sodium/soda. Yet BP at such high levels is still rather unusual. I hope the doctors could soon find out the reasons.

Thanks again.
regards,
Fanny