Background: Two years ago (at age 29) after having a ruptured disc repaired in my lower back, the doc discovered that my BP was running high. (Primary hypertension. All my recent bloodwork came back pretty normal.) After a few months consulting with my family doctor and trying conservative measures, she started me on medication to get it under control. I don't remember what was tried first, but it made me urinate every 15 minutes for the entire day, so we soon switched to Norvasc for a few months. Norvasc made me sleep. Constantly. And it didn't help. Next came Cozaar, which helped mildly, but no more than I could achieve on my own by chanting a soothing mantra for 8 hours a day. Then came Hyzaar (which I guess is just Cozaar with a diuretic?). About the same result.

Unmedicated, my BP typically runs 160/115 on a good day, and upwards of 185/130 on a bad one. I've spent a couple nights in ER because of symptoms that were just way too scary, and I didn't want to take the chance of a heart attack or stroke.

Okay, fast forward to today. I'm taking a combination of Hyzaar (100mg) and Toprol (50mg). The Toprol got me to 135/85 on an almost daily basis, and I'm looking at this as darn close to a miracle. However, I'm back to the point of frequent urinations and nasty fatigue. There come days when I know I can't afford to water the porcelain all day, or when I know I need to be at the top of my game, so I accidentally *cough* miss a dose. Sometimes I do just plain forget. I am, after all, human.

Anyway, I've noticed this pattern of things that happen when my BP begins to elevate. It's been happening for a couple years now, and this series is getting more and more pronounced with each episode.

First, I start to get irritable. My desire for social interaction shuts down. Then a small anxiety attack sets in, just about the same time I lose my vision. The vision loss is scary and bizarre: it starts with a couple floaters, then progressively spreads into this blue-hued blanket of nothingness wherever I try to focus. It typically covers about half my field of view, so I'm incapacitated for the next hour or so until my vision returns. Once my vision comes back, it's headache time -- for the next 12+ hours. Not just little headaches, either. I'm talking "slam your head in the meat locker" headache. They bring tears to my eyes, and I'm the type of guy that only cries at the end of Rocky II (you know, when Rocky is standing there in the ring yelling, "Yo, Adrienne... I DID IT!!!").

Anyway, there are times where the headache doesn't really settle in. Those are the scary times for me. Those times, I feel like a space cadet. I can't keep my eyes focused on anything, I completely lose fine motor control (can't scribble my own name), and things like walking tend to make me look more like the town drunk than anything else. Last time that happened, I had a few strange muscle twitches, and anytime I started to relax, I felt instant vertigo. (You ever been leaning back on the hind legs of a chair and had someone grab the back all suddenly and play like they were going to tip you over? That's what it feels like.)

When that's all said and done with, I fall asleep. Hard. For 12 hours. Then I shake the cobwebs out and I'm fine again.

Okay... So here's the deal. I brought all this up to the doc, and he was pretty dismissive of the symptoms. I had wondered if the couple more severe episodes were TIAs (mini-pre-warning-type strokes), and he agreed that they very well could have been, but said NOTHING as a follow-up to that, instead assuring me that the new regimine of Toprol would work wonders.

Okay, it has, but... but...

Does ANYONE follow me on this? Is there anything I should be worried about? Or is this all "normal?"

I think you've got a vascular situation that is more than just hypertension. Perhaps the hypertension is not PRIMARY at all.
Your taking a pretty potent mix off 3 drugs (losartan, thiazide, and metoprolol) and not even then getting tight control of your BP. For you to manifest all these symptoms from forgetting ONE dose is really beyond bizarre.

If I were you, I'd keep on top of it with, perhaps, in order of increasing price, a thyroid workup, tests for pheochromocytoma or adrenal tumors, and then some kidney scans and finally a brain MRI. These should paint a clearer picture (beware the scourge of the INSURANCE COMPANY.)

Slearly, you DON'T want to miss your daily dosing, for safety's sake.

Have you suffered from any anxiety disorders in the past? Are you obese?

It also sounds like you could be experiencing migraines. I know that when I get them, they usually cause vision problems and tend to raise my BP.

Toprol xl gave me severe headaches and vision problems. But that's me, i am soooo sensitive to meds. I think zip, is right though, maybe you should have your thyroid checked. I was diagnosised with graves disease.

Definitely some things to think about. I've had to reschedule my follow-up, which is poosibly a good thing; it gives me time to look a bit deeper into suggestions and questions for the next appointment.

Tangent: Do doctors LIKE mildly educated patients who get overly active in their own care? I know that in other service fields (I've been a service tech before), I'd rather the customer just leave the troubleshooting and repair to the pros.

The thing that bothers me about these headaches (maybe they are migraines) is that my BP rises BEFORE the vision loss and ensuing headache, and isn't triggered by stress (or anything else I can put my finger on, like diet).