Hello all. First of all, thanks to anyone reading or replying to this message.
I am a 39 year old white male, 5'11" and 215 lbs. Four weeks ago today, I went to the hospital in an ambulance for the first time. I had an episode with my vision, which the ER said was possibly an ocular migraine. The real problem (to me) was that, after the alleged migraine had subsided, the paramedics took my blood pressure and it was 170/110. In the ER, it hovered around 150/89 and really didn't go back down until later that afternoon. My blood pressure has always been normal and my normal resting heart rate is around 55-60.
I was discharged and happened to be sharing this story with a client, who holds a PhD in neurology and pharmacology and he said it was a TIA. Sounded plausible to me. I followed up with my PCP and he doubted it was a TIA, but said that my blood pressure was elevated and we needed to deal with it. I began taking Lisinopril (just 10mg). Long story short, my blood pressure spiked on several occasions, one time landing me in the ER and I am now taking 30 mg of Lisinopril. The spikes are averaging in the 168/96 range and my resting heart rate at times has been as much as 78. I can tell when my BP is going up because I feel like I am being stuck with needles all over my body. I have tremendous anxiety, my heart feels like it's doing flip-flops and my pulse rate soars. My doctor was concerned that the Lisinopril was not controlling the BP and prescribed me a beta blocker, which has usually worked wonders.
Not convinced that I just all of a sudden had high BP, I asked my Dr. to think about running some tests. We got a test back showing high catacholamines and he suspected pheochromocytoma. During this time, I was still having BP spikes occasionally. I have seen a heart specialist and they did echocardiogram and stress test and my heart is solid. After some other testing, today I had a CT scan of my abdomen and my PCP's office called and said there is no tumor on my adrenal gland.
Finally - my question. Something is just not right. My mother has high BP and she can only tell when hers is through the roof. I believe they call hypertension the silent killer, because it's not usually felt until it really gets out of control. My hypertension seems to accompanied by the same exact symptoms as an adrenaline burst, which is a hallmark of pheochromocytoma, yet there's no sign of that near my adrenal glands. Additionally, I have come kidney pain in my right kidney area. The spikes are not due to stress or physical exersion - I have stopped exercising completely over the past 4 weeks, because I am scared to continue. There is no rhyme or reason to the spikes - I have had a spike while sleeping, watching television, driving, etc....
Do I really have hypertension or could this be something else? Has anyone had these type of symptoms with BP which is only 155/95? Would it worth continuing to check for a pheochromocytoma somewhere else (I think they can occur in other parts of the body)? I am married and I have a 4 and 1 year old and I just don't think I can live every day wondering if my BP will spike or not. It really scares me when it happens and I feel like I have dumped the care of the house and children on my wonderful wife. Something just feels out of place, but so far, nothing is turning up as a cause.
My question revolves around your statement that you added a beta blocker "which has usually worked wonders". Have you been on beta blocker therapy for a while? ever? or is this a new pill for you?
I feel like I'm a broken record on this site sometimes, but I had such a bad experience with Atenolol (a beta blocker), with very similar adrenaline bursts, anxiety and quickly elevating blood pressure, that I have to ask you about it.
In some people, especially ones with poor peripheral circulation, the elevated BP will be caused by beta blockers because they restrict peripheral circulation as part of their action. And most of the time the BP is OK, but bam! out of the blue comes the adrenaline burst (high catacholamines), headache, ringing in the ears and racing heart.
So if I were you, I'd do some research on the beta blocker you are taking and see it's side effects and go from there.
...Would it worth continuing to check for a pheochromocytoma somewhere else (I think they can occur in other parts of the body)?
I definitely think that is worth investigating, and yes, they do occur in other parts of the body. As far as I know, no one has recently posted on pheo, and the most recent posts weren't as helpful as the older posts, so I would encourage you to do an advanced search of the high/low blood pressure boards for more info. If I recall correctly, there are only a couple of labs in the country that have good tests for this, so again, I would do a thorough search for those who has some solid info on the identification and treatment of this condition.
Also, I agree wholeheartedly with ms58's post! And I might even question the 30 mg of lisinopri, especially if started you on 30 mg without trying a lower dose first.
Wow, thanks for the quick responses. As a matter of fact, I had another spike this afternoon...tingling (more like needle pricks than tingling), chest pain, etc.... I haven't ruled out just a plain old anxiety problem, but I do have a relatively stress-free life (other than being an attorney and having the afore-mentioned 1 and 4 year old girls).
As for the Lisinopril, we started out with 5mg, which one Dr told me was nothing. After a couple spikes they raised it to 20 and then 30mg.
The beta blocker I am taking is Propranolol. I have only been on that med for about a week. The first few days of taking it, I felt better than I had since the problem began, I assumed because it got my heart rate down to where I was used to having it. I did just start taking an antibiotic for a sinus infection, and in the two days I have taken it, I have had trouble keeping my BP down. I check the antibiotic out and see if there is some sort of issue with taking it with this other stuff going on. I was really down this afternoon when I posted, because I was just so certain this whole thing was the Pheochromocytoma and it would go away once they removed the thing.
I am going to an endocrinologist and a hypertension specialist (my Dr. has set this up this afternoon), so maybe a different perspective will yield some results. Also, have a sleep apnea study lined up. I have never been sick with anything other than a cold in my life and this is just hard so hard to stomach.
I think sometimes a root cause can be found, or one can make a hypothesis---or perhaps a real condition that is known to cause hypertension-----but to me the main thing is, okay, what do we do now?
I know people will yell at me and say it is ridiculous, you can do lifestyle changes and get rid of hypertension. Happy stroke to you.
In all of the reading and in talking to doctors and pharmacists---it is pretty typical in an aging population. When I first found out I had hypertension in 2003 when I was 54, I was hysterical because I stupidly assumed only under-active, poor diet, overweight, don't pay attention to their health----people---got hypertension.
Well, obviously thin, fat, old, young, active, in-active people can have hypertension. I mentioned in another post Cindy McCain has hypertension and a few years ago when she had lost weight and was exercising extensivey decided to stop her meds---and had a stroke.
Several doctors have told me that since I had pre-eclampsia with my first pregnancy was a pre-cursor of hypertension later in life---
same way women who have pregnancy induced diabetes are more likely to become diabetic later in life.
so after becoming hysterical, I decided okay let's see what is the best combination of drugs----and what more can I do to stay healthy-----and since the drugs control my bp well, I will be on them for the rest of my life----
In my case a cardiologist did a lot of tests----and I am very sensitive to all meds and I am the type sensitive to adrenaline and stress------so I take atenolol because I was having a high pulse rate when first diagnosed.
I have recently switched from a calcium channel blocker which my first doctor I think should not have prescribed and am starting an ace inhibitor---
which my new doctor says is more protective of the kidneys among other things and he likes----
So if your bp goes up you may never know exactly why-----you can do a lot of things to make it better-----but the way I look at it, God gave us the knowledge to create medications to use cautiously and carefully---but he gave us the knowledge all the same.
So I am into okay what do I do know---and sometimes it takes experimentation and a good doctor to work with you to figure it out---
I certainly don't want to chaulk it up to plain ole anxiety, but I have to admit your story sounds similar to mine I, too, landed in the ER several years back for something unrelated to BP, but my BP there was 160/100 - that began this weird relationship with me and my stupid blood pressure and the question of "am I hypertensive or not". I've come to the conclusion that I'm a hyper-responder, but that is beside the point. An anxiety attack with DEFINITELY cause your BP to spike - especially if you head for the cuff and are hoping for a low number. Additionally, your symptoms of tingling & chest pain are similar. Also, my doctor has previously prescribed me propranalol to help curb my anxiety attack while helping control my BP at the same time. It's an excellent drug for many people to help their anxiety. BUT, I do think you should continue on your current course of action - I'm just saying anxiety is a certain possibility.
One more thing. I had 2 occular migranes after the birth of my son. Scarriest thing EVER. I'm not sure how yours went, but mine started off with this sensation that something sort of looked funny in my line of vision. I ran upstairs to try and get my mind off it, while telling myself I was fine and was just having an anxiety attack or something. When I tried to read my book, I realized I couldn't see the words from the perspective of my right eye. I could see all around it, but not directly in my line of vision. I automatically thought I was having a stroke. Gradually, my line of vision cleared, but it started moving into my periphreal vision and made jagged lines. Like a circular sawtooth kaliedescope. Freakiest thing ever - lasted about an hour from start to finish. Might have been cool if not so flipping scary! I found a description on the net and decided that's what it was. Anyhow - I did see my opthamologit who had recently bumped my glasses perscription up, and come to find out it was too high. He swore it was my lactating hormones, I still blame it on the overprescribed glasses
Good luck! And totally check out the archives. Lots of good info there!
... I haven't ruled out just a plain old anxiety problem...
In my opinion, anxiety is a secondary condtion which means, as in the hypertension, something else is causing this symptom.
Sounds like the lisinopril is not the problem giving the "start low, go slow" prescription.
As far as pheo's go, beta blocker's can make the hypertension worse, so you might keep that in the back of your mind.
..I am going to an endocrinologist and a hypertension specialist (my Dr. has set this up this afternoon), so maybe a different perspective will yield some results. Also, have a sleep apnea study lined up. ....
Sounds like you're getting quality care and that your doctors are taking the right steps...
I might add that treatment for sleep apnea dropped my pressures more than 10 points. Glad you're doctors are considering screening for this, too.
Zekat - that describes my experience to a T (the ocular migraine). It was tiny light in the beginning, right in my field of vision - I could not see about one or two letters on the computer screen RIGHT where I was typing and, from there, it went haywire just like you described. Glad to hear someone else describe it like that, so I am pretty confident that's what it was.
Ocular migraines are so common. I think everyone on my street has had one. Mine started in my 30's but most people seem to get them in middle age. I go lay down in a dark room with a cool washcloth over my eyes for a half hour. Wear sunglasses when outside will help; avoid looking at anything shiny. It's probably a money maker for eye Dr's. The Eyecare source book by Jay Lavine is an excellent resource to have on hand for eye issues.
... One more thing. I had 2 occular migranes after the birth of my son. ... mine started off with this sensation that something sort of looked funny in my line of vision. ... When I tried to read my book, I realized I couldn't see the words from the perspective of my right eye. I could see all around it, but not directly in my line of vision. ... Gradually, my line of vision cleared, but it started moving into my periphreal vision and made jagged lines. Like a circular sawtooth kaliedescope. Freakiest thing ever - lasted about an hour from start to finish. ...
I've also endured many of these "Migraine Auras". During mine, it is difficult for my eyes to focus on anything before, during or after the Aura. Also, during my Aura, my eyeglasses don't provide clear vision as well as they do normally.
Now that my blood pressure is at healthy levels, I've lost a lot of weight and my blood sugar and insulin is at healthy levels, I get far fewer Migraine Auras.
Hi, Ray. If it were me, I'd buy a glucose meter and check myself whenever an episode starts. If it is a burst of adrenalin, then you'd expect blood glucose to rise - since adrenalin causes the liver to produce glucose. OTOH, you can simultaneously rule in or out whether reactive hypoglycemia is causing adrenalin release. (I'd also take note of what I'd eaten before an episode.)
I'd also think of taking an extra propranolol as an episode starts, to see if that attenuates the symptoms. It should start to kick in at around 15 minutes or so.
I also wonder why you're on such a primitive drug. Since somebody else mentioned peripheral vasoconstriction in this thread, you should be aware that there is a new vasodilating beta blocker called nebivolol.
Hi, just a thought, but have you ever had your calcium and parathyroid hormone checked at the same time? Blood pressure spiking like that can be a symptom of hyperparathyroidism. And I think that I read that you had kidney involvement too (maybe I am wrong), but if that is so, that can be a symptom too.
I take proponalolo too. I take it for tachycardia. The first week it seemed to work really great, but now it is not working so well. I was on toprol before that and I could not even drive because I was so dizzy.
I do believe if a person continues to have elevated blood pressure numbers, it is indeed real.
And at some point, what the root cause is----is not as important as treating it so that the numbers remain down.
Some people will swear that with lifestyle changes alone bp meds are not necessary---perhaps in some cases that is true.
But much hypertension is hereditary and seems also to come with aging, and even thin and active people can have hypertension.
I come from an era and I do this to myself---that if there is something wrong with me, i.e. hypertension, then I am a horrible awful person. When I was first diagnosed with hypertension 5 and a half years ago I was stunned---I was always so healthy, so active, never smoked. I had thought only lazy people who didn't take care of themselves got high blood pressure (only kidding here, but our minds do strange things to us)
Always, we can do things to stay as healthy as possible. And then work with a doctor to find the best combination of treatment. I have been well-controlled for years, but then decided I didn't like the side effects of one med
and we are trying some new ones---and there is definitely a period of adjustment.
I also have a huge tendency to anxiety, all my life. I think it is a body type, mental and emotional type----so I have taken a beta blocker, atenolol, very successfully for a long time. We are experimenting with a second drug to maintain the levels I need, but the atenolol solves the issue that I can tend to have a rapid heartbeat and my cardiologist did a number of tests and my rhythm is good, but I need the beta blockers for that piece of it.
I also happens to be used for the treatment of anxiety---as I am trying to find the right combination of a new medication which my doctor thinks will be much for beneficial for me, I have been experiencing a great deal of anxiety which I thought I had left behind. Well, the atenolol helps with that.
My doctor told me he has a patient who is a musician and when he travels, he has a level of anxiety that is not helpful, so he uses a beta blocker for that.
And you know the number one issue with so many people and their blood pressure?? They don't take their meds on a regular basis---they get lazy if they are feeling okay. I understand that some meds have horrible side effects for some people, so they need to find a different drug.
But there are people who are fine on a drug or drugs and simply do not bother to take it on a regular basis.
My father had hypertension and coronary artery disease---but he lived to be 89 and died more of natural causes because he had great care and always took his meds.
His mother, my grandmother, died way too young, way before I hardly knew her because she didn't believe in doctors, believed in spiritual healing---not that there is anything wrong with that----except when she finally decided to take medication for angina it was way too late in her life----as far as how many years she had had high bp but didn't treat. She died way too young at age 67.
I will be 60 this year and I am vigilant about treating my bp---no matter what the root cause.
Hang in there