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Old 02-21-2010, 10:13 AM   #1
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High blood pressure spikes awake when sleeping

I have been sick for over two months now with adrenaline- like surges that make my blood pressure spike as high as 170/100, and the doctors are stumped. At first, the surges began in the evening, with pounding heartbeat, shakiness, breaking out in sweat, anxious feeling, and the need to have a bowel movement. Sometimes this would continue until I had fully evacuated my bowel, waking me again and again for up to four hours, and then would subside. Then, the frequency continued until these surges were almost constant. I lost my appetite, could barely eat due to nausea (no vomiting), began losing weight, diarrhea.

My doctor first considered hyperthyroidism. I was already taking Atenolol (beta blocker) for many years for intermittent palpitations from mitral valve prolapse and migraines, so he increased my dosage to twice a day to help with the symptoms. I felt better within an hour of increasing the dose, but that didn't last. I checked my blood pressure with a home machine because of the increase in beta blocker and found my blood pressure was elevated off and on throughout the day. Thyroid blood tests were normal, but my thyroid scan showed increased uptake at the 24 hour interval. Was assured by endocrinologist that scan was normal.

The Endocrinologist ordered a plasma and urine catecholamine levels checking for pheochromocytoma that were normal. I was started on an alpha blocker (Doxazosin) for the hypertension which spiked up to 171/ 93, 160/ 103. My blood pressure was maintained at or below 140/80 during the day but continued to spike at night, waking me each time I was at the beginning of a dream (possibly REM sleep) with a surge, causing my heart to pound, etc. My blood pressure was 150-160/ 90's just after these episodes. Every hour to hour and a half, I wake with these surges, just as I begin or in middle of dreaming. Cortisol and ACTH levels checked for Adrenal Insufficiency were also normal. Endo doc gave up on me since the diagnosis was not an easy find.

Internist ordered 5-1AA test for hormone secreting carcinoid tumor and results were normal. Began to wake to chilling when blood pressure rising with facial and neck flushing and breaking out in sweat when blood pressure lowering. After the alpha and beta blocking combination, appetite improved some, and over the counter 24 acid reducer taken for indigestion. After eating, diarrhea changed to constipation and now is normal. Total loss of weight so far twenty pounds.

I have a long history of chronic illness which may or may not be relevant. Systemic Lupus, Fibromyalgia, Chronic fatigue, Irritable bowel, GERD, osteopenia, spontaneous rib fractures, brain stem stroke (ischemic of unknown cause). Had no history of hypertension except after stroke which resolved. I have never smoked, do not drink, and had been riding my bicycle 10 mi. a day, five days a week. I did have a bout of flu- like symptoms, the H1N1 vaccine, and an upper respiratory infection, sinusitis just prior to symptoms getting worse. Also was taking 2 pseudophedrine tabs for sinus congestion and drinking caffeinated beverages. (Stopped when symptoms started). Other significant history: Took 2 year course of Forteo (Parathyroid hormone) for repeated rib fractures supposedly due to long term use of Prednisone for lupus. After quitting Forteo injections, lost 45 pounds. History of mild ankle swelling that developed after stroke which responded well to taking diuretic and potassium replacement. (Quit taking when became somewhat dehydrated with nausea. My sister and mother both have hypertension and are on medication.

Internist sent me to gastroenterologist. I had a previous colonoscopy which had a very small polyp which was removed but too small to biopsy about 4 years ago. Was supposed to get another colonoscopy, but became ill. He said he would do work up after other issues addressed. CT scan of abd. showed 9 mm lung nodule, most likely post infectious, (suggests to repeat in 3-6 mo.) spleen cyst, and no other abnormalities.

Other significant (?) things: Turned in bed and thought I had fractured another rib. Xray did not show fracture. Continue to have pain to right lower rib area still after several months. Keeping underwire bra off helps some. Continue to have a hyper-startle to loud noises such as telephone, television volume, etc. Had one episode similar to this 6 years ago when recovering in the hospital from a hysterectomy and ovarian cyst removal. (Possibly due to decreased estrogen level?) Now, years later, I am 50 and had my estrogen levels checked because of mood swings. Estrogen low. Also quit taking Lexapro which I had been taking for fibromyalgia (which is in remission) and mood swings when given high doses of Prednisone when my lupus flared and after my brain stem stroke.

Now, while taking alpha and beta blockers, typically my blood pressure is normal or slightly hypotensive during the day, most likely to being more active and up walking. My husband has to drive me to doctor appointments which are over two hours away. I have given up on having enough energy to prepare meals and stick to trying to fold a few clothes, and wash dishes. The alpha blocker makes me dizzy and cloudy headed. I can't concentrate very well. My blood pressure continues to spike mainly at night and the surges wake me every hour or so in the middle or beginning of a dream, sometimes with brief burning pain to my chest. Increasing my beta blocker at night has helped with the intensity some. My blood pressure usually recedes to normal after each surge if I get up and walk. As you can tell, I am becoming sleep deprived, and am not sure how long I can take this. I fear my fibromyalgia will become active again or that I could have another stroke. Occasionally have a better night in which bp only goes up to 140/90, but still wake with surges, although are less intense. Have found that BP is high when lying down, lower sitting, even lower standing, and low kneeling. (Possibly due to antihypertensives).

I am sorry that this is so long, but I want to give all my symptoms and somewhat complicated history to see if anyone can relate. The next step is to get a 24 hour halter monitor and pulse oximetry. My doctor was hoping to find some abnormal lab test so that he would know what department to send me to a tertiary care center such as UCLA or USC.

I have all the symptoms of pheochromocytoma without any of the lab results or scans to prove it. Have read up on pseudopheochromocytoma boards that discuss anxiety and sleep apnea as possible differentials of diagnosis. (I have snored all my life, but don't suspect sleep apnea, and any anxiety seems to be related to the adrenaline- like surges). Dr. gave me a prescription for low dose Xanax when symptoms were really intense, but never took any. Once I got on a better routine with the antihypertensives, the anxiety improved. The only real problem during the day is making sure that my bp doesn't bottom out when I get more active.

This is very frustrating for me and my family. Anyone who has any ideas is welcome to remark. Thank you.

Last edited by Sunsetnan; 02-21-2010 at 11:28 AM. Reason: corrections and clarity

 
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Old 02-23-2010, 08:24 AM   #2
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Re: High blood pressure spikes awake when sleeping

Does anyone have any ideas that can help me? I increased my Atenolol at night and that has helped the adrenaline- like surges and increasing the blood pressure medicine at night has helped decrease the high blood pressure spikes to the 140/ 90 area. These are just helping the symptoms but not the cause. Any suggestions out there to what is causing this?

 
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Old 02-23-2010, 07:27 PM   #3
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Re: High blood pressure spikes awake when sleeping

Hi Sunsetnan,

Not sure about all of your symptoms, but I have those blood pressure spikes at night and sometimes during the day along with hot flashes and then the chills. Mine are caused by menopause. To me, it feels like my body is releasing some kind of chemical or something that causes it to happen. I first thought that I was having some kind of adrenal issue, but I think now it just has something to do with hormones. Have you had your hormone levels checked lately? Just a thought. I also take atenolol, 25mg in the morning and 25mg before bedtime.


Take care and I hope you feel better soon.
Missy

Last edited by missy222; 02-23-2010 at 07:28 PM.

 
Old 02-24-2010, 09:51 AM   #4
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Re: High blood pressure spikes awake when sleeping

Missy222: I just wrote a reply and I accidentally deleted it, so here we go for the second time. First of all, thank you very much for replying. My estradiol level is <10 which, according to my doc is low (couldn't find the reference ranges). I have only one ovary and 50, so menopause may be complicating this. But, I have had these other symptoms, heart palps, shakiness, anxiety, nausea, loss of appetite, etc. The surges or rushes of adrenaline- like hormones were typical of someone scaring you, but much more intense. I speak in past tense, because the medications have augmented them. The chills have always been associated with a bp spike, usually the higher ones 150, 160, 170/ 100's. The sweats have always been when my bp is low (100/50, 90/ 50). Because I have labile hypertension, the antihypertensives keep me generally hypotensive especially when I am up and active except when I spike. Maybe the changes in bp and chemical surges stimulate a hot flash. I have had night sweats when I took an antidepressant for my Fibromyalgia and these are different.

So, does the Atenolol you take do anything for your night bp spikes? Are they less high? How long have you had them? What does your doctor say?

I will have the halter monitor and pulse oximetry put on today for a 24 hour test. I have to drive 2 hours to the doctor. I have a consultation appt. with another doctor on Friday (second opinion) since my doctor seems to be stumped. He says he has other patients with somewhat similar symptoms, and sometimes they have just gone away. I am praying for that to happen, but this has been going on since before the new year. There have been good efforts to help control the symptoms but not to find the diagnosis and a possible cure.

Would love to hear from anyone else, even if it is good thoughts. My husband and family have had an earful of venting to last a lifetime.

 
Old 02-24-2010, 06:40 PM   #5
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Re: High blood pressure spikes awake when sleeping

Hi Sunsetnan,

Hope your doctor appointment went well today.

The atenolol does help with my blood pressure and heart rate most days. When my blood pressure does it's spike, there is no controlling it. I can be sitting very calm watching tv and all of a sudden boom, I feel like someone just scares the heck out of me. I guess it's the fear or flight feeling kicking in which also sends me into a major panick attack. I also have anxiety, heart palps, shakiness and twitching of my muscles. This all started last June when my periods began to become irregular. I posted several times on the menopause board and alot of the women experience the exact same thing. I guess that's why I feel better when it happens knowing I'm not alone.

My doctor said it's just anxiety and wanted to start me on anxiety meds and increase my blood pressure meds. I declined because I am not anxious about anything going on in my life right now. I truly believe it is hormonal and try not panick or worry when it happens.

I hope you find the answers you are looking for at your second opinion appt.

Take care,
Missy

 
Old 02-25-2010, 11:19 AM   #6
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Re: High blood pressure spikes awake when sleeping

It does help to know that I am not alone. My main problem now is trying to get some sleep. The good thing about having my husband drive me 2 hours to my doctor appointments, is that I am able to sleep on the way. I am still waking every hour at night. The adrenaline- like rushes still wake me and my blood pressure goes up, but not as high as before. I broke down and took a Xanax yesterday to help with the anxiousness and shakiness feeling, and it really helped. I have always been a worrier, just like my mother, but have never been overly anxious. I have always been the more calm, patient, level- headed type of person, so this anxious feeling is new to me. I am trying to keep a calm atmosphere at home, but it is hard with two active boys and a demanding husband. Will let you know what happens tomorrow.

 
Old 02-27-2010, 07:41 AM   #7
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Re: High blood pressure spikes awake when sleeping

Saw the secondary consult yesterday. I was really impressed with his thoroughness. Unfortunately that translates to the tune of 13 vials of blood for tests. He made a few suggestions of potential causes that both encouraged me and scared me. (Simple fixes to ones with no cure). I'm praying for the simple fix, permanent cure one. He stopped one of my medications that could be the cause or could be making me worse off. He said it would take a week or so before improvement would show. He ordered a sleep study in hopes that he would get concrete documentation of what was happening to me. (All this news was easier to take with a Xanax on board and my husband beside me). Trying not to dwell on the more serious causes, although it's hard not to see the elephant in the room.

Because I have such a long and abundant medical history, the potential causes seem to multiply and become more serious. You have to remember that I haven't seen myself as a person with a serious chronic illness. At Thanksgiving, I was riding my bike nearly ten miles a day, five days a week. My stamina was never up to the average "healthy person," but I thought I was doing better than I had in a long time. Maybe I was doing too much. Maybe the viruses and the H1N1 vaccine threw my system in a tailspin. Maybe this was slowly creeping up on me and I didn't see it coming.

Something that this doctor said encouraged me. He said that some very competent intelligent doctors had done some very appropriate testing on me. He acknowledged the problems with the accuracy of the tests in finding a diagnosis, and he took my problem very seriously and didn't patronize me. I felt like he was working with me and my husband to try to uncover the cause of all this. But, I've had doctors come out of the gate running, and never finish the race and give up.

I really didn't want this post to sound so depressing. But, its hard to hold onto something with all of the "balls in the air," so to speak. I am blessed to have some good friends who give me encouragement and a family who keeps me busy enough to keep my mind sidetracked.

I plan to keep posting, and hopefully won't be so long- winded. I think I am benefiting from venting and getting more encouragement than I am giving at this point.

 
Old 02-27-2010, 01:23 PM   #8
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Re: High blood pressure spikes awake when sleeping

Hi Sunsetnan,

Glad your appt. went well. 13 vials of blood??? I would have passed out!!! Keep your head up and I'm sure it will all work out. Let us know what happens.
Missy

 
Old 03-03-2010, 08:46 PM   #9
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Re: High blood pressure spikes awake when sleeping

Update: Saw cardiologist today. Echocardiogram, 24 halter monitor readings, and pulse oximetry were all normal. Yeah! However, he gave me a bit of a frank lecture saying that I may never find a reason for all of this and for me to quit spending all my efforts on finding a cause and try to find a way to live with it (and most likely get on with life). He assured me it wasn't life threatening. I did assure him that after so many months, I came to the realization that this wasn't something with a quick cure. For a while, I was putting myself and everything on hold for after I was diagnosed and treated. Of course, I was so miserable, I certainly couldn't do anything else. Now, I realize that I'm no where near the end of this and life will pass me by if I don't watch out. And that may very well take me out of my controlled atmosphere at home with my "handy dandy" blood pressure machine and medication bottles on my bedside table. Now that I am eating more and feeling a bit better, getting some sleep if only an hour at a time, maybe I can do that. Sorry, got a bit philosophical there...

I believe the cardiologist was trying to help me, and I'm sure I was certainly overwhelming him with information that was out of his area of expertise. But, my theory, the more people you tell/ ask, the more ideas you get, and everyone has different experiences and knowledge, and that may just lead to helping in some way. Even if it meant a discussion on living with a chronic illness. (Nothing new to me). And, I've found out that doctors actually like having it all handed to them in black and white. So, I ceremoniously gave him a detailed three page paper of my lengthy and complicated medical history and current symptoms.

After everything, he did recommend I see an Internal Medicine specialist at UCLA. So, I suppose this visit wasn't a total loss. I ruled out yet another serious medical problem, and realized that even though I may feel pretty miserable a lot of the time, I still need to find time to enjoy myself. I plan to give my kids and husband an extra hug for having to deal with the turmoil this has caused and may continue to disrupt our lives. Hopefully we will be all the better for it.

 
Old 03-04-2010, 04:31 PM   #10
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Re: High blood pressure spikes awake when sleeping

Hi Sunsetnan,

Glad your test were all normal! That's good news! Perhaps your cardiologist is right about letting go and start living. I think that if we spend too much time worrying about what's wrong it gets to us and we then develop health anxiety. I hope you take the much needed time to "smell the roses". Good luck with USC!!

Take care,
Missy

 
Old 03-07-2010, 01:30 PM   #11
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Re: High blood pressure spikes awake when sleeping

Two things come to mind.
My health care pro told me that waking in the middle of the night and needing to go poo is a sign that your liver is toxic.
Another thing that will wake me at night is if I eat a sugar food before bed. I think the rise and fall in blood sugar levels is what wakes me up.
You might want to look into doing some liver cleansing, especially if you are on ANY types of meds, exercise in the morning (good for liver) and try not eating a carb/sugar at night.

 
Old 03-07-2010, 05:28 PM   #12
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Re: High blood pressure spikes awake when sleeping

Thank you for responding to my post. I know what is waking me up at night. It is the adrenaline- like surges that happen every hour or so. Thankfully now, my blood pressure has not been spiking (day or night), most likely because I have increased my Atenolol and the surges are much less. Obviously not decreased enough to sleep longer than a couple of hours at most. The diarrhea has stopped, but has been replaced by constipation, most likely due to the medications I take that are decreasing the adrenaline- like hormones. Plus, when it gets bad, I can't eat and have a hard time drinking. I get up and walk around until I recover and then I go back to sleep. These surges happen during the day as well, and I am working on getting the right dosing to help control them without making me a zombie.
Unfortunately, my doctors have not been able to find a cause, so I must find a way to help control the symptoms while minimizing the medication side effects while they are searching.
You are right about the sugar/ high carb restriction before bed time. When I am able to eat, I have been having peanut butter on a slice of bread before bed. The white bread might not be the best choice, but the natural peanut butter is lower in sodium and a protein that should help even out my blood sugar levels. Since I have been sick, my blood sugar has been on the higher side of normal. My husband is a diabetic and has a glucometer that he checks his blood sugar with. I used it to check my BS at times when I was shaky and even right when I got up in the morning, and it was never low. So, I would guess low bs is not contributing to my sleep problems. Thank you though for your thoughts.

 
Old 03-07-2010, 05:47 PM   #13
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Re: High blood pressure spikes awake when sleeping

I know very little about BS problems, and you obviously do.
My thought in regarding eating the carb at night, is that after eating the carb, my BS rises, right? Then about 4 - 6 hours later is drops and wakes me up.
Does this make sense as to how and why it is happening?
Your adrenal problem is interesting to me, as I too thought I was having adrenal problems once and went to dr. to discover that my low thyroid was causing the problem. I'm sure you've had yours check.

 
Old 03-08-2010, 08:42 AM   #14
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Re: High blood pressure spikes awake when sleeping

I have had problems with reactive hypglycemia in the past. It is essentially what you have experienced. You eat something with high carbs and your blood sugar goes extra high and then your body responds by secreting extra insulin, and then your blood sugar goes lower than normal. Mine got so bad that I would have periodic paralysis. Talk about scary! I started noticing it would happen around Halloween time, and yes... you've guessed it, I would snack on Halloween candy. I have had glucose tolerance tests, and was diagnosed as having gestational diabetes when I was pregnant with my second son. My husband is diabetic. In fact, we found out he was diabetic during the time I was pregnant and used my glucometer to test his blood sugar. Also, and I am a Registered nurse and taught diabetic education to new pediatric diabetics for twenty years (although I haven't been able to work for the last ten years due to illness). So, I would agree that I have some knowledge about blood sugar issues. However, I certainly don't think that I know everything there is to know about the subject by any means, only what I have been taught and experienced. I agree with your statement that low blood sugar can wake you at night. In fact, I have tested myself in the middle of the night, suspecting that is what happened when I have awakened shaky, but it has always been on the high side of normal.

I have posted on the high blood pressure message board if you want to read my complete list of symptoms and multitude of tests. I would love to hear yours and anyone else's opinion on my problem. Yes, I did have thyroid tests done, and I have actually posted my lab results on the thyroid board for others to interpret. My doctors are stumped. I am hoping someone will recognize these symptoms and help point me in the right direction for treatment. It sure helps to know how to take care of yourself when you know the cause.
I had a very bad day yesterday, with terrible surges and anxiety. I was pacing while I watched the academy awards last night, and my blood pressure began spiking again last night. I haven't been able to eat, only sip on nutrition drinks. I woke with chills and slept part of the night in the living room next to the fireplace, and the rest of the night under my heated throw. The only thing I can link it to is that either I tried to do too much yesterday, or I'm getting worse, or this thing is cyclical, or that I am requiring a higher dose of my blood pressure medicine, or all of these things combined.

I was considering one thing that I have not pursued and that is menopause. I read up on it last night and I have very severe extremes of menopausal symptoms. But, I have never heard of menopause symptoms that kept you from eating. So, logically it could be that what I have is most likely due to a hormonal/ endocrine imbalance or even a hiding hormone- secreting tumor or similar problem. But, which hormones? Where is the tumor? Do my lab tests need to be repeated? It looks like unless they find out something soon, I will be heading south to a University Hospital Clinic for further answers. I am surviving each day with hugs from my sons and husband. Thank you for responding.

 
Old 03-08-2010, 09:48 AM   #15
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Re: High blood pressure spikes awake when sleeping

What you post and your case is very interesting. Thanks for the BS info.
Have you ever had a blood test done to determine if you are deficient in any nutrient/amino acid etc.? Have you considered going on a natural estrogen cream just to see if it's a menopause/hormone problem?
I found that a lot of my problems were due to deficiencies in calcium, Vit. D and magnesium.

 
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