Hard to control HBP

  : Hi,
  :   Thanks for taking my question.
  :   In August of this year, I found out I had high blood pressure. My BP was
  : 170/120 in the dr's office. Since then I have tried over a dozen different
  : types and combinations of BP drugs... usually with the same results. They
  : will provide initial lowering of BP (usually to around 130-140/95-100) but after
  : within a few weeks, my BP begins to climb again. I am currently taking:
  : Tenormin 100MG once a day
  : Monopril 10MG once a day
  : Cardizem CD 180MG once a day
  :   I just began these a little over a week ago and they are following the
  : usual course so far (my BP was 130/100 after first week).
  :   I don't smoke, drink, or use drugs. I'm not highly active, but I do go for
  : walks with my kids (which is close to impossible now because of the BP
  : meds affecting my asthma). I am moderately over-weight.
  :   My question: How normal is it to have HBP so resistant to being lowered.
  : Also, what might be causing the drugs work for a short time, then quit?
  :   Thanks,
  :   Carolyn
  ------------------------
  oops, guess it would be helpful if you knew my age... :o)
  I'm 40 years old.
  Also, I'm fairly healthy, other than my asthma which is usually only triggered
  by seasonal alergies (allergies) (rag weed) and I recently was diagnosed with a low grade
  glioma on my left temporal lobe.
Dear Carolyn,
Topic Area: Hypertension
Thank you for your question.  You are in a small group of individuals with difficult to control hypertension.  Most likely this is "primary" hypertension - that is no cause can be found.  However, it is important that you be evaluated for "secondary" causes of hypertension that could be causing your problems.  These are very rare but treatable and include renal vascular hypertension, pheochromocytoma and some other rare conditions.  Your doctor can order the tests to evaluate for these if he has not already done so.
Here is some additional information.
High blood pressure, or hypertension (HTN) , is defined in an adult as a blood pressure
greater than or equal to 140 mm Hg systolic pressure or greater than or equal to
90 mm Hg diastolic pressure. Blood pressure is measured in millimeters of
mercury (mm Hg). High blood pressure directly increases the risk of
coronary heart disease (which leads to heart attack) and stroke (or brain
attack), especially along with other risk factors.
High blood pressure can occur in children or adults, but is particularly prevalent in
blacks, middle-aged and elderly people, obese people, heavy drinkers and women who are taking oral
contraceptives. Individuals with diabetes mellitus gout or kidney disease have a higher frequency of
hypertension.  
High blood pressure may be primary (essential) or secondary.   If the  hypertension is secondary there may be a treatable cause.  Most of these causes are relatively rare (i.e. renal artery stenosis, pheochromocytoma).  If no secondary cause is found then the high blood pressure is said to be primary.  The vast majority of cases of HTN are  primary.  The main cause of primary HTN is genetic.
Q: How do salt and sodium affect high blood pressure?
A: Most Americans consume far more salt (sodium) than their bodies need. Heavy sodium consumption increases blood pressure in some people, leading to high blood pressure. People who are diagnosed with high blood pressure are often placed on restricted-sodium diets.
Reducing sodium (or salt) consumption may help lower blood pressure in some people. Your doctor may
recommend a sodium (salt) restricted diet. This will mean you'll have to avoid salty foods and cut down on the amount of salt you use in cooking and at the table.
Q: How does being overweight affect high blood pressure?
A: Studies have shown that body weight, changes in body weight over time, and skinfold thickness are related to changes in blood pressure levels. These factors have been linked to the subsequent rise and development of high blood pressure. People who are overweight are more likely to have high-normal to mild high blood
pressure.
Physical inactivity is a risk factor for heart disease. In addition, a sedentary or inactive lifestyle tends to
contribute to obesity, a risk factor for both high blood pressure and heart disease. Regular exercise helps
control weight and lower blood pressure. Don't be afraid to be active - exercise should definitely be part of your daily program. Besides helping to reduce your risk of heart attack, it can also help you lose weight or maintain a healthy weight.
Statistics show that many people who have high blood pressure are also overweight. If you are overweight or have gained weight over time, you'll be advised to cut down on calories and lose weight. Your doctor can prescribe a diet that's right for you.
If you're given a diet, follow it closely, including any recommendations about reducing your consumption of alcohol. Alcoholic drinks are high in non-nutritious calories, so if you're trying to lose weight, avoid alcoholic beverages. Often when people lose weight, their blood pressure drops as well.
Q: How does medicine help control high blood pressure?
A: For some people, weight loss, sodium reduction and other lifestyle changes won't lower high blood pressure as much as it needs to be lowered. If that's your situation, you will probably need to take medication. Many medications are available to reduce high blood pressure. Some get rid of excess fluid and sodium (salt). Others relax constricted blood vessels. Others prevent blood vessels from constricting and narrowing. Because there is usually no cure for high blood pressure, treatment generally must be carried out for life. If treatment is stopped, the pressure may rise again.

Q: Will I have to take medications for my hypertension the rest of my life?
A: Generally, someone with high blood pressure will be on lifelong medication.
Q: At what point do I need to see a heart specialist for this condition?
A: Usually hypertension can be managed by an Internal Medicine doctor.
Q: Will there ever be a right combination (of medication) to treat this condition?
A: It may take several trials to find the right combination of drugs.   There are many different medications and new ones are coming out each year.
Q: My parents both had heart attacks and strokes and father had a bypass in Sept. 97 (age 74), mom had her stroke at age 49. They still take meds for hypertension. With this history is there a possibility I might have a heart attack in my later years?
A: Heart disease tends to run in families.  Those who have a family history of heart problems shoud take extra care of themselves (i.e. weight loss, high blood pressure control, exercise, etc.).

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/hbp.html
http://www.ihr.com/medreprt/articles/bloodpr.html
http://www.musc.edu/iash/
http://www.am-osteo-assn.org/ccoop/hibldprs.htm
http://www.mco.edu/whl/know.html
http://www.bloodpressure.com/
http://www.mediconsult.com/hypertension/
http://www-med.stanford.edu/school/DGIM/Teaching/Modules/HTN.html
http://www.merck.com/!!uYfKE0uiyuYfKE0uiy/pubs/mmanual/html/khgnjgcd.htm
http://www.aafp.org/afp/091596/special.html
http://pharminfo.com/disease/cardio_db.html
http://www.pslgroup.com/HYPERTENSION.HTM
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.


HTN