Hypertension resistant to drugs

Posted by Donna on July 05, 1999 at 13:08:48
Thank you for this service, it is wonderful.
I have been diagnosed with hypertension--I wore a 24 hour monitor after 4 visits to GP showed BP varying from 160-190 on 95-110.  Monitor averaged 155/95--varied from 190/115 to 130/90 during the day.
GP put me on a beta blocker.  BP went to 140/90 for 3 weeks, then crept up to 170/110 again.  Then he put me on a ACE inhibitor.  Went down to 130/90, then after 3 weeks began to creep up, by 6 weeks was at 175/105.  Took me off that and started calcium channel blocker.  BP went down to 140/90 again, but on Wed., after 6 weeks on CC Blocker, it was 200/120.  GP doubled the dose, and I go again this afternoon to see what it is.
I am 51, female, overweight, smoked a pack a day for 30 years, quit smoking just over 6 months ago, pretty sedentary...cholesterol and triglycerides are good, though.  Strong family history of stroke.  I know I need to lose 30 pounds, but feel the quitting smoking is more important, and I don't think I can quit AND lose weight. Successful quitters have told me the quit takes a year.
My question is, why doesn't my BP stay down?  I  never, ever forget to take my medication on time.  I am also taking premarin and synthroid.
Thank you.
Posted by CCF CARDIO MD - DLB on July 06, 1999 at 12:25:09
Dear Donna
I think your GP should refer you to a specialist in high blood pressure. This can be a cardiologist or sometimes a nephrologist (a kidney doctor). You should be evaluated for certain rare causes of high blood pressure that are curable and are not treated with medications. Examples include disorders of the kidneys or adrenal glands. Once this evaluation is complete, if nothing unusual turns up, I suspect you will probably need to be on at least two medications at high doses to control your blood pressure. Furthermore, certain over-the-counter medications can raise the blood pressure, such as cold remedies and non-steroidal anti-inflammatory drugs (e.g. Motrin); these should be avoided. Similarly, alcohol can raise blood pressure. Weight loss can help your blood pressure some, but I agree that smoking cessation is most important.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. 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.
Posted by Donna on July 06, 1999 at 13:13:00
Thank you so much for your prompt answer.  I think I should be referred to a specialist, too, but my GP seems very reluctant to do that????  Yesterday afternoon bp was 185/110, so he told me to take double the dose again and see him in a week.  I told him that I felt pressure on my chest--like somebody was squeezing in there?  Its hard to explain the sensation.  But it DIDN'T hurt.  He did a EKG - a 20 second strip the nurse called it.  He told me that there were a few extra beats, but that was no big deal.
I drink alcohol very rarely--a half dozen times a year, on special occasions, I will have a cocktail or a glass of wine.  Should I not be drinking at all?  Its no big deal, because I just drink it to be sociable--don't really like the taste. anyway.  I didn't know that about cold medications, so I will be careful--haven't taken any for probably a year or so anyway.
I am a little nervous about exercise because I get so out of breath when I walk any distance.  If I climb two flights of stairs it feels like I am NEVER going to get enough air.  I can't walk and talk at the same time.  But I will NEVER lose weight unless I exercise, I think.
Should I just INSIST on a referral?  I can't get an appointment with a specialist unless my GP refers me.  If he won't, should I see another GP?  I am getting quite concerned about this BP, but I think I'm pretty healthy otherwise...?
I'm sorry for rambling.  I'm just worried.
Donna

Posted by Shannon on July 06, 1999 at 13:35:31
Donna, not to be terribly blunt or anything -- insist on a referral.  Sometimes you just have to let your physician know exactly what you want.  I can't imagine that your doctor would say no to a referral.  
Shannon

Posted by CCF CARDIO MD - DLB on July 07, 1999 at 19:26:59
Dear Shannon
Regarding patient-initiated referrals, I am generally against them. I think that they are usually unnecessary and raise the cost of medicine tremendously. In Donna's case, however, I absolutely agree that a prompt referral is necessary.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. 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.
Posted by Shannon on July 08, 1999 at 01:55:20
Dear Doctor DLB --
Under most circumstances, I agree with you.  If you can't trust your doctor to do the right thing -- whether it's a referral or whatever -- then you probably have the wrong doctor for you.  I believe a major reason my own cardiac problem (mitral regurgitation, rapid deteriortation and recent surgery) went as well as it did was that I completely trusted the entire medical team.
However, there are times -- in Donna's case, where she feels she will be called upon to make decisions that will significantly affect her life without adequate information -- where the patient has every right, indeed every responsibility, to request a referral.
Thanks again for this excellent forum.  The time the CCF physicians dedicate to this site is invaluable to those of us with heart problems.
Shannon

Posted by Donna on July 13, 1999 at 17:26:40
Just to keep you up to date...
Saw GP again yesterday, BP was 179/110.  He started me on lozide in addition to the cc blocker and an anti-depressant called Serzone.  I do NOT think I am depressed!  I am concerned certainly, but I do NOT understand why he would think I am depressed.  So I am not going to take them.
The good news is that my husband came with me to yesterday's appointment and just INSISTED that I get a referral.  Somehow, when it was my husand insisting, it wasn't a problem anymore??? I am starting to feel my feminist hackles rise! The cardiologist's office called this morning and I have an appointment for Friday, which is unheard of!  I expected to wait 6 weeks or so anyway.
So I am feeling much better about things except for this weird thing that started Saturday with my eyes.  The only way I can explain it is when I turn my head, it feels like my eyes arn't turning at the same speed as my head?  It makes me dizzy, and I have actually thrown up a few times--I don't have any problems with my stomach--I eat too much!  But I feel like I'm on a Tilt-a-Whirl or something.  Could this be caused by the medication?  When I told the Dr. about it last night that's when he prescribed the Serzone.  Is this some kind of hysterical thing?  I don't FEEL hysterical.
Sorry this is so long.
Donna

Posted by CCF CARDIO MD - DLB on July 14, 1999 at 10:04:31
Dear Donna
While nausea could be a side effect of medications, it is also possible that your symptoms are due to the blood pressure still being too high. Very elevated blood pressures can lead to symptoms such as headache and nausea by increasing the pressure in the brain - this is what increases the chances of stroke in patients with high blood pressure.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. 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.