What Should I Do

Dear Doc,
I am a 49 year old female hypertensive ex-smoker.  I currently take Diovan Hct 160/12.5, an aspirin and a soy supplement. I recently had a TTE/TEE as part of a neurological work-up.  The results were left ventricular hypertrophy (12mm), IVS hypertrophy (12mm), Right Ventricular Hypertrophy (no value given), dilated pulmonary artery (30mm) and anterior mitral valve leaflet prolapse.  I went to my internist with these test results and she said that they indicate damage due to hypertension and possibly pulmonary hypertension.  She took my blood pressure and it was slightly elevated - 150/90.  She prescribed additional medicine ACE Inhibitor)  and I was told to return in a month.  I couldn't tolerate the medicine (developed a bad cough) so I stopped taking it.  When I returned to her office, my blood pressure was 120/88 and she said I don't need any further blood pressure control.  I went to a follow-up appointment with the neurologist and once again my blood pressure was slightly elevated. He stated that since I have End Organ Damage my blood pressure should be treated aggressively.  What do I do now?  Should I be concerned about the heart findings -do I need more tests/treatment? What should I do about my blood pressure?  How often should I measure it during the day and how much fluctuation is acceptable?  For instance if it only goes up during the day and goes back down in the evenings when I'm at home, is that acceptable or must I have round the clock control?  Sorry for the lengthy question, but I am totally confused about what to do.  Thanks for this service.

[CCF-M.D.-KE]

The results of your echocardiogram suggest that you might have pulmonary hypertension, which is a separate entity from systemic hypertension.
1. Pulmonary hypertension:
Pulmonary hypertension is an elevation in the pressures on the right side of the heart, which delivers blood to the lungs.
I would recommend being evaluated by a cardiologist to look for any cardiac causes for your pulmonary hypertension. If the cardiologist's work up is negative then you should see a  pulmonologist (lung specialist) to evaluate whether or not the lung has caused these changes.
This is a serious condition and I would make an appointment soon.

2. Systemic hypertension
This is what is known as high blood pressure. Your neurologist is correct you have evidence of organ damage as a result of hypertension. I think you should be on medication to treat your blood pressure. It is good practice to keep a daily log of your blood pressure and share it with your doctor. I would get the results of your echocardiogram and see a cardiologist.

Thanks for your question,


CCF-MD-KE

[nurse12hr]

How many milligrams of the Ace Inhibitor were you on, and what brand?  You may be able to get by with a smaller dose, or a small dose + a mild diuretic if you BP is not drastically high, which may control it without the cough.  
Perhaps switching brands would help, too.  Your doc is right, if you have end organ damage, you must lower your pressure.