Uncontrolled BP, lengthy

[Margot49]

A few weeks ago, my husband passed out and I had to call an ambulance.  I took his BP (prior to him passing out) and it was something like 77/59.  When the paramedics got here, he was starting to come around and his BP was up some. They thought it was dehydration. I don't think so as it was not that hot, he had been working outside on and off but I made sure he was drinking water.  They ran a stress ECHO at the hospital and some other tests and said the heart was okay.  My husband did not want to stay another night, against doc's orders.  I was told not to give his BP that night as his BP was low. The next day, I take his BP and it was (can't remember exactly now) but around 200 over something.  Called the ER doc who said to increase his meds, which we did.  He saw our own doctor the next day who added Metropolol to the Linisopril he had been taking with the instructions he could take the Metropolol, 1-2-  tabs twice a day. He started that and his BP went down to going up and down but in a more acceptable range.  Two days ago I was after him to check his BP and it was again up to 200/100 then 208/90.  I called the doctor and took him in.  Our own doc is out of town.  The associate doc told my husband to increase the Lisopril (?) to 20 mg, up from 10. He just started that last night.  This morning he took the 2 Metropolol and decided he felt well enough to mow the lawns. Had him check his BP this afternoon (he fights me having to check this) and it was 196/89.  I  had taken in our machine to have them check it and ours was a little higher. Which one is calibrated correctly, I'm not sure. My husband refused to let me call the doc. Said he wants to wait and see if the new med increase will help.  Actually, the doc didn't seem all that concerned and husband is to go back in 3 weeks.  Scares the heck out of me.  One thing the doc said, that we were unaware of, was not to take any larger dose of the Metropolol as it slows the heart rate and can cause him to pass out.  :(  Any input?

[Margot49]

Well, his BP today is like 154/87.  Doc told him to check it once a day and he will not let me call the doc, as usual. However, when we took our machine in with us, I had it compared to the one in the office and ours was a bit higher then theirs. They suggested we get a new machine but that isn't going to happen either so his BP may be a bit lower then that.  He has no symptoms and seems fine.  I know, the silent killer.  :-(

[erijon]

His new meds would have kicked in the same day he started them. He needs to at least let you call the doctor and get their opinion. Here's a thought, does your insurance provide have a "Ask a Nurse" feature like Blue Cross does? You could always call them and get their opinion.

In any case, his new meds are doing what they are going to do, he needs to be seen again. Keep pushing him.

Jon

[Margot49]

His BP is still elevated (no symptoms) and he refuses to let me call the doctor. I was trying to do that before evening as this is now Friday.  He just gets upset which, I'm sure, doesn't help his blood pressure. This is all making me very nervous.  I think he is waiting for the meds to kick in.  He has only added the 20 mg of the Linisopril (?) 2 nights ago.  Doctor increased it from 10 mg to 20mg.  
If I call and they tell us to go to the ER (which is a  nightmare anymore), he will go ballistic and refuse to go.  :-( How long can he sustain this BP with no side effects?  At what pressure will someone have a stroke?  I can't find that info.

[erijon]

Welcome and I'm sorry to hear of your husband's issues. This is very difficult, I would be very concerned about the huge swings from low to high BP. His current numbers are way too high, his new BP meds should have already started to work so they are obviously not controlling his BP yet. Also, the doctor is correct, any more Metoprolol will slow his heart rate too much.

I would not wait another three weeks to see the doctor, I would be back in as soon as possible as his levels are just too high. When you speak to his doctor, ask about other classes of drugs that can be used with his current meds like ARBs which work by helping the arteries stay flexible and absorb the force of each beat.

One other concern is his high pulse pressure. This is the difference between the top and bottom number which should be under 60. Your husband has a pulse pressure of over 100 which means there is some diastolic dysfunction going on in which his heart may not be functioning properly in is diastolic phase when the heart is refilling so some one needs to sort out the underlying cause.

There is much going on here, I would get in to see the doctor as soon as I could get an appointment.

Hope this helps,

Jon