Fluctuation Readings

[CyndyisMe]

My BP is usually high despite 300mg of Avapro daily. With Rx it is approx. 154/96  Without Rx it is 176+/106+  I am being tested for something called Central Nervous System Syndrome. Upon awaking, before getting out of bed, my BP is fantastic (around 118/60), but as soon as I sit or stand up, my BP jumps dramatically to 174+/102+  and has risen as hign as 198/128. I recently had a 24 h BP done and 90.9% of the readinging were over 120/80 w/ 79% being over 140/90, again repeating the quick elevation upon rising first thing in the a.m., but being normal to low while lying down or sleeping. However, my pulse is not affected by the BP rise and fall, seeming to be independent of these shifts. Do you have any clue to what is going on?
Thank you.

[CyndyisMe]

Hi and to answer your question, no. My blood pressure continues to rise during the day, despite medication. Although 300mg is the highest recommended dose for Avapro, my cardiologist recently increased it to 450 mg (150mg 3 times a day) because the 24 hour blood pressure monitoring I had done showed that my BP was not being adequately controlled with the 300mg dosage. It wore off and my BP quickly elevated. We tried splitting the 300mg dose to 150 a.m. and 150 p.m., but then I began having BP peaks in early afternoon (as high as 212/128). So now we are trying 150mg, 3 times a day.  The Central Nervous System Syndrome has to do with two things in the brain stem (I forget what they are called) by which the arteries to the brain pass by. For some reason is pressure is put on these structures, they can cause pressure on the blood vessels causing a BP rise. That is what they are looking at now.

[Barbarella]

Cindy, Do you maybe worry about your BP after getting out of bed?  My cardiologist explained to me that worrying about if your BP is high can raise it.  This is the case with me.  As soon as the cuff inflates I get anxiety about what the outcome of the BP numbers are.  I'm on meds.  My first reading is always 150/95 or sometimes higher due to anxiety.  Less than 2 minutes later its down to 130/85 and in 5 more minutes its down to 120/75.

[CyndyisMe]

Thank you for you quite response.  I am already on a diuretic, Lasix 40mg.  I cannot take any of the hydrochlorothiazides (due to drug allergy) and the calcium channel blockers (norvasc, cardizem etc) cause severe swelling and pitting edema in my feet and legs.  I have asthma (so beta blockers are out) and am an insulin dependent diabetic, which is why the angiotensin II (Avapro) was chosen. The original doseage of 150mg worked well for two year. I have been hypertensive for 30 years. This change to unstable BP has occurred within the last year. An increase to the maximum dosage (for Avapro) 300mg has produced no change in BP levels.  The Central Nervous System Syndrome, is, from what I believe my cardiologist said, related to some problem with the brain stem.  Do this make any difference in your reply to me?
Thanks!

[Cleveland Clinic]

Cyndy,

Thanks for the post.

To tell you the truth, I'm never really heard of central nervous system syndrome and it is not something I would leap to based on your posted information.

That said, from the information you provide, all I can say is you have suboptimally treated hypertension.

Normal blood pressure fluctuates during the day with cyclic peaks and dips, and if Avapro is the only medication you are taking I wouldn't think too much of it, other to put you on another agent, preferably a diuretic and do a careful history and physical to establish there are no other causes of your blood pressure elevation.

good luck