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Jef Burk
Jef Burk, Doctor
Category: Medical
Satisfied Customers: 2639
Experience:  MBBS. I've been teaching,practicing and learning since 1985.
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my mother has intermittent high blood pressure that goes as

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my mother has intermittent high blood pressure that goes as high as 200/100. It is sometimes accompanied by headache and dizziness but not always. She has been to a cardiologist, a nephrologist, and an endocrinologist. She has taken beta blockers, diuretics, and catapress (works on brain? she says). No meds have worked in lowering her blood pressure significantly. She often finds that her blood pressure goes up when at rest or reclined. She is currently taking levothyroxine .50mg per day. She has high cholesterol >200 but she cannot take any cholesterol meds due to digestive problems
(acid reflux & esophagitis & diverticulitis & hiatal hernia). The cholesterol meds have also caused bad side effects of her muscles and joints. She also has a hx of PCOS and is pre-diabetic. She is 30 lbs overweight. She has had an US of kidneys, 24 hour urine collection, 24 hour blood pressure monitoring (avg was 140/70), echo-stress test. All of these tests were negative. She has had various blood tests. She has one cataract and she cannot get cleared for surgery due to the high blood pressure. Im afraid that she will have a massive stroke before someone can diagnose her properly. She is 71 and very active and still works as a CPA. There is no family history of high blood pressure. Can someone point us in the direction of an MD who can help us get to the bottom of this? We live in the NYC area.
Submitted: 3 years ago.
Category: Medical
Expert:  Jef Burk replied 3 years ago.

Jef Burk :

Hi

Jef Burk :

How long has your mom had this problem?

Jef Burk :

How often is her blood pressure elevated?

Jef Burk :

How long do these episodes last?

Jef Burk :

Are you there???

Customer :

one year, every day especially at night when she is resting, one hour yes

Jef Burk :

Thanks

Jef Burk :

Her 24 hour BP was normal?

Customer :

sorry they last about one half to one hour

Customer :

not normal but average was 140/70

Jef Burk :

Thanks

Jef Burk :

To be honest she is not really meeting the diagnostic criteria for hypertension - ie basically your BP is eleavted all the time

Customer :

perhaps she has disease of her small blood vessels or should go to a neurologist

Jef Burk :

Consequently the risks of untreated hypertension cannot , strictly speaking , be applied to her

Customer :

could'nt she potentially have a stroke during one of these episodes

Jef Burk :

If she had a disease of her small blood vessles this would not affect her BP

Customer :

ok, could she have a physical abnormality in her kidneys.

Jef Burk :

One condition , a phaeocromoctoma , can cause intermittent elvatioins in blood pressure - but you mention a 24 hours urine collection so that has been excluded

Customer :

do u know of anyone in nyc that she couls see maybe something is being overlooked

Jef Burk :

Her BP is not really high enough to cause a stroke - anyways the causes of stroke are multifactorial - smoking status , age , cholesterol and longstanding poorly controlled hypertension

Customer :

Her GI doctor has said pretty much what u r saying

Jef Burk :

These guys seem to tick all the boxes when it comes to managing BP

Jef Burk :

Probably in her best interest to stop checking her BP every day - this has not been proven to help ptient care and often just causes excess anxiety for patients and family

Customer :

It just worries me because something is obviously off balance and it seems that the BP is the compensatory mechanism

Customer :

maybe it is anxiety related

Jef Burk :

Interesting point - the only scenario in which that would apply would be if there was an elevation in ICP ( intracranial pressure) - this would usually though been in the context of a head injury. Blood pressure rises to maintain cerebral perfusion.

Customer :

is there anything else in the whole scheme of body systems that u can think of that might be causing this.

Customer :

her mother had something called normal pressure hydrocephaly and required a shunt this helped manage her dementia sx. perhaps my mom has something going on in her ventricles and or brain. she had an mri a long time ago due to an overproduction of prolactin but it was neg.

Jef Burk :

Hi

Jef Burk :

If there is then it must be a real small print issue.

Customer :

did u get my last inquiry

Customer :

what do u mean by a real small print issue? does she need a test w/contrast or a more specialized test, should she have an MRA

Jef Burk :

Just got it - that is interesting but not usually associated with hypertension.

Jef Burk :

It usually presents witht a dementia picture

Customer :

no dementia going on, Maybe she should see a neurologist

Jef Burk :

you can read about it on the link above

Jef Burk :

no harm in that - a simple CT of her head would rule it out

Jef Burk :

dr jef

Customer :

ok. if u have any more info can u send it to my mom atXXX@XXXXXX.XXX

Jef Burk :

hi

Jef Burk :

sorry your moms details have not shown up

Jef Burk :

i think that we are not allowed to exchange contact info

Customer :

well it is the e-mail that I registered on this site when i paid the fee

Jef Burk :

sorry - i have no access to admin info.........

Jef Burk :

please feel free to come back to me though if you like

Customer :

ok thanks

Jef Burk :

you are welcome

Jef Burk, Doctor
Category: Medical
Satisfied Customers: 2639
Experience: MBBS. I've been teaching,practicing and learning since 1985.
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