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Hi! I hope someone can help me with this problem. My father is 74 years old, hx of quad bypass in 1989, 1/3 right upper lung removal in 2003 due to a vascular blood clot that could not be removed, hx of COPD. In 2005 he began to experience chest pain and was re-cathed only to find that his arteries are blocking with "sludge" and the surgeons/cardiologists have concurred that there is nothing surgical they can do. At that time it was discovered that between 2003 and 2005 he had an MI affecting the right lower ventricle. He is a very very active man for his age and walks as much as he can and comes to work each and every day (family business). A tough old farm boy bird. His meds consist of the following: Simvastatin 10 mg one tablet every 3 days; Amlodipine-Benazapril 5/20 q.d.; Carvedilol 12.5 mg b.i.d.; Isosorbide Mono 60 mg q.d. a.m.; Plavix 75 mq q.d.; Nitroglycerine 0.4 sublingual prn; aspirin 81 mg q.d.; centrum silver q.d. 3 weeks ago his bp began to spike. i need more room

Submitted: 26 days and 4 hours ago.

Category: Health

Value: $18

Status: CLOSED

Posted by Schuyler_ANP 26 days and 4 hours ago.

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26 days and 4 hours ago.

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Cool and thanks! 3 weeks ago his blood pressure began to spike for no apparent reason, and only when he stood up from his chair here at work after sitting for over 30 minutes. Then it began happening while he was home and driving his car or pickup, but only after he had been sitting over 20 minutes. The dizziness has been so bad he's staggered as if he were a drunk. My RPh husband - 35 years experience - had him take his corig at night and the Lotril in the morning. Of course, the doctor was gone for a week. His blood pressure would be good when he got up in the am, and then the spiking would begin again. Two days ago i got him in to see his doc, and his bp was 141/73 in the doc's office. They sat and chatted, and when dad stood up the headache began and the dizziness; doc saw the BP hit 178/98. Five minutes later it was back near the previous range. His doc stopped the lotril and put him on triamterene-HCTZ 37.5 on Monday am. He is still spiking and the dizziness is so bad that every time he stands up he's swaying. We are baffled, and also less than pleased with the "stay home and take it easy until you get used to the medicine" attitude. Please, do you have any idea what is happening with my dad? i'm a retired paramedic and i've never seen anything like this before, nor has my husband.

Accepted Answer

It sounds like a neurocardiogenic problem. Normally the brain and heart coordinate blood pressure through chemical transmitters so that it remains fairly constant no matter what position someone is in. The most common malfunction in this relationship is that when someone has been sitting blood vessels enlarge and blood pools in their lower extremities causing a drop in blood pressure. When they arise, the blood pressure is too low causing dizziness and perhaps fainting. Fainting or feeling like they are going to do so, causes the person either to sit back down or fall to the floor where gravity helps the blood to get back to the brain. The change in blood pressure in this instance is called orthostatic hypotension (low blood pressure).

What is puzzling is that your father seems to have high blood pressure rather than low blood pressure. This may be his body's attempt to overcome lowered blood pressure from sitting. The phenomenon is called orthostatic hypertension (high blood pressure). It is thought to be the body's overcompensation reaction. Treatment is geared to obtaining the best blood pressure control possible, which can take a week or two after each medication is changed.

If the Dyazide change doesn't work, there are other medications to consider. His primary can also send him to a cardiologist to see if there are other reasons other than this more common one for the problem.

The article below has an excellent discussion on orthostatic hypertension. It is a medical site and requires that you register to use it, but it is free.

http://www.medscape.com/viewarticle/543590

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Expert:	Schuyler_ANP
Pos. Feedback:	99.5 %
Answered:	10/28/2009

Nurse Practitioner

Board Certified Nurse Practitioner, MS, RN. Private practice and hospitalist experience.

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