Q. Why do I get anxiety and hot flushes at 4 PM everyday?

Hello doctor,

I recently was referred to a renal specialist for low sodium levels by my primary care physician. After a complete kidney workup, he said that they were functioning well. But, he changed my hypertension medicine from Lisinopril to Losartan and discontinued my diuretics. As a result, my sodium level came up to the normal range. During the two-month time frame, I felt that Losartan made me very anxious, and I noticed hot flushes, which I never experienced before. My blood pressure was fluctuating, but he refused to put me back on Lisinopril, which I had taken for nine years.

At this week's follow-up visit, I told him about the flushes and my blood pressure. I also have a white coat syndrome and get very nervous when I go there, causing my face to go red. He then said I might have carcinoid syndrome and wants me to take a 24-hour urine test. I researched this for days, on the internet, and I have no other symptoms of this syndrome, except for the flushing and uncontrolled blood pressure, which I never had until he changed my medications. I want your opinion as I am very upset and scared that I may have this syndrome. I hear that those 24-hour tests are highly inaccurate and I do not want to go for a list of unnecessary tests based on this renal specialist's opinion. I would appreciate your thoughts on this, as I heard this is a very rare disease. I am now back on my old Lisinopril medications with 12.5 mg of Hydrochlorothiazide. I am feeling better in just four days. My 4 PM flush is disappearing slowly.

Hello doctor,

Thank you for your reply. He told me that the Losartan was better for my kidneys and Hydrochlorothiazide was omitted initially to see if my sodium levels got higher and within five days it did. He then put me back on Hydrochlorothiazide 12 mg instead of my original 25 mg, after my blood pressure continued to elevate, but he would not change the Losartan until I told him that after two months I had enough of it.

I have no diarrhea or abdominal pain, shortness of breath or rashes. I never had this type of hot flushing on my face until my medicine was changed. Also, my complete blood count is normal except for a fraction lower than in my previous test. All in all, he said my reports were pretty good. It is probably the first time he said that. I have a family history of high blood pressure and always had high cholesterol. I sometimes in the past, have had a slightly red face when agitated and thought my blood pressure might have been elevated, but I never before noticed a red hot flush that seemed to be timed around 4 PM.

With no other symptoms, and normal kidney and liver function reports, do you think I should be worried? I am a bundle of nerves since he told me this. Since back on Lisinopril for four days, my daily flush seems to be reducing. Please let me know what you think. I always felt good walking three miles daily, but now I think my nerves got the best of me. I never had low sodium levels until I was put on the Hydrochlorothiazide.

Hello doctor,

Thank you for your thoughts. Yes, I do drink two cups of decaffeinated green tea usually at 3 o'clock. Yesterday I had water instead and experienced no flushing. My last menstrual period was about 12 years ago, and I had no accompanying flushing with it. I read that Losartan is known for causing a flushed face as a side effect. I am very light complexioned, and so all my life, I was prone to a reddened face but never hot and red like a reaction. The stress of a doctor's visit always affected my face though. Should I be overly concerned about this doctor's opinion? He only knows me for two months now and formed an opinion due to my face. What do you suggest? I am a nervous wreck over this, and he said it was extremely rare to get this syndrome. He saw only two such cases in his 33-year practice. He mentioned that it is not life-threatening. However, the internet tells a different story.

Thank you doctor,

I will make an appointment with my primary physician and hold off on the 24-hour urine test. I will also request to see an endocrinologist.

Hello doctor,

Thank you for replying. It has been about 15 days since I stopped taking Losartan and it seems like my flushing is taking its time leaving. However, I had it last night but not for four days before that. I feel as though I am in some kind of withdrawal from not taking this medicine. I feel very nervous and anxious. Is this possible with this medicine? I will see my primary physician tomorrow and want to meet him with some substantial information. I worked as a neurosurgery coder for 15 doctors in my area, for 15 years. So, I do have some medical knowledge, but I am not able to apply it when it comes to myself.