My BP increases during the evening. Why?
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Q. What is hypertensive urgency?

Answered by
Dr. Amit Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 24, 2016 and last reviewed on: Feb 15, 2024

Hi doctor,

I am a 55 year old male. I am diabetic for the past 15 years and I also have high BP. Before 20 to 25 days, while walking I felt like dizziness and I could not climb the staircase. Before my BP was 240/140 mmHg, but now it is 160/100 mmHg. Later on the creatinine and blood urea was also more. Now, my BP is 160/100 mmHg. As the day proceeds by evening I feel unstable and feel uneasy then BP increases to 190/110 mmHg or more. Yesterday night, I felt like a paralytic stroke of my left leg while sleeping, but any how suddenly got up and I was safe. My current medication is tablet Telma 40 mg, tablet Telma 20 mg and tablet Amlong in the morning and at night respectively. For diabetes, my current medication is tablet Glycomet GP2 both in the morning and night. Presently, I am not taking any Insulin due to controlled sugar. I am attaching my blood test report. Please advise some medications if any keeping in view of the above reports.

#

Hi,

Welcome to icliniq.com. Based on the information provided, it appears that you are experiencing accelerated hypertension with a significantly elevated blood pressure reading. This hypertensive urgency poses a risk of hemorrhagic stroke, which can be life-threatening. However, it seems that you were fortunate this time. The episode of leg paralysis that you experienced and resolved requires a thorough evaluation through a combination of history-taking and investigations.

Your renal function tests indicate some abnormalities, and it is important to consider that prolonged diabetes can lead to kidney disease. To better understand your condition, I would like to ask a few questions. Firstly, how long have you been suffering from high BP, and when did you start taking medications for it? Additionally, how long have you been diagnosed with diabetes, and how long have you been on medication for it? It is also important to know if you have a history of smoking or alcohol consumption and whether you have an active occupation. Furthermore, have you experienced any past or present complaints of shortness of breath or chest pain? Have you had any recurrent chest pain that is relieved by resting? Do you have any other chronic diseases or complaints of palpitations or excessive sweating in your body or legs?

Currently, there is no immediate need to worry as you were fortunate this time. However, it is crucial to start taking better care of yourself since the presence of both diabetes and hypertension with poor renal function suggests potential future problems if neglected. In terms of the treatment plan, it is recommended to continue with the same medications, but ensure regular monitoring of your blood pressure and sugar levels. If you experience swelling in your feet or shortness of breath, consider switching to Telma H (a combination of Telmisartan and Hydrochlorothiazide) instead of plain Telma. Adding multivitamins to your regimen is also advisable. To rule out any neurological deficits, it would be beneficial to undergo a noncontrast CT scan of the head (NCCT). Please upload your renal function test reports (RFT) for further assessment.Additionally, it is important to get an HbA1c test (hemoglobin A1c) along with fasting and postprandial sugar tests to evaluate your diabetes control. A complete urine examination, lipid profile, and ultrasound (USG) are recommended to assess your kidney function and structure.


The Probable causes:

High uncontrolled BP and sugar.


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