Why does my grandmother’s BP keep rising despite treatment?

Question

Hi doctor,

My grandmother has been hospitalized again due to high blood pressure, measuring 170/99 mm of Hg, with a pulse rate of 123 beats per minute. Her nephrologist has referred her to a cardiologist. The cardiologist has recommended changing her medication to Clonidine 20 mg twice daily and Concor 5 mg once daily.

Can you please advise if this combination will help control her blood pressure? Is it effective for my grandmother's case? I have attached her medical files for reference. Additionally, please provide your opinion on why her blood pressure issues recur every two to three months.

I would greatly appreciate your guidance on this matter.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns, and I want to explain this calmly and clearly, step by step, in simple terms.

As per your grandmother's symptoms, it shows a renal-driven, volume-dependent hypertension characterized by sympathetic surges rather than a primary cardiac issue. The current blood pressure reading of 170/99 mm Hg with a pulse of 123 beats per minute indicates decompensation rather than a newly developed pathology.

The use of Cilnidipine at 20 mg twice daily and Concor (Bisoprolol) at 5 mg once daily is understandable. Cilnidipine is effective and renal-friendly, while Bisoprolol serves a temporary purpose in managing tachycardia. However, we must remember that this addresses symptoms rather than the underlying cause.

Relying solely on this combination for your grandmother would not effectively prevent future occurrences of hypertension. The core issue here is that the patient is underdosed, as evidenced by inadequate management.

This leads to a gradual accumulation of salt and water, resulting in sudden blood pressure surges every two to three months, reflex tachycardia, and frequent hospitalizations.

Regarding referral to cardiology, while cardiology input can assist with rate control, nephrology should maintain primary ownership of your grandmother's case. The long-term solution for your grandmother lies in effective volume management rather than escalating beta-blockers.

For your grandmother, our plan should focus on the following:

Optimizing diuresis first to achieve euvolemia (balanced volume of blood and body fluids).
Reassessing blood pressure after diuresis optimization.
Retaining the beta-blocker only if there's persistent tachycardia after achieving euvolemia.
Avoiding concurrent use of multiple medications.

This approach will help ensure better management of your grandmother's condition and prevent recurrent episodes.

I hope this information helps with your situation. Please share your valuable feedback to improve patient care, and let me know if you have any further questions. I would be happy to assist you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

It is better to do that. You can consult a nephrologist for your grandmother.

I hope this helps you.

Thank you.