Does blood pressure variability indicate hypertension?

Question

Hi doctor,

My blood pressure is high when I am up. It is 150/95 mmHg but drops as low as 77/45 mmHg when laying down. My cardiologist told me this makes no sense and dismissed me. I am not lying. This is happening every single time. My left-sided heart, liver, and spleen are enlarged. I have a history of hyperlipidemia, diabetes, thyroid, and renal cell cancer. I am currently on medications like Humira, Levothyroxine, Aripiprazole, Duloxetine, Lunesta, and Glimepiride.

Answer 1

Hi,

Welcome to icliniq.com.

Thanks for the query. Yes, this can occur. It is called orthostatic hypertension, and it signals an abnormality in cardiovascular autonomic control mechanisms. Diabetes mellitus may be one of its causes as it leads to autonomic dysfunction. Control diabetes, cholesterol, and thyroid status. Get renal cell carcinoma treated. Maintain a proper weight with exercise and a healthy diet. Regards.

Answer 2

Hi,

Welcome back to icliniq.com.

Echocardiography: Your cardiac structure and function are normal. Echocardiography shows no structural and functional abnormality. Diabetes: You have diabetes, so you should have strict blood sugar control. HbA1c should be less than 7. You should take the lipid-lowering drug Rosuvastatin 10 mg daily to decrease the risk of cardiovascular disease. Raised triglycerides: Do regular exercise, lower weight, eat a Mediterranean diet, avoid fatty foods. Take Fenofibrate 200 mg daily to lower triglyceride levels. High triglyceride levels can cause pancreatitis. Please note that combining Fibrates with Statins can cause muscle pains and weakness. Solution: Start taking one medicine (Fenofibrate in your case) and repeat triglyceride levels after three months. Then you may add a lower dose of 5 mg of Rosuvastatin to lower the risk of cardiovascular diseases. Have LFTs (liver function test) done before starting the medicine. Blood Pressure: Your blood pressure response is orthostatic hypertension which can be due to autonomic dysfunction or over-sensitive baroreflex response, which itself may be due to neck surgery or radiation leading to glossopharyngeal nerve damage. Cancers: You have renal and thyroid cancers. Renal cancer may metastasize to the thyroid (not a very common site but occurs in about 25% of cases), or it may be two cancers simultaneously as components of any "syndrome." Both cancers should be staged and treated accordingly by a multidisciplinary team consisting of an oncologist, radiation expert, endocrinologist, urologist, psychiatrist, and primary care physician. Enlarged liver and spleen: Maybe due to metastasis but also due to non-cancer-related causes. Complete workup is required. If liver enzymes are very high (3x normal), do not start Statins or Fibrates. Antipsychotics: Please remain in touch with a psychiatrist and psychologist as you are taking antipsychotics, and you may need their help as well. I am praying for your health. Regards.