Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hello doctor,
I am writing on behalf of my grandmother who is suffering from various heart related symptoms that have become increasingly concerning and I am thus seeking for a second opinion. She is a 73-year-old woman with rheumatoid arthritis and is currently being treated. She is also on Adalimumab and just stopped taking Methotrexate. Her trial nurses have discredited the connection of the heart problems to these drugs and are not that concerned about the heart readings. She is also on Levothyroxine because of thyroid problems. Due to several psychologically-tragic life circumstances, she became increasingly sensitive to anything that might cause anxiety and thereby developed hypertension rather early. She has been taking the following heart medications Lercapin 10 mg once daily for the past 10 years, Eliquis 2.5 mg (Apixaban) twice daily since February, and Rytmonorm 150 mg once daily since February. Currently, the tracked statistical average of her heart readings are as follows. Systole: 137 mmHg (107-224), Diastole: 67 mmHg (36-148), Pulse: 64 bpm (50-102), Pulse pressure: 70 mmHg (35-109). More recently, she has been experiencing episodes of confusion and dizziness which coincide with extreme heart pressure readings (223/114, 214/148). In the past (more than 10 years ago), she was hospitalized due to a similar episode which resulted in short-term amnesia but did not cause any permanent damage. What concerns me the most is the rather large baseline pulse pressure as well as the episodes with extreme heart pressure. Are these numbers generally anything to be concerned about or are these expected at this age? If they are indeed something to be concerned about, what might be the primary cause of these type of readings and how should she go about in preventing them?
Hello,
Welcome to icliniq.com.
Firstly, nothing to worry about pulse pressure and it may widen with age. Also for diastolic BP, readings anything less than 90 mmHg is fine, be it any low. Now most important is systolic pressure. Ideally it should be around 110 to 140 mmHg. Occasional elevated readings up to to 150 are also fine, but more than 170 to 180 mmHg should be treated actively. Now you should identify the triggers for it like any stress, pain killers intake like NSAIDS (Ibuprofen, Naproxen, Diclofenac, Etoricoxib, etc), RA medications, or any particular diet. Pain killers are quite a common precipitator for high BP. So try to avoid those. High BP may also be related RA medications, as it is a known side effect of these medications although not very commonly seen. These spikes may simply an age related events. So irrespective of the cause these need treatment. Also, see for the time at which BP spikes are usually seen, so we may be able to add an additional dose of Lercanidipine 5 mg few hours before the expected spike. So for that make a chart of BP three times a day for a week period. Avoiding excessive salt, having adequate fruits and regular activities whichever are possible would be helpful. I hope this helps.
Patient's Query
Thank you doctor,
Please find attached a comprehensive overview of her tracked heart data for the past few months (this is pre BP spike episodes). There is indeed visible a general clustering of increased BP at around 6 PM. Both of the episodes have also occurred later in the evening. Does this hold enough statistical significance?
Hi,
Welcome back to icliniq.com.
Yes, this is significant. But as I can see, the maximum BP reached was 175 mmHg and rest majority of the readings are fine. So you need not add any medications on a regular basis. However, keep Lercanidipine 5 mg ready with you, which you may give BP crosses 150 systolic. However, if it regularly started rising then should routinely give additional 5 mg. Rest try to identify triggers that I mentioned above and take appropriate precautions.
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Cardiology
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