What could cause high blood pressure in a doctor's office?

Question

Hi doctor,

I have been regularly taking hypertension medications Amlodipine and Losartan with Hydrochlorothiazide for a long time. My blood pressure was normal when measured at home using an automatic BP monitor and a mercury sphygmomanometer by a doctor's assistant. However, in the clinic, my doctor diagnosed me with a blood pressure of 190/110 mmHg. He changed my medications, and I have uploaded the new prescription for your reference.

After taking Metoprolol succinate at 9 PM, I experienced severe symptoms such as excessive thirst, a severe headache, sleeplessness, and dizziness one hour later. When I consulted my doctor the next day, he advised me to stop taking Metoprolol succinate. I slept better the following night, but I still felt like I had an overdose, as I was feeling weaker, lightheaded, and had tremors. My blood pressure readings at home have dropped below their usual values, while the readings at the hospital remain at 160/100 mmHg. Please suggest the appropriate dosage of the prescribed medications.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

You are taking antihypertensive medications. Your blood pressure remains controlled, but elevated readings in the doctor's clinic are referred to as white-coat hypertension, which may be due to the stress you experience in that setting. You have taken Cilnidipine, Amlodipine, Metformin, and Metoprolol, all of which are beta blockers. Taking two or more beta-blockers may cause your heart rate to slow down, and this seems to be the cause of your dizziness. Whenever a doctor prescribes a new medication, always show them your previous records.

You are obese, which is a risk factor for hypertension, heart disease, and diabetes. I recommend reducing your weight, exercising, and decreasing your salt intake. These measures will help stabilize your blood pressure. Additionally, try to ensure you get good sleep and manage your stress and anxiety. You did not provide your age or whether you have diabetes. Please share these details so that further diagnoses and potential causes can be ruled out. If you do have diabetes, it is important to control your blood sugar levels.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

It is good to know that you do not have diabetes. I am not sure how long you have been hypertensive, but if you developed high blood pressure before the age of 40, then secondary causes of hypertension should be ruled out. In that case, in addition to the investigations I suggested earlier, a renal Doppler ultrasound will be very helpful. Your previous medications are effective for controlling blood pressure, and I recommend that you switch back to those. Please consult your doctor, discuss your options with them, and take the medication with their consent. Remember, medications are only a part of the treatment for hypertension, not the entire solution.

Controlling blood pressure requires more than just medications. Here are some steps I suggest:
Reduce your weight so that your BMI (body mass index) is less than 25.
Avoid stress; yoga can be beneficial for this.
Engage in regular exercise, such as brisk walking for at least 30 minutes a day, at least five days a week.
Decrease your sodium intake to less than 2,500 mg per day, which is approximately one teaspoon of salt.
Avoid fatty foods, junk foods, and fast foods.
Take your medications regularly, ideally at the same time each day.

Blood pressure is a dynamic entity; it can change from time to time and under different conditions. Blood pressure should not be measured in a stressful environment. Home blood pressure recordings provide a better reflection of your true blood pressure than those taken in a clinic. I strongly recommend purchasing a blood pressure monitor for home use and checking your blood pressure regularly.

When measuring your blood pressure, sit in a chair with a backrest for 10 minutes. Ensure your arm is at heart level, supported on a table. Avoid caffeine and smoking for at least two hours before the measurement. Relax and think of some happy moments in your life for 10 minutes to help you feel calm. This way, your blood pressure will be more representative of your actual levels. Take two readings with at least a 30-minute interval between them. Remember to check your blood pressure in both arms, and use the higher reading as your reference.

I hope this helps.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

When it comes to controlling high blood pressure, there is no need to fast. You can eat whatever you like, as long as it is home-cooked. Just avoid fast foods, junk foods, high-salt, and fatty foods. You can enjoy fruits, vegetables, pulses, rice, chicken, fish, and occasionally mutton as well.

Regarding fasting as a religious practice, you can do so without harm. For weight loss, fasting is not necessary; regular exercise and avoiding the aforementioned foods are sufficient. The best exercises include brisk walking, jogging, cycling, swimming, and playing sports. Remember, a brisk walk means walking as fast as you can without running.

I hope this helps.

Thank you.

Answer 4

Hi,

Welcome back to icliniq.com.

Yes, you can fast and take your medications either before or after fasting. Do not miss your doses. Sometimes, taking medications on an empty stomach can cause stomach discomfort. If you have ever experienced such symptoms with these medications, then you should avoid taking them on an empty stomach. You can fast without harm, but it is important to take your medications regularly.

I hope this helps.

Thank you.