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High Blood Pressure

When BP medicine does not work

05/30/2008

Question:

I have been on Altace (10 mg/day) and hydrochlorothiazide (12.5 mg/day) for one year. When I go to the doctor, my pressure rises even when I try to relax. My doctor said "this is it" after putting me on the HCTZ. She acted like there were no other treatments available to lower my pressure. Is this correct? I check my pressure at home frequently and it is about 130/60 and sometims lower, 105/58. My pressure always goes up at the doctor and I am unable to relax to lower it. Any ideas??

Answer:

Hello and thank you for your question. From what I gather, "white coat" hypertension is definitely a possibility that requires further exploration. That is it appears your blood pressures spike during office visits, and remain relatively well controlled in more controlled and relaxing environments. One way to be more certain, provided you have an accurate blood pressure reading device is to randomly take your blood pressure at home after being seated for at least five minutes. If when you obtain your random readings, they are with in normal limits (i.e. what your doctor has prescribed for you), then report these values to him or her and they will probably agree that you are fine and require no additional therapeutic manipulations or additions. If however these random readings consistently show you to be in the hypertensive state, then you will probably need some additional intervention. From your drugs and their respective dosages, you still have room to increase their dosage. Additionally, there remain several other therapeutic options to achieve optimal control which should be relayed to you by your treating physician. By no way are you at the end of your rope. Just be persistent in having an open and educative dialog with he or she. I hope my answer has been of some assistance to you, and I wish you the best with your health.

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Response by:

Kaine C Onwuzulike, MD, PhD Kaine C Onwuzulike, MD, PhD
Resident of Nuerological Surgery
School of Medicine
Case Western Reserve University