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Wednesday, December 11, 2013
High Blood Pressure
My brother`s blood pressure is out of control
My brother has extremely high blood pressure and has had for some time. The doctors keep changing his medications, but nothing seems to help. He recently had a mild stroke./ His systolic pressure runs from 180`s to over 200. His dialstolic pressure is usually over 100 - up to the 120`s on occassion. Is there any new medications out there or is there any specific testing that can be done to see why he does not respond to medications?
It is always difficult to make specific recommendations without having all the information. However, a few points can be made:
Your brother does indeed need much better blood pressure control. With a history of stroke, his systolic blood pressure (the upper number) should be 130 mmHg or less. A patient who is on three different blood pressure medication (one of which should be a diuretic) and cannot be controlled is considered to have refractory hypertension. Such a person may need an evaluation to include kidney function, some hormonal tests (screening for high aldosterone levels), a test of the renal arteries and a urine test for catecholamines.
If these tests are negative, an adjustment of his medications is in order. Your brother may need treatment with drugs such as labetalol or minoxidil, which are among the most potent blood pressure drugs available.
Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati