High blood pressure with me/cfs?

[MeSci]

About seven years ago I had a hypertensive crisis with numbers similar to @pdgoldinc It was accompanied by an unbearable ice-pick headache - absolutely the worst pain I have endured so far. The doctor had no idea what was wrong but he did prescribe a combo BP medication. He "treated" the headache with a CT scan which showed nothing. I got nothing for the pain.

Since I had recently started Cymbalta I asked if it could cause my symptoms. He insisted it could not, but fortunately I did not believe him so I immediately reduced the dose, and that stopped the headache. When I checked the manufacturer's professional information sheet for Cymbalta, extreme hypertension was listed as a "rare" adverse effect.

My BP is always high at any doctor's office. I used to think it was just the "white coat syndrome", but now I think it's a combination of "white coat syndrome" plus hyperadrenergic POTS, which is made much worse by having to sit up in the exam room for a long time while waiting for the doctor.

Like other folks have mentioned, my pulse and BP tend to be all over the place. I have found a low-dose beta blocker (I use atenolol) to be very helpful in controlling the tachycardia and hyperadrenergic symptoms like feeling hot and having cold and clammy hands and feet at the same time.

I have found that POTS is a more "acceptable" illness to present with. More doctors seem to understand that POTS is "real" and treatable. The psychobabblers have not been as successful in convincing doctors that POTS is a "psychosomatic" illness perpetuated by "false illness beliefs".

I started getting migraine (at least that was the original diagnosis, which I think is correct - I now seem to have a new, conflicting one) last year, and that too is accompanied by especially-high bp. I'm not taking any drugs that could cause it, as far as I am aware. Just nebivolol 2.5 mg and desmopressin (about 50-300 mcg per day, as required). Otherwise just OTC drugs (rotated, modest quantities) and supplements.

 

[pdgoldinc]

Thank you for the new replies. Last time I was at the doctor's office, I did not get a prescription. I again, had asked for something for brain fog and the unbearable sleepiness. I often sleep 20 hours of a day and I am completely worthless. After 2 years of asking, I'm really getting tired of my primary and will not go back there again. I am trying to get an appointment with Dr. John Leander Po in Tucson, he seems to be very knowledgeable. My husband and I are getting back in business in the beginning of January and I need to be functioning. We have been in business all our lives and he needs me. I can't be sick everyday! I really hate it! I was in a car accident in 2009, have severe pain from it and I am used to hurt. I can deal with this and all the the other symptoms. Has anybody ever tried Nootropics? They have some for brain fog and for sleepiness. Thanks again for all your concern and you all have a very, Merry Christmas!

 

[CFS_for_19_years]

... I again, had asked for something for brain fog and the unbearable sleepiness. I often sleep 20 hours of a day and I am completely worthless. After 2 years of asking, I'm really getting tired of my primary and will not go back there again. ...My husband and I are getting back in business in the beginning of January and I need to be functioning. Has anybody ever tried Nootropics? They have some for brain fog and for sleepiness.

A naturopath at Life Extension recommended PQQ to me. It helps me stay alert during the day. PQQ isn't a nootropic; it acts more like a B vitamin.

These PQQ tablets are 20mg and can be split with a pill cutter if 20mg is too much for you. Don't take it after 1 p.m. or you may have problems with insomnia. I find 5 -10mg/day to be about right for me. Some people say PQQ makes them feel wired and so they can't tolerate it, but others have liked it.

www.amazon.com/Source-Naturals-Mind-Supplement-Count/dp/B00BQS87D2 (60 tablets)

http://www.amazon.com/Source-Naturals-021078025184-Mind-Tablets/dp/B00EEEMB32 (30 tablets)

 

[pdgoldinc]

Thank you for informing me about PQQ. I need to do something and will order a bottle. If it works for you, it may work for me. Is anybody else using something to stay awake during the day, who is reading this thread? I would appreciate your opinion and what was prescribed for you or what you purchased online/OTC. Thank you!

 

[free at last]

Saw this thread. And it seemed a good place to share. was first diagnosed with ME around 1995. Never had high BP as far as I was aware, Recently developed ice pick type headaches on the top back and in both temples of my head. Also Both eyes ach off and on ( started on the right eye which is worse ) Getting all this now everyday.

At its worst it feels like a pressure or squeezing, or something behind my eyes that shouldn't be there. Recently had a eye exam. Nothing showed up ? My BP is much lower than others reporting here, read on two different occasions at the doctors at150/90

Doctor said all these symptoms might be related to the mildly high BP. And wanted to find out.

So started a 3 week cause on the BP med Amlodipine. Only took one pill, two hours later the headache and eye pain, and sensation of something behind my eyes got far worse. Convinced this med worsened the problem a lot.

So have stopped taking it, am yet to talk to a doc about what to do next. Wonder what conditions, with these symptoms, can be made worse. By this BP med ? Wondering if I need a MRI or such.
Hope you don't mind me talking about this on your thread pdgoldinc.

Wasn't sure if I should have started a new thread ? Strangely about a year ago, I had a episode were my balance went so bad that I could hardly sit up, moving my head, everytime I tried, The room started spinning and turning over ?

 

[*GG*]

Is it possible to have high blood pressure with me/cfs? My BP was 250/150 at my last doctor visit. 5 minutes later it read 200/136. My doctor has no clue what's wrong with me and I need to find out on my own.

I have been having issues with high blood pressure as well lately. Was reading in a magazine that this could be due to not having a CPAP machine for over a year now. Have Medical Insurance again and have an appt with sleep specialist at the beginning of next month.

Not sure the 2 are correlated, was thinking it was due to Florinef drug, which I was not on for long. Didn't' seem to help my dizziness, think the dizziness might have been more to me overdoing things. I was working at the time, not any longer!

I am also on BP medicine now, seems to have helped, but probably not going to cure it, if I need to still be on a CPAP!

GG

 

[pdgoldinc]

I tried Noopept for the terrible brainfog. It worked somewhat. Now I am taking Phenylpiracetam and Adrafinil, I'm back to normal, I think. I have forgotten what it is to be normal, it has been so long, for about a year now I have been unable to get out of bed. Normally I slept 22 hrs/day. Yesterday for the first time I drove for 4 hours straight, I can't believe it! I had Epstein Barr in the 80ies and from then on I had nothing but problems. I went to an eye doctor too because I thought it was caused by eye problems. My blood pressure is still high, not as high as it was. I will give an update from time to time. I heard that there was a study done in Russia about Phenylpiracetam and patients improved. I have not heard anything about it mentioned in the States. Talk with your doctor about what I'm taking, you should give it a try!

 

[Noah GB]

I would strongly advise pdgoldinc to go to the doctor and get the BP sorted and say nothing about ME at all. It is extremely unlikely that the BP has anything to do with ME since hypertension is a hundred times more common than ME and ME is not documented as a cause of hypertension. As members often point out any reference to ME often makes a doctor think they can ignore everything and move on to the next patient.

Once the risk of stroke and heart failure from hypertension has been dealt with then may be the time to consider whether ME is an appropriate diagnosis.

I went to the ER because I was concerned about my blood pressure which had been rising the past couple of days along with headache. My numbers were around 168/136, and I have POTS in addition. Of course this change only happens when I'm standing, and it's worse in the mornings. The ER doctor started Googling ME/CFS and told me that a blood pressure rise was normal. She even proceeded to suggest running..!

 

[MeSci]

I went to the ER because I was concerned about my blood pressure which had been rising the past couple of days along with headache. My numbers were around 168/136, and I have POTS in addition. Of course this change only happens when I'm standing, and it's worse in the mornings. The ER doctor started Googling ME/CFS and told me that a blood pressure rise was normal. She even proceeded to suggest running..!

 

[Countrygirl]

I went to the ER because I was concerned about my blood pressure which had been rising the past couple of days along with headache. My numbers were around 168/136, and I have POTS in addition. Of course this change only happens when I'm standing, and it's worse in the mornings. The ER doctor started Googling ME/CFS and told me that a blood pressure rise was normal. She even proceeded to suggest running..!

 

[Countrygirl]

I am catching up with you @pdgoldinc . My BP is 250/140 and the little arrhythmia sign is flashing. Not feeling good at all.

 

[free at last]

I am catching up with you @pdgoldinc . My BP is 250/140 and the little arrhythmia sign is flashing. Not feeling good at all.

Hi countrygirl Have you started any BP meds.
That is a very high reading. My doc has started me on Ramipril. And my reading is much lower than that. Don't like theses meds, side effects can be horrible. Especially when they mimic all the symptoms I originally went to the doc about.

 

[MeSci]

Hi countrygirl Have you started any BP meds.
That is a very high reading. My doc has started me on Ramipril. And my reading is much lower than that. Don't like theses meds, side effects can be horrible. Especially when they mimic all the symptoms I originally went to the doc about.

This thread has some warnings about ACE inhibitors.

 

[CFS_for_19_years]

Medscape ran a quiz for doctors to see how sharp they were regarding hypertension. You have to be logged in as a member to view it, so I'll just quote some of their information here.

Here's the huge overview:
http://emedicine.medscape.com/article/241381-overview#showall

Summarizing:

Especially severe cases of hypertension, or hypertensive crises, are defined as a BP ≥ 180/120 mm Hg and may be further categorized as hypertensive emergencies or urgencies. Hypertensive emergencies are characterized by evidence of impending or progressive target organ dysfunction, whereas hypertensive urgencies do not include progressive target organ dysfunction. In hypertensive emergencies, the BP should be aggressively lowered within minutes to an hour by no more than 25%, and then lowered to 160/100-110 mm Hg within the next 2-6 hours.

The JNC 7 recommends the following screening tests for specific identifiable causes of hypertension:

• Chronic kidney disease: Estimated glomerular filtration rate
  
  
• Coarctation of the aorta: CT angiography
  
  
• Cushing syndrome; other states of glucocorticoid excess (eg, chronic steroid therapy): Dexamethasone suppression test
  
  
• Drug-induced/drug-related hypertension: Drug screening
  
  
• Pheochromocytoma: 24-hour urinary metanephrine and normetanephrine
  
  
• Primary aldosteronism, other states of mineralocorticoid excess: 24-hour urinary aldosterone level, specific mineralocorticoid tests
  
  
• Renovascular hypertension: Doppler flow ultrasonography, magnetic resonance angiography, CT angiography
  
  
• Sleep apnea: Sleep study with oxygen saturation (screening would also include the Epworth Sleepiness Scale [ESS])
  
  
• Thyroid/parathyroid disease: Thyroid-stimulating hormone level, serum parathyroid hormone level

Uncontrolled and prolonged BP elevation can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy, coronary artery disease, various conduction system diseases, and systolic and diastolic dysfunction of the myocardium, which manifest clinically as angina or myocardial infarction, cardiac arrhythmias (especially atrial fibrillation), and congestive heart failure.

According to the SPRINT findings, achieving a target systolic pressure of 120 mm Hg reduced cardiovascular events (eg, myocardial infarction, heart failure) and stroke by nearly one third and reduced risk for death by almost one fourth when compared with a target of 140 mm Hg.

Latest news in hypertension management - the SPRINT findings:
http://hyper.ahajournals.org/content/67/2/263.long

 

[MeSci]

The JNC 7 recommends the following screening tests for specific identifiable causes of hypertension:

• Chronic kidney disease: Estimated glomerular filtration rate
  
• Coarctation of the aorta: CT angiography
  
• Cushing syndrome; other states of glucocorticoid excess (eg, chronic steroid therapy): Dexamethasone suppression test
  
• Drug-induced/drug-related hypertension: Drug screening
  
• Pheochromocytoma: 24-hour urinary metanephrine and normetanephrine
  
• Primary aldosteronism, other states of mineralocorticoid excess: 24-hour urinary aldosterone level, specific mineralocorticoid tests
  
• Renovascular hypertension: Doppler flow ultrasonography, magnetic resonance angiography, CT angiography
  
• Sleep apnea: Sleep study with oxygen saturation (screening would also include the Epworth Sleepiness Scale [ESS])
  
• Thyroid/parathyroid disease: Thyroid-stimulating hormone level, serum parathyroid hormone level

Wow - do they do those tests in the US when they find that a patient has hypertension? When mine was discovered, and I asked my doctor why he thought I had hypertension, he said "The commonest reason is no reason" and just prescribed an ACE inhibitor (which as it happened had severe adverse effects). I knew that his answer was rubbish, but assumed that doctors in the UK just don't do tests unless drugs don't work.

 

[Noah GB]

Wow - do they do those tests in the US when they find that a patient has hypertension? When mine was discovered, and I asked my doctor why he thought I had hypertension, he said "The commonest reason is no reason" and just prescribed an ACE inhibitor (which as it happened had severe adverse effects). I knew that his answer was rubbish, but assumed that doctors in the UK just don't do tests unless drugs don't work.

Do you have POTS or is your hypertension almost always present? Doctors like what you describe makes me dread going to have any symptom checked.

 

[MeSci]

Do you have POTS or is your hypertension almost always present? Doctors like what you describe makes me dread going to have any symptom checked.

No POTS, just hypertension. It's not all the time - jumps around all over the place, and can change dramatically from minute to minute, without me doing anything - just sitting quietly.

 

[CFS_for_19_years]

Wow - do they do those tests in the US when they find that a patient has hypertension? When mine was discovered, and I asked my doctor why he thought I had hypertension, he said "The commonest reason is no reason" and just prescribed an ACE inhibitor (which as it happened had severe adverse effects). I knew that his answer was rubbish, but assumed that doctors in the UK just don't do tests unless drugs don't work.

Oh hell no

I think it all depends on whether the doctor suspects there is another cause, other than getting on in years.

Patients with rare conditions such as Cushing's syndrome and pheochromocytoma would have other clinical presentations that should alert to the doctor to send the patient to an endocrinologist.

Sleep apnea and chronic kidney disease would be much more common reasons for elevated blood pressure.

Here's more info about the recommended work-up:
http://emedicine.medscape.com/article/241381-workup#c8

Initial workup
Initial laboratory tests may include urinalysis; fasting blood glucose or A1c; hematocrit; serum sodium, potassium, creatinine (estimated or measured glomerular filtration rate [GFR]), and calcium; and lipid profile following a 9- to 12-hour fast (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides). An increase in cardiovascular risk is associated with a decreased GFR level and with albuminuria.[3]

Assessment of suspected secondary causes
Other studies may be obtained on the basis of clinical findings or in individuals with suspected secondary hypertension and/or evidence of target-organ disease, such as complete blood count (CBC), chest radiograph, uric acid, and urine microalbumin.[3] Table 2, below, summarizes the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) screening tests for specific identifiable causes of hypertension.

(I posted Table 2 in my earlier post.)

I think the key words here are suspected secondary causes. There may be NO suspected secondary causes present at all, other than old age, and then it's called primary or essential hypertension, rather than secondary hypertension.

Secondary hypertension (secondary high blood pressure) is high blood pressure that's caused by another medical condition. Secondary hypertension differs from the usual type of high blood pressure (essential hypertension), which is often referred to simply as high blood pressure

So to summarize, the recommendations are to do the initial work-up as posted, but to also consider secondary causes; only do the additional tests if a secondary cause is suspected from the clinical history and presentation.