Dr. Roach: Erratic blood pressure may be emotional reaction
Dear Dr. Roach: I’m an active 85-year-old woman. For the past four years, I have been having erratic blood pressure readings. Sometimes my blood pressure is 80/50, other times 200/90 or higher. I am treated with nadolol as needed.
My cardiologist said he cannot help me. The doctors at the hospital have no idea why I have this problem. When my blood pressure is low, I have blurry eyesight and trouble walking. They tell me to eat salt when my blood pressure is low.
Dear Anon: Blood pressure that fluctuates that greatly over a short period of time is unusual and has a short list of potential causes.
One, which I am nearly positive your cardiologist has looked for, is a tumor that produces the substance epinephrine, also called adrenaline, or similar molecules that raise the blood pressure. This is called a pheochromocytoma (or paraganglioma, if it’s outside the adrenal gland) and is quite rare. Blood and urine tests are used to diagnose this condition, or more likely, to exclude it. Rarely, other substances that raise blood pressure can be produced by the body, as in carcinoid syndrome.
Blockages in the arteries to the kidneys can cause blood pressure to go way up and way down. Some drugs can do it. We see it occasionally in a person who has had a stroke. But by far the most common reason is emotional. Occasionally, these emotions are understood and acknowledged by the person suffering through these frightening blood pressure jumps, but often the person is not aware of any emotional distress at the time of the event. Physical symptoms, like the blurry vision and walking difficulty you mention, are universal. Common symptoms include headache, chest pain and dizziness. The blood pressure is normal apart from the symptoms, unless the patient has been put on blood pressure medication.
This condition, paroxysmal hypertension, is much more common than a pheochromocytoma, but many doctors aren’t aware of it. A careful and very thorough evaluation is absolutely necessary before making this diagnosis, but with a correct diagnosis, treatment is generally effective.
For an acute attack, treatment may be with a short-acting blood pressure medicine, such as labetalol. Given intravenously, it starts working within a few minutes, as opposed to the nadolol you were given, which starts working three to four hours after an oral dose. Also, an anti-anxiety medicine, such as alprazolam, may be helpful as it begins working very quickly. This is effective even if a person does not feel anxiety. People with very frequent episodes of symptomatic high blood pressure may benefit from medication to prevent symptoms.
I am fortunate to have experts in high blood pressure at my institution who are highly skilled at managing conditions like this.
Dear Dr. Roach: Is it true that a wound will heal faster if someone kisses it?
Dear B.B.: It may make it feel better, as generations of children will attest, but it won’t make it heal faster. In general, wounds should be kept clean and covered, with a protective ointment to keep the wound moist. Many people feel that wounds should “get air” or “dry up,” but without the protection of the outermost layer of skin -- the epidermis — cells regrow best when moist.
Keeping the wound free from additional germs from a well-meaning kiss is helpful, but it’s also important to keep the kisser free from germs, too, in a world where drug-resistant bacteria like MRSA are becoming far too frequent.
Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.