Ever heard of Malignant High Blood pressure?

In My Humble Opinion
1

Me neither, till now. And yes, I learned the hard way!

I’m 55yrs old, my hubby is 65yrs old, most of our peer group takes meds for high blood pressure. All with the same sort of onset. Slowly over time their MD noticed the BP slowly rising, when it reached some threshold, they were started on starter meds, sometimes a little tinkering but, for everyone I know, it was quite a seamless transition. No issues with meds tolerance, no hospitalization.

Turns out though, you can have regular to low (moi) blood pressure all of your life and then, out of the clear blue sky, develop shockingly high blood pressure. There are no early warning symptoms and, even when it does hit, it can easily manifest as a blinding, if unexplained headache, sometimes with vomiting. For which, I have to believe, most people would simply take some pain meds and Gravol and not give it another thought. Thing is, it can shoot up to dangerously high and then, drop down to dangerously low, quite quickly. Making you feel unwell in ways that are hard to diagnose.

My first bout landed me in emerg with a sudden onset wicked headache, accompanied by vomiting. In emerg they IV’d me with gravol, potassium, morphine, thinking it was driven by the headache. BP did come down once pain stopped. The sudden onset of the extreme headache, meant CT scan, followed by a spinal tap to be certain - no brain aneurysm. Not fun, but good to know. Released with a diagnosis of wicked headache.

Two days later, at the dental clinic they take my BP and it’s 207/ 186. Yikes! They send me immediately to my Dr, where it’s now higher still, they send me to emerg, where I am, to my surprise triaged right in. For high blood pressure? A headache? I’m pretty sure there was a guy bleeding out there in the waiting room. I’m confused.

Again, blinding headache, vomiting, which they immediately address the same way, then triage me to ‘Pod C’, while they administer 5mg of something to bring down my pressure and I’m hooked to some monitors (BP every 5 mins, blood oxygen, pulse) overseen by a nurse.

A cardiac guy arrives to consult, before the second 5mgs, (they’ve given us the lifestyle talk, less salt, no processed foods, etc, and I think I’m nearing getting sent home, with instructions to see my own DR, yay!) While the cardiac dude is there explaining that he doesn’t think this is a cardiac event, yada, yada, suddenly, and for no good reason, again my BP spikes up to 199/ 170 with my heart clicking up to 143. Everyone just suddenly stopped talking and were all taking my pulse at once. I felt just awful in a way that’s really hard to describe.

Things started happening fast at this point, there was nobody explaining what was happening, I was terribly confused, and kept asking, “What’s wrong with me?” I was a perfectly healthy, active woman with no health issues whatsoever! The cardiac dude cancels the second dose of 5mg and orders 15mgs, and suddenly we’re wheeling down the hall so fast I can’t see my hubby any more, on our way to Pod A.

Where, in rapid succession I am gowned, have a bedside EKG, next an internist appears, tons of questions. Tests, and more tests are ordered, now they are saving my urine, still no one has told us much about what is happening or why. Xrays to chest and abdomen, ultra sound of my heart - I’m not even sure what they are looking for.

I spend the night in Pod A and am admitted to hospital, (On a long weekend, Easter, WTF?) where I spend 5 days, feeling like crap. Being given drugs, literally by the fistful. I have a second similar episode my second night in hospital, Dr called to bedside everyone scrambling around again. I’m still confused.

The drugs are kicking my ass, I can barely sit up, walk only unsteadily, constantly feel nauseous. One day all the meds were liquids? I’m so confused. How can this just be high blood pressure, WTF? They have me on the maximum dose of tylenol for the headache. Life sucks.

I am released after 5 days with lots of meds and instructions to see my DR within the week. The drugs have me undone. I cannot sit up for more than 20 mins, walking makes me feel to pass out, I am always nauseous and spend a week lying very still on my couch with an icepack on my brainstem and wondering what the hell happened to by life. The drugs are now driving my BP into too low range. I am still confused.

My Dr takes me off all the meds, but makes me take BP readings 5 times a day and call them into her office. (each reading an average of 3 over twenty mins, both arms, WTF?) As soon as BP hits 150, back to the heavy duty meds, 1/2 tab this time, per day.

By now 3 wks have passed, and I am struggling to come back to life. Lamenting how weary I am of feeling so sickly and being so incapacitated. But slowly I start to come round to being up, active and more myself again. Here starts the good days/bad days cycle.

This is when I was able to get online and do some research as to what the hell this is, that’s when everything they were doing to me, and why they were reacting the way they did, starts to come into focus and to make sense. Turns out, when your blood pressure gets that high it’s easy for it to permanently damage your organs, like your liver, kidneys or heart! Who knew? Not me, I’d never heard of such a thing.

All that testing was less to see what was causing it, I think, than to see if it had caused any damage! The doctor that released me said I was fortunate, but I was so excited, to be set free, I barely heard him. He said if I’d been obese or diabetic or a heavy drinker, things could easily have gone otherwise. Not until I did the reading did I understand what that meant. I could have left the hospital with life impacting damage to my vital organs. Again, who knew such things were even possible? Not I.

Have you ever heard of such a thing? Do you know anyone who went through a similar experience? I am still a little floored. But I’m feeling much better now,:smiley:

Still struggling with getting the meds just right, the diuretic ,when added back into the mix, (when BP hits 160 on the top), kicks my ass and I’m back to lying perfectly still with an icepack on my brainstem. But I’m back to the hospital tomorrow where I’m hoping they’ll modify the dosage to address that issue. Also my Dr won’t let me return to work until the hypertension specialist says it’s a go. I’m hoping that will happen tomorrow, and I’m probably in for another sleep test (blood oxygen) which I can hopefully arrange to have at home.

Here it is, almost one month later, and I’m just now able to walk my dog and go out of the house unescorted. From high blood pressure! I am still astounded.

I’m hoping that by sharing this story, other people will become aware of this and maybe not be as confused and taken aback as I have been through the whole experience. As have my family and friends. I mean, it’s just high blood pressure, which everybody I know cruised right into without incident. Also know I was very fortunate to have received great quality medical care all the way through, even if there was no time for lots of explaining. I’m definitely counting myself a lucky girl, though it took me some time to really understand that.

2

[nonmod]Glad you’re feeling better![/nonmod]

[mod]I’m going to move this from MPSIMS to IMHO, home of medical threads involving anecdotes, advice, diagnoses, etc.[/mod]

3

Good lord, you’ve been through the ringer. I have heard of it, but I didn’t really know what it entailed. I feel for you- it does sound like you really haven’t felt well at all, not to mention being cooped up. I always find it ironic that they give you a spinal tap when you have “the worst headache of your life”, which gives you an even worse headache, or at least it did me. I hope that they get this under control for you asap- we can’t have you being sick.

4

You know, I really hate it when docs get all excited and start doing stuff AND WON’T TELL THE PATIENT WHAT THE HELL IS GOING ON!

Here’s hoping they get things under control and you get your life back, soon.

(I actually had heard of malignant high blood pressure before. It’s deadly serious, so I’m glad you were under close medical attention even if the whole thing has been really unpleasant)

5

I never had a hypertensive emergency, but my blood pressure, which had been slowly creeping up over time, did suddenly jump all the way up to 175/145, complete with the massive headache (still qualified by me as “the worst pain I’ve ever felt”). I will never forget standing at a payphone desperately trying to get through to the doctor, while screaming in pain. This was the direct cause of me switching to my current much better doctor, who tried me on five different medications before finding one that was able to keep my pressure under control. Fortunately I never had to be hospitalized (although like you, I later learned how much risk I was at at for stroke or organ damage). I did have to start testing my pressure daily. At one point, I became so tuned in to my numbers that even though I hadn’t taken my pressure that day, when I went to the doctors office, I was able to tell the nurse exactly what my pressure was before she took it.

The good news is that since I found a medication that worked, around 6 or 7 years ago, my pressure has stayed around normal levels and I have never had another incident. I do check my pressure at home periodically just to be sure, because I know that sometimes medications that worked for a while will stop working. Good luck to you, and I hope you have a similar positive outcome.

6

I’ve heard of it because my grandfather died of it - in the 1960s, so not to alarm you. I’m sure you’ll be ok since you’re being actively treated and medicine has no doubt advanced a lot in 50 years.

I mention it to people from time to time because it’s so unusual and regular “I need to eat less salt” hypertension is so common.

7

I’ve seen this at work a few times … however I’ve NEVER seen a reading as high as yours.

I don’t know how you didn’t have a stroke. If you believe in any kind of god(s) – you might wanna go thank 'him/her/it/them.

That said, it sounds like you’re in good hands and you’re compliant (soo many HTN patients simply won’t take their meds, or won’t change their diet, won’t quit smoking, etc.). It might take a while to find the right medication combo but if you keep doing what you’re doing, you’ll get there :slight_smile:

Good luck!!!

8

Thanks for the good wishes and encouragement.

We’re not there just yet, today was truly awful, after many good days. The good days make my optimist spirit soar, I can almost see my old life again. But the bad days, make me spiral something terrible. I’m not sure if I’m right but today’s stormy weather seems to be a part of the equation (I noticed it earlier), now that the storm front has passed I’m actually feeling much better, y’know, in a relative way. Hey, I’m sitting up without two ice packs - Yay me!

It is startling to go through such an experience and not really understand it, until weeks later. But it was a holiday weekend, and the care I received was indeed top notch. I have no complaint. I hate to think what the outcome could have been, had the dental clinic not taken my BP. I would have had a house full of company, for Easter, and likely just tried to power through. Either way it would likely have been days before I thought to see a doctor. (I’m headed back to that dental clinic on Wednesday with flowers for that Dr, I’m sure it was an easy call for her to make, but on reflection it made all the difference.)

Only when I was leaving hospital did I learn that I had been in the care of the Premier specialist in hypertension, more published research than anyone else in the field, in this province certainly, possibly in this country. In addition to his medical degree he has a PHD in pharmacology. I guess it pays to live near a teaching hospital. I’ll be seeing him tomorrow.

It’s harsh to go from not taking any meds to jumping into the deep end of the pool. I keep telling myself I’ll get used to it, but it sure ain’t easy. No starter meds, the hard goods and no way around it!

(I think my saving grace was that I am not overweight, don’t drink coffee or alcohol, walk an hour everyday, don’t drive but ride a bike, and no ongoing conditions like diabetes? I could be wrong, I’m not the doctor, and, as you can see easily confused!)

Trust me, I am indeed thanking the Gods for the ‘good fortune’? An odd thing to say after a month of feeling like complete crap, but there you go.

Thanks for listening!

9

elbows…wow. Glad you’re doing better…and looking forward to hearing more as you get it under control and get back to normal.
-D/a

10

This probably indeed was your saving grace. If you were overweight and didn’t exercise the outcome probably wouldn’t have been as good. (Most likely, anyway, there’s always exceptions. I’m way overweight and a slug/desk jockey and my BP runs around 90/65 - however I’m not naive enough to think that I’m typical.)

11

And the Doctor says:

I’m good to go back to work, just don’t over do it initially!
(Happy Dancing, but not to vigorously)

The diuretic that was kicking my ass? He says I can take a quarter tablet, just keep checking the BP, at least twice a day. Anything nearing 160 (on the top) and it’s time for another dose. He also said don’t be surprised if the frequency closes as I tolerate the drug more. The day may well come when I am on a full tab of each medicine, possibly within 6 months to a year. Strikes me as unlikely, judging by the way I started out, but he’s the specialist.

And in the learning department, when I asked why I was so teary and weepy after 10pm each night, he explained that the kind of BP numbers I presented with, cause almost concussion like injuries to the brain!:eek:

When I asked if it would diminish, over time, and pointed out that it had been almost a month, he said, maybe yes, maybe no. Like a bad concussion it can leave permanent damage.:eek:

Then said there was a good chance the effect would diminish over time but brains heal slowly. Then he pretty much reiterated what Pandabear 77 had said. I was very, very fortunate, the outcome could have, in fact should have been, much worse.

He was delighted to see me smiling and well. No more delighted then I was to have come through it unscathed. Still I had to have a nap when I got home, I was worn out.:frowning:

Still a great day, in my book.
(Happy dancing, just a little more!:D)

12

Wow what a story!

Good luck going back to work…for Pete’s sake, take it easy!!

13

Oh, and I got an answer to this, as well.

Turns out, telling someone they may be about to have a stroke, not really a good idea. Y’know, likely to raise their blood pressure! :smiley:

If it hadn’t been a long weekend, we’d have probably been getting more info, but I truly have no issue, whatsoever, with the quality of care I received, for obvious reasons!

14

I hate reading and worrying about my blood pressure because I have hypertension and am a hypochondriac, and my hypochondria caused my BP to go up, which causes more hypochondria, etc. My numbers are nowhere near as bad as yours were, but they can jump pretty high when I am anxious (anxiety and stress add 30-60 points to my blood pressure, but it comes back down when the adrenaline is gone). When I am not stressed my BP is either ‘high normal’ or ‘mild’. When I am stressed it goes a lot higher.

Anyway, a diastolic that high is insane. How are your internal organs? Have you looked into any surgeries for blood pressure? Renal ablation and baroreflex pacemakers have been looked into for this issue.

15

Three Dr’s in two days, and all were universally impressed at how much better I was. Each one said, “You look like a new woman!” Awesome.

I am so keen to get back to work, to my old life. I’ve waited a month, after all.

It’s my nature to jump in with both feet. I’ve always been a goer, y’know, jump up and race off to the next task. Answer the phone, get the door, whatever. I’m the busy bee type, always a big to do list of projects I’m working on. Being a tad hyperactive made me a natural fit for working in service, which I did most of my life. It’s deeply ingrained in who I am, my very nature.

I don’t think I was particularly active yesterday, a couple of Dr’s visits, walked to and from one (only a couple of blocks away!), dropped into the store where I work twice a week. But by the time I got home, I was exhausted, and had to lie down. When the boy came home, we went to the grocery store together (drove), where we didn’t do much actual shopping mostly reading sodium contents on various items, etc. I did make dinner, something simple. Rested after that, rallied a bit, did some dishes. Nothing terribly strenuous, to my mind. But by bedtime I felt really awful again, it’s just so disheartening. I took a sleep aid, mostly because I was upset and knew that couldn’t be helping. (BP’s all good though!)

Today I am forcing myself to take it very easy. But it’s so hard, when I’ve waited this long and am itching to get back to who I was. My garden is screaming for attention, now that the weather has turned warm. My house is covered in dust and disorder. I’ve never been an obsessive house work girl, but it’s bugging me. When the awful arrives, however it is enough to make even me swear to go slower tomorrow.

But it’s frustrating and depressing. There is a lot I should be rejoicing about, I know. I’m impatient. I want to be that girl again, that races around the house, get lots done in little time, spend a whole day getting dirty in the garden, and enjoying that sleep that comes from having worked hard all day. I am exceedingly tired of feeling sickly and weak. My optimist heart, when I feel well, wants to take that and run with it, but I just can’t.

I’m really not sure if it’s just the drugs kicking my ass, or the recovery not being as swift as I’d like. If it’s the drugs, I wonder, will I get used to them? And will I ever get back to who I was?

Sigh, I guess I’m just too impatient! I hadn’t anticipated this part being so hard dammit! I’ve been so healthy, all my life, I have no practice with this part and it’s hard.

Thanks for listening to me whine!

16

You didn’t just dodge a bullet–you dodged a damned bullet train!

It’s absolutely crucial that you abide by EVERYTHING you’ve been told to do. The blood pressure average, taking in both arms is necessary to forecast any damage going on inside. If there is a major difference between the two arms, it can be indicative of nasty business.

If you haven’t already, expect to receive orders for kidney scans and brain scans. Wildly fluctuating blood pressure can be caused by problems in the endocrine system. The pituitary gland and the adrenal glands are major players in that parade.

I would think that malignant hypertension isn’t as prevalent today as it was fifty years ago, because there are so many drugs on the market that are super efficient at controlling blood pressure. When I was a kid, I remember my grandmother having high blood pressure, and she was prescribed phenobarbital!

Aside from strokes and heart attacks, malignant hypertension was notorious for pounding kidneys to dust.

You were so incredibly fortunate to be seen by the preeminent hypertension specialist, with a PhD in pharmacology! I’m sure his input was utterly invaluable in your treatment.

Keep us updated with your progress!
~VOW

17

Wow, Elbows, I so glad you are better even if the problems persist.
Having this come out of the blue must have been scary as heck.
To be honest, before I go to bed tonight I am going to check my BP.
You can never be too careful and I am older than you are.

Thanks for sharing this. Good luck!

18

Really happy you are back on an even keel. May I inquire as to what meds you have been prescribed for the crazy BP?

19

Vow - very well put, bullet train indeed.
I do count myself extremely lucky, even if it took me some time to truly understand how and why. And I believe I’ve had every test known to man; 3 CT’s, at least as many EKG’s, heart ultra sound, several urine collections type tests, chest xrays, abdominal xrays, and blood tests up the wazoo. Seriously, when I was in hospital I was convinced they were trying to lower my blood pressure just by taking blood out of me! I suppose they were checking on doses of the meds they were pumping me full of, but I could be wrong. Sleep tests for blood oxygen, and as this coincided with dental surgery, a full orthodontic series of xrays. Seriously, the first two days I was in hospital was spent going from one testing area to another. There’s probably some I’ve forgotten about too!

Out of the blue is the scariest part, definitely. No really recognizable symptoms until it’s an emergency. I am telling everybody I know who has let their health slide, (not uncommon in my age group!), without, as yet, medical consequence. It was really impressed upon me how badly this all could have gone, so easily.

If I’d been an even moderate but regular drinker, if I’d been overweight to obese, if I’d been diabetic/prediabetic, if I’d had a sedentary lifestyle. This describes a shit load of people I know, all of whom think because they’ve suffered no medical side effects, from these things, that’s it’s all okay. But I could easily have left hospital needing dialysis, with life impacting impaired liver function, or life restricting heart damage. And that’s not even taking into account the stroke thing. That’s a toss of the dice no one should be willing to take. (I cared for my MIL, 6 yrs, fully bedridden, stroke survivor, in my home, as her primary caregiver. I know exactly how devastating stroke can be!)

The chosen drug is called Twynsta, the diuretic is Chlorthalidone, plus, just for good measure a very expensive drug call Co ondansetron. It’s actually the strongest Gravol like drug available, because I’m diving into the deep end of the pharmalogical pool, and having taken such few drugs previously, it’s been a difficult adjustment, toleration wise, for me. I take less of it all the time, now that the dosages have been adjusted. I probably won’t have to renew it and will be able to revert to simple Gravol, with a little more time. In addition I am working my way down from the maximum dose of Tylenol. (I was amazed, in hospital, they were giving me 4000mg a day! I weigh 115lbs! It just seems so, unlikely somehow. I would never take that much in a day, on my own! Ever.) Most days I’m down to about 1/2, or 2000 mg. Also a sleep aid, for when I’m feeling crap, .5mg Lorazepam, again, less and less often as I adjust. That’s a boat load of drugs, right there. And yeah, I know I have to follow orders, but that’s a little upsetting all in itself.

After the first horrific week home, the Twynsta 80/10, was dropped to half a tab a day, which made a big difference for me tolerating it, and being back in the land of the living. The diuretic have been reduced from 1/2 tab to 1/4, only when my BP hits 155-160, currently once every 5 days or so. As I said the Tylenol is reducing as the headaches diminish. Oh, also I’ve been given 5mg Statex Morphine for when Tylenol won’t do the job. Ordered, strictly, and in no uncertain terms, to never, ever let the headache rage! But I take it less and less, now mostly when the weather gets stormy (seems the trigger).

When you’ve waited so long for your life to come back around, it’s really hard not to jump back into being the race around girl you were. But it’s slow and steady that’s going to get me there. Not easy as it’s so opposed to my nature, but I’m working on it. Hard.

I am a smoker, in the process of quitting, not easy when you mostly lie around trying to keep from doing too much all day. I was actually going to my Dr, that day, to get a script for Champix, (at the drug store awaiting pickup), my friend used it with great success. I didn’t have a smoke for about 3 wks, I could barely sit upright! I’m down to about 1 cig a day right now, from a small pack every 2-3 days. I don’t really want to take yet another drug just now, so the Champix is out. I don’t even know if I can take it with the drug regime I’m on now. I’ll get there, I have no illusions about it, believe me.

I have to return to all these Dr’s again, they are not done with me yet, it seems. My physician has me still taking my BP’s 3 times a day, and charting them for her. The hypertension specialist explaining about how it’s like a severe concussion for your brain, was actually a big help in understanding that it will just take time, and understanding the tired easily, worn out feeling that overcomes me when I do too much in a day. It was very helpful to me to understand this part, moving forward. I would be very protective of my child’s brain if they suffered a concussion, and I’m pretty found of my own brain function, so I will indeed take all the care required, even if it’s slower than I’d hoped for. It also explains why I couldn’t do a crossword puzzle, something I’m quite good at doing, while in hospital. I thought it was the drugs or just not being able to focus. Now I see that a little differently.

His most powerful words to me, delivered with absolute sincerity, involved this being his field of expertise and how rarely he gets to see such a good outcome, and how life devastating most of the outcomes he sees are. I could see he was genuinely tickled to see me so well.

On the drive home I told my husband this is why I never buy lottery tickets, I was saving all my luck up for something important!:smiley:

Spread the word, stay healthy your future could depend on it, none of us know what could be waiting round the bend. Thanks so much for listening!

20

Oh yeah, one more, somewhat amusing detail I learned.

This occurs in only about 1% of people who develop hypertension, (80% of people develop some form of hypertension by the time they are 80yrs of age!).

I find that a little bit amusing, as we return to the season of Occupy Protests, that I, who have lived a terribly humble life, don’t drive a car, no trust fund, bank owns our house, am actually part of the ‘1%’.

Ok, maybe it’s just me, but that’s kinda funny!