Last Monday, my 76-year-old mother-in-law’s blood pressure suddenly shot through the roof and my father-in-law took her to the emergency room of our local heart hospital. When they left home, she had a splitting headache and was starting to get incoherent. By the time they saw a doctor, she was completely incoherent, was having convulsions, and didn’t know where she was, to the point that she tore out one IV and the ER staff had to sedate her and put her in restraints. After a head CT scan, an EEG, an ECG, many blood tests, and a spinal tap, the doctors (two cardiologists and a neurologist) settled on a diagnosis of hypertensive encephalopathy. She was given IV Nitroprusside sodium and her blood pressure came down to 150 over 90 (from a high of 215 over 120, if I recall correctly). She remained incoherent and confused until the next afternoon, when she woke up enough to eat Jell-O and inquire about her grandchildren’s Halloween costumes. They did another EEG and ECG as well as a renal ultrasound, all of which we were told looked fine, and after she slept off the incredible amount of sedation she’d been given in the ER, she was pretty much herself again. She was released on Wednesday on a higher dose of oral Diovan than she’d been taking.
My mother-in-law is in generally good health for her age, but she has had a history of sudden blood pressure changes and she seems to react oddly to medication. Her doctor has tried at least four different medicines this year, and they haven’t gotten a consistent result from any of them (including the lower dose of Diovan that she’d been on before the hospitalization). She once had the experience of her pressure getting dramatically lower after her doctor took her off all blood pressure medications because he was worried about her renal function, but it then rose again after a month or two. Her blood pressure seems to stay at a decent level for the most part, but she gets these sudden dramatic increases at unpredictable intervals. She’s gone to the ER four times now for a severe headache and sometimes confusion in conjunction with extremely high blood pressure, but this last time was certainly the most dramatic and frightening episode. She has rheumatoid arthritis (in remission for the most part), mild osteoarthritis, and glaucoma. She’s also had some problems with arrhythmia in the past, which is why she has a cardiologist, but that’s been under control. There’s evidence that she’s had two small strokes in the past, but there was absolutely no evidence of anything this time around.
She’s been doing pretty well since she got home, although she’s very tired. She’s been having more vision problems (the vision of one eye was already somewhat limited from glaucoma), has had two somewhat severe headaches, and says that she’s having visual hallucinations when she watches TV in low light or closes her eyes to go to sleep. Her blood pressure has been staying around the same level it was when she was released from the hospital - high but not (as I understand it) immediately dangerous.
Now, my mother-in-law has an appointment with her ophthalmologist on Monday and one with her primary care doctor Tuesday. She has an appointment with her cardiologist for two weeks from now. I’m not really looking for specific medical advice here, but I’d like to know if anyone has any experience with this condition and, more specifically, any advice about what things we could be doing differently. My father-in-law took her to the Heart Hospital because he thought that high blood pressure was something her cardiologist would be best equipped to deal with, but now he’s afraid that he’d have been better off taking her to a general-care facility (although her cardiologist doesn’t have privileges at the local hospital that has the best emergency services). We’re all afraid that the root cause of such an unpredictable increase in blood pressure is going to be really difficult to track down and treat, and we’re terrified that she’ll have another episode in the meantime.
Any thoughts or advice? Unsupported opinions? Encouraging anecdotes? We’re trying to gather as much information as we possibly can at this point. Thank you all in advance.