Vomiting, extremely high BP related to a stroke?

Factual Questions
1

My father-in-law was admitted to the ER last night for what was apparently a mild stroke; he has a good prognosis. The symptoms that he reported were feeling flushed, then losing control of one arm, and slurred speech.

While he was in the ER last night, his blood pressure was rated as at least 200-something (my husband recalls it as being 270-something) over ~150. It remained at that level long enough for them to medicate him for it. Apparently he vomited after being given this medication. From what I was told (through one of my sisters-in-law), he was given at least a couple other drugs to attempt to reduce his BP, and the vomiting/dry heaving continued for a few hours.

My FIL had a history of high blood pressure, but was not compliant in visiting a doctor often or in taking his meds regularly. The doctor that he would go see is out of the country currently, has his own practice, and the medical records are probably not accessible, so we don’t know what his usual BP is or if it had been checked regularly. My FIL has claimed in the past to have checked his BP at drugstores and said it was fine or only mildly elevated, nothing on this level. I can’t imagine his BP getting out of control to that point, but perhaps it did, since we have no records to show what it had been like.

I plan to ask the doctors about this, or have one of his children ask, but after searching the Mayo Clinic’s info site I’m still a bit confused.

  • I know that high BP is a risk factor for stroke, but can people typically be walking around with a BP at that level? His family members were attributing it to the stress of having a stroke and being in the ER, even though it continued to be high for at least a couple hours while he was there. I’m wondering if it hadn’t been slowly rising for quite some time and finally caused a stroke.
  • The family members also blamed the vomiting on a medication bad reaction/side effect. Could extremely high blood pressure cause that? I know it’s listed as one of the symptoms for a stroke, but I saw it listed together with a headache and usually as a symptom for a hemorrhagic stroke, which he didn’t have.
2

Speaking anecdotally as I am not a doctor but I do have high blood pressure. I really hope QtM pops in as I’m very interested in the answers to your questions myself.

I went to my GP one day and my BP was 106/70. 24 Hours later it was 151/108 and I was dizzy with a killer headache and had plenty of nausea and diahrea all from the blood pressure spiking so high and so quickly. All those symptoms came on within the span of an hour.

My guess is he was walking around with elevated blood pressure and either that finally crossed some kind of threshold and caused the stroke or the stress of the stroke on the body caused the spike.

Either way he needs to take better care of himself!

3

Those are impressive numbers. A number of thoughts come to mind …

Sometimes, when the high blood pressure is extremely high, it can cause symptoms that may mimic a stroke. This is called hypertensive encephalopathy or malignant hypertension. Vomiting frequently accompanys hypertensive encephalopathy.

Sometimes, rare conditions cause ‘paroxysms’ of elevated blood pressure which punctuate intervening periods of much lower or even normal blood pressure (eg. pheochromocytoma). Flushing can be a symptom of pheochromocytoma.

Still, it is most likely that the stroke itself lead to your FIL’s acute elevation in blood pressure. Stroke is a potent stimulus for peaks in blood pressure, especially in people with high blood pressure to begin with. Paradoxically, in many cases, it may actually be harmful to treat high blood pressure in the setting of an acute stroke (eg. see here).

All of this is, of course, theoretical. The doctor who makes diagnoses over the internet is almost as silly as the person who takes his advice.

4

I am tired.

Please pardon my phrase “high blood pressure is extremely high” and my spelling (“accompanys”). :o

5

Thanks for the informative links. Obviously I’ll take it with as much salt as is required. It turns out his blood sugar was also rather high (somewhere over 200), so at this point I’ll let the professionals try to sort out all of the causality and will just see what they think at the end.