Blood pressure spikes could be evidence of labile hypertension

Dear Dr. Roach: I'm 85 years old and in basically good health for my age. I am an active nonsmoker, eat healthy, practice tai chi, and enjoy having many friends. I have no reason to experience extreme anxiety.Yet, for months, I have had unexplained blood pressure spikes. The highest I had was 243/127 mm Hg, and this is when I called local EMTs, who took me to the emergency room. I was given meds to lower my blood pressure, two electrocardigorams, and an X-ray. I was discharged after three hours and was told that my heart seemed fine.I am now taking losartan and propranolol. I tried triamterene after consulting with a cardiologist, but I couldn't tolerate the side effects. I occasionally use lorazepam.Today, a blood pressure reading showed 197/100 mm Hg. Just the thought of checking my blood pressure spikes the reading. How long can I go on with these blood pressure levels? Can these readings be normal for some people? — S.O.Answer: No, these readings are not normal. Since you say that the blood pressure "spikes," I think you mean that most of the time, your blood pressure is normal.The biggest concern is a condition where the body intermittently secretes substances that raise the blood pressure. This may be caused by a tumor called a pheochromocytoma. They are exceedingly rare, but must be looked for in a case like yours, with sudden and dramatic spikes in your blood pressure. Your regular doctor or cardiologist will know how to look for a pheochromocytoma.If you have a spike, a blood test will be dramatically elevated for epinephrine and norepinephrine. But if your blood pressure is normal at the time of the visit, a 24-hour urine test is done.There are other rare causes, including blockages in the arteries to the kidneys and certain drug use, such as monoamine oxidase inhibitors (very rarely used for depression) in combination with some foods. Cocaine use is another cause in a person on a beta blocker, like the propranolol you are on.Even more likely is a condition called labile hypertension, where emotional stress leads to an increase in blood pressure levels. This is more likely for you because of the last thing you said: Just the thought of checking your blood pressure may cause it to spike.Managing labile hypertension should be done by an expert. There are experts in hypertension, who may be generalists, nephrologists or cardiologists who have expertise in managing the very unusual cases of hypertension.Your doctor may have already considered this diagnosis because lorazepam is often used for spikes, sometimes in combination with short-acting blood pressure medicines, like labetalol or clonidine.Dear Dr. Roach: I'm a 62-year-old woman in good health who has always been very active. When I was younger, I would hardly be sweaty after I worked out. My clothes would be dry. Now when I do a similar workout, I'm so sweaty that my clothes are wet. Why is there such a big difference? Is it hormone-related? I also have hot flashes. — M.C.Answer: Yes, it's very likely to be related to the hormonal changes of menopause. When estrogen levels go down due to the ovaries ceasing production, temperature regulation at the level of the hypothalamus in the brain is changed. The brain causes heat-losing changes, like skin flushing and sweating, much more easily.This can happen for no particular reason, but it may be triggered by exercise. So much heat can be lost that a woman may get so cold she shivers to rebuild heat.If it's bothering you, try less-intense exercise, exercising in air conditioning or near a fan, or swimming.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.