Which MD/Specialist to choose?

By Stacie Tuesday, May 22, 2007

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33 yr old male diagnosed with HBP 3 yrs ago (220/140). Has been on numerous medication to get his BP under control. Allergic to ALL Ace Inhbitors (severe reaction). He has seen a Neurologist, primary MD thought maybe sleep deprevation was cause; no luck. Had tonsils & adnoids removed 4/06 to help sleep/blood pressure=no luck. Saw a Nephrologist 10/06 when we ended up in the ER (again!) because he was going numb in limbs & "didn't feel right". BP at that time was 200/120. Patient had been taking Labetolol 300mg 2x/day, Norvasc 10mg 1x/day. After ER, Minoxidil was added (Norvasc d/c) along with Aldactazide 1x/day. Patient responded poorly to Minoxidil and was changed to Hydralazine 50mg 2x/day. After 1 month, still no significant results. Pt is appx 50lb overweight, went to dietician, lost some weight and still no change in BP. Aldactazide was added at that point. Recently patient ended up in ER with dizziness/'pass out' feeling. BP dropped to 130/60. Upon leaving ER BP was back up to 160/90 and "call your primary". Primary MD added yet another medication, Hytrin 2mg. Patient took for 4 days, still BP is hovering at 170/110. Primary told patient to double dose.. 4mg now (with Labetalol, Aldactazide & Hydralazine) patient took for one week & is lethargic, tired & out of it, but BP is still 172/110. Called primary & was told to double dose again (now Hytrin 8mg). Patient had started with personal trainer to try & lose weight but felt so awful today he couldn't go. Patient has no history of diabetes or high cholesterol, MRI & CAT scans all come out normal. High level of CPk (varies from 850-1100) but normal limits of triponin. Patient's father had quadruple bypass at age 50. After all this, my question is what specialist can help him? We are in Massachusetts and at this point we will try anything. Patient is beyond upset and stressing himself out more because he feels that no one can help him. Any advice would be wonderful. Thank you.. Patient's wife, Stacie

Comments (14) | Add comment

Laura, Editor

6/13/07 12:12pm

Dear Stacie,

I'm sorry about your husbands luck with getting help for his HBP. You might want to refer to this site http://www.healthcentral.com/common/frame.html?url=http://dbapps.ama-assn.org/aps/amahg.htm. Just enter the speciality and state in the search box. The site contains information on almost all licensed physicians in the U.S. I hope this helps and good luck!

-Laura

Joy

10/13/07 1:08pm

Hi Stacie, Reading your account of your husband's blood pressure condition, it sounds just like my husband's condition. He has uncontrolled BP for years and they keep doing the same tests over and over and when they can't figure out what to do next they add more medicine. He has had two sents put in and his carotid artery on the right cleaned out . He just doesn't feel good and he has TIAs alot along with chest tightness. But again they don't know what to do. He was recommended to go to a BP specialist, so we are trying to find a good one in our area. What did your husband end up doing? We live in Bradenton, Fl Please write me back, thanks. Joy

Anonymous

10/30/07 10:53am

See a neurologist. My dad (74 yrs old) has similar symptoms due to a blocked carotid artery. He gets dizziness/numbness and generally bad feelings when his blood pressure is too low due to lack of blood flow to the brain

Ian

6/ 2/09 10:18pm

I have HBP I'm 32 years of age BP 160/90 taking diovan 320mg amplodipine 2.5mg and atenalol

try to search for a specialist

http://www.ash-us.org/specialist_program/directory.htm#

click on the directory. Hope this help.

angie

10/17/11 5:51pm

did you get any results fom your url for directory assistance in locat8ing BP specialist

randall l

4/11/10 6:21am

what have you done with your husband's situation?

Ruth

1/14/11 4:30pm

Hi Stacie,

What's going on with your husband right now? Did you find a specialist who could help him? I'm sorry he has that problem. I've had several BP meds over the years and have bad reactions to most of them or else they just plain don't work. I need help too.

DoctorBlobby

4/21/11 9:00am

dual calcium channel blockers should be tried.

take nefidipine 60mg SR combined with diltiazam 240mg SR once

a day

titrate dose as required

side effects will be swelling of the lower legs and itcy rash on shin

if dose is titrated due to side effects add in hydrene 50mg - 100mg once daily OR

fosonipril HCT 20/12.5 mgs. (do not add both of these at once to the dual CCB or you will suffer from hypotension).

good luck

DoctorBlobby

4/21/11 9:02am

ok allergic to AI so forget the fosonipril if titrating just use the hydrene!!

Stacie

4/21/11 11:12pm

Thank You to all who had written. I did not know anyone had responded/commented until I received notification of a comment made today, 4/21/11!!

My husband stuck with the Nephrologist. He has also seen a Cardiologist at MGH in Boston, who did not have any magic tricks - said we were doing all we could. Also saw a Neurologist, who confirmed no blockages, etc. but did do another sleep study and my husband now has a CPAP machine. We have ended up in the ER a few times because of the symptoms he gets when BP gets to high, appx 200/140 (mostly during the summer, when very humid)
Current Med List:
Tekturna 300mg daily
Doxazosin 8mg daily
Toprol XL 50mg daily
Spironolactone 25mg daily
Chlorthalidone 50mg daily
Amlodipine 10mg daily
I will say, the one medication we have noticed the most improvement on, is the Tekturna. This drug has been around for many years, but available in Europe; only recently approved in the US. It has done wonders for my husband, which is a miracle. His BP has been 'stable' at
130-140/80. It may not be perfect numbers, but it's a lot better than what we were dealing with!
Someone mentioned Ca Channel Blockers (Nifedipine, Diltiazem) but for some unknown reason, my husband in all these years, has never been prescribed them.
So, he's still trying to lose weight (a very tough thing for him), no salt, no processed foods, sleep with CPAP machine and see his Nephrologist every 3 months to stay on top of his condition.
Thanks again for everyone's input, very much appreciated!!
~ Stacie

lew huggins

8/ 4/11 7:02pm

Stacy I have had a problem similar to your husband in that my blood pressure has been very high for several years. I am currently loojking into parathyroidism. If blood calcium is high a whole list of problems can insue. I have been attempting to get my BP low enough to have surgery on my parathyroids. The internet has considerable information about parathyroids. Lew

Stacie

8/ 4/11 10:17pm

To Lew:
To say he has had every (and I mean every) test possible is an understatement!! He's been tested on a regular basis for T3, T4,TSH & Parathyroid because his sister has hypothyroidism.
I, as well as his doctors, have been rather amazed that other tests have not come up abnormal. I will say, the only thing he does have to constantly do is a 24 hour urine collection because no matter what he tries, his sodium levels are thru the roof.
I am proud to say, this is the first summer (knock on wood) that he has not been a guest at the cardiac unit of the hospital. Very proud moment for us - one that hasn't happened for about 7 years.
In my husband's case, even though no test seem to 'say' or indicate it, his PCP and most of the specialists he's seen have all agreed that his problem lies within his kidneys and will ultimately - or with their help, NOT - result in kidney failure.
So, I'm not sure what the best answer is for anyone; for us it was really the Nephrologist (and I'm telling you - the Tekturna!!).
I appreciate everyone's input & support; we were at our wits end, which takes ALOT... my husband's sister is a cardiac ICU nurse and I am a Pharmacist going on 15 years now, so his condition and the medication surrounding was nothing new but having to deal with personally is a little different.
Good Luck to everyone!!
Thank you all ~ Stacie

angie

10/17/11 5:42pm

wish to know if anyone else has problem with labile hypertension, particularly high systolic, plus orthostatic hypotension wherein blood pressure drops dramatically upon going from prone position to standing upright. Severe dizziness comes about immediately.

Angie

HBP

8/26/11 8:54am

I have had similar problems in the last year. Not quite as severe. Anyway, I'm not a doctor, but I do know that losing weight, walking, and giving up coke, esp. diet coke or pepsi, anything with Equal(aspertame) in it will make a world of difference, plus cut down on all caffeine, and it will do wonders over time, not an instant cure, but a lifetime benefit. I even was diagnosed with Fibromyalgia, and it has disappeared. Good luck to you both.JN

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