Hello doctor, I am 42 years old, single parent with two kids aged 15 and 10. The last 19 years, I have had several stress related (in my view) ailments. History: Erratic bowel syndrome 19 years back, corrected now. Polycystic ovaries, corrected now (was on Metformin for one year.). Severe migraines twice a week that lasted 2-3 days. Corrected now. Hyperthyroidism which got over-corrected to hypothyroidism and therefore medication was stopped (was on Eltroxin 0.25 mcg). I was diagnosed with BP issues and chest pain 7 years back. I was on Lonzaep for anxiety and Prothiaden 50 mg a day. ATEN 25 mg for BP. Had a D&C for continuous periods- Biopsy was clear. ATEN was stopped and Nebistar 5 mg once a day was initiated by my cardiologist along with 20 mg Telmisartan. I was also diagnosed with arterial stiffness (Persiscope Cardiovascular Analysis report enclosed). I experienced alopecia and lost almost all my hair. I got it back after treatment. The Cardiologist increased Telma to twice daily (20 mg) along with Nebistar 5 mg, recently. My concerns and questions: 1) The BP continues to fluctuate going as high as 170/110 and then dropping very suddenly to very low. BP rises typically in the evenings, while it is very low at night (I understand that this is the case naturally). While I understand the concept of BP fluctuating all day, and looking at the average, I am worried that when it is very low, I am probably aggravating the situation by taking a medicine to low it further. ABP reports taken all these years are enclosed. 2) When the BP is high (mostly) I have chest discomfort and pain in the chest for 3-4 days and then subsides on its own. I am concerned that my arteries are inflamed. Please see reports on High Sensitivity C Reactive protein. 3) When I had continuous migraine and chest pain I went in for a coronary angio and a brain MRI- reports enclosed (Acute ischemic foci- Is there a correlation)? 4) My cardiologist was concerned about my echo tests and the BP shooting up very quickly during the stress test. Can you explain what the test implies and the connection between the inflammation and these tests results? 5) My stress levels overall are definitely better, I am consulting a Psychotherapist for the last 3 years, practising yoga, however the BP seems to have shot up again the last few weeks. Is it because of the extreme winters? I am undergoing a stressful situation at the moment. 6) On the whole, I would like to know: If I am at risk of a stroke? If yes, what is the probability? Is there inflammation? If so how bad is it? How can I control/reverse it? Why does the chest pain persist? The pain is usually followed along with high BP when I particularly have a heavy session in Psychotherapy or overthink some issues. -What do I do when the BP reaches dangerous levels like 170/110? Are there any drugs that I should avoid? What are the safe supplements that I can have for magnesium? I am taking Omega 3 supplements. Are there any follow on tests and medications that you recommend? I got a full health check done four months back and kidney tumors, etc., have been ruled out. Happy to share additional reports in case needed.
Hello. I would largely comment from cardiac point of view. So overall, other than BP, your cardiac status is normal. Your heart function is normal and no RWMA, your blood vessels were clean on CT coronary angiography (attachment removed to protect patient identity). So, I do not think there is anything to worry from cardiac perspective. Regarding chest pain, if BP is elevated then it can cause some strain over the heart and cause chest pain. But it would be limited to time during which BP is elevated. Now considering that you did not have any chest pain during stress test and BP was elevated during stress test, pain is probably unrelated to BP or heart. If you are having any ventricular ectopics or extra beats then it can cause some dull ache in chest. Now other aspect is BP. You have tendency for BP elevation due to your genetic make up which is part of PCOS, etc. How much do you weigh? Also, your psychological issues tend to worsen BP. BP may rise during exercising and considering your high BP tendency, it may excessively rise during exercising. Other factors which can worsen BP is stress, high salt intake like pickles, NSAIDS like Brufen or other pain killers, migraine medicines or even any pain can worsen BP. So, avoid pain killers other than Paracetamol or Tramadol, plenty of fruits, have low salt diet, regular exercises, try to keep weight under control. If BP elevates then you may have an additional dose of Telmisartan. Maximum you may up-to 80 mg in a day. Also, while taking BP readings, you should keep your arm relaxed, take 2-3 readings at a time and take BP after rest of 5-10 min. If BP is rising persistently in the evening then additional dose of Telmisartan may be added in the afternoon 2 hours before the expected BP rise. Your average in last abpm was fine and occasional high readings are not worrisome. Regarding inflammation, best way to settle inflammation is healthy lifestyle like avoiding fatty oily and high calorie diet. Having regular exercises like brisk walking or running according to capacity. Also, you should get your lipid profile done and statins like Rosuvastatin prescribed to settle this inflammation. Dinner should be light. Now, regarding your stroke risk, it is better to get a neurologist opinion. The changes may be related to inadequate BP in the past, but you should also obtain carotid artery Doppler for source of emboli. Also, transesophageal echo should be obtained to rule out possibility of patent formanen ovale as a source of emboli.