Patient called me with a blood pressure of 170

He has resistant hypertension that has been well controlled since we added spironolactone. He reported that his systolic blood pressures were between 170 and 205 over the last three hours. In the morning his blood pressure was 120 and for the last week he had been getting blood pressures of 115 to 135, trending toward the lower end of that range.

I told him that I wasn’t worried about the isolated spike in blood pressure. The goal of therapy is to get the average blood pressure down and that chasing individual isolated episodes of hypertension becomes a hopeless game of whack-a-mole.

The treatment of hypertension is like trying to change the climate, not control the weather.

What do you do when they get this phone call? Do you chase after elevated blood pressures with prn clonidine? Is there an evidence based approach to this?

3 Replies to “Patient called me with a blood pressure of 170”

  1. Not qquite so simple. Check out HYPERTENSION june 1011:57:1087-1093 and editorial commentary.Highest home systolic BP predicted increased TOD(LVMI) regardless of mean systolic BP…not quite ready for prime time, but suggests whatever we can do to decrease BP variablity may be helpful( diuretics, ccbs) OR that folks who vary have underlying phys issues that predispose to increased TOD

  2. above was steigerwalt s i dont know how to post with attribution- i dont have a blog yet

  3. Completely agree with your approach. Chasing these asymptomatic events will do nothing but drive the patient further into BP paranoia. Identify inciting event if possible, otherwise just follow along and watch the trend.

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