Last Monday, I went to my Asthma clinic for my bi-monthly Fasenra injection. After checking in, the technician called my name and, as usual, checked my vital signs: heart rate, oxygen saturation, and blood pressure. While checking my blood pressure, I felt the cuff around my arm getting tighter than usual, so I knew my numbers were going to be higher than they typically are. The tech said “Wow, is your blood pressure always this high?” When I looked at the numbers on the machine, even I was shocked. My blood pressure was 276/150. Thinking it was an error, we checked it again. I took a deep breath, made sure both feet were on the ground, and tried to relax as much as possible. The reading was a little lower this time, but not by much—it was still well over 250. Thinking that this was a just a fluke I told the technician not to worry about it, as my blood pressure always tends to run high when Im at the doctors office and that I would recheck it when I got home. With that assurance, we proceeded to the injection room, and she gave me my shot. As is protocol for this office, I went back to the waiting room and hung around for another 30 minutes before leaving. (In retrospect it probably wasn’t the wisest thing to get the Fasenra shot while my BP was so high.)
Anyways, it wasn’t until I actually walked out of the office to my car that I started feeling weird. I knew that high blood pressure for prolonged periods can be dangerous, and I wanted to get home to check it again. However, I had to make another stop before heading home. The previous evening, I had left my phone at my aunt’s house, so I needed to pick it up. The drive from the allergy clinic to my aunt’s place was about 45 minutes away by freeway. Feeling anxious about my high blood pressure and starting to feel the side effects of the injection—or maybe the hypertension—it was a very tense ride. We rely so much on our phones, and I kept thinking about what I would do if I got a flat tire or if the high blood pressure affected my ability to think while driving. All kinds of thoughts were going through my head, including the vision problems I had experienced a couple of days earlier. More about that later.
I made it to Aunties house in onw piece. When I got there, I told her what had happened at the clinic and asked to use her blood pressure machine to see if my blood pressure had dropped. I tried her machine three times and kept getting an error message. I could tell by the rising numbers on the machine—200, 220, 230—that the pressure was so high it couldn’t calculate it accurately. That’s when I knew this was serious. I had now been extremely hypertensive for at least two hours that I knew of. I needed to get home and sort this out. I made it home in about another 45 minutes, and the drive this time was definitely more stressful. It felt like my head was in a vice. I’m sure my anxiety about the whole situation wasn’t helping. I rechecked my blood pressure, this time on both arms, and sure enough, it was sky high. First, it was 240/160, then 250/160. It just wasn’t coming down. I didn’t really know what to do except take another 40mg of Benazepril, which I take daily for my hypertension. I then tried to get a message to my doctor, but it was lunchtime, of course, and I was put on endless hold. I then remembered that my healthcare provider offers on-demand video appointments. Great, I’ll try that. Nope, the service is not available between 11:30 AM and 1 PM. Finally, I got through to a receptionist who relayed a message to a nurse. They went back and forth asking me a few questions and just said I needed to go to the nearest ER. Well, off we go.
It’s a Monday, and of course, the local ER is packed. I thought, great, we’re going to be here all day. I got in line to register, and to my surprise, it only took 10 minutes for the triage nurse to call my name. Almost apologetically, I said, “Sorry to bother you with this blood pressure thing, I know you guys are swamped.” She replied, “Hey, that’s what we’re here for.” She checked my blood pressure, and it was now 280/220! “You did the right thing by coming in, this is what we call a Hypertensive Crisis” She asked if I had any other symptoms, like chest pain, headache, vision problems, or speech problems, then whisked me to one of the ER beds. From entrance into the ER to a bed in less than 12 minutes—outstanding!
While in the ER they did the expected battery of tests to rule out things like stroke or a heart attack. They did an EKG, took blood, and then put in an IV and accessed my port. From there, they gave me an IV bolus of Hydralazine, which brought down my blood pressure a little bit but also caused severe nausea and triggered my asthma. I was wheezing and retching at the same time. Trust me, not fun. They eventually gave me something for the nausea which helped and then switched me to a Nicardipine drip, which allowed them to titrate the dose to my blood pressure. It took about four hours, but they were finally able to reach a target pressure of 160 and below. Because my asthma was acting up and my breathing was getting more labored, they simultaneously started me on a continuous albuterol nebulizer and had the pulmonologist come see me. A great guy, the lung doctor had already learned a lot about me through MyChart and pretty much let me call the shots on how to proceed with the respiratory part of my treatment. Knowing that I have problems with high dose steroids, we agreed that I would get an initial 120 mg dose of Solumedrol and then 40-60mg a day after that.
Shortly afterward, the hospitalist physician made her appearance. Dr. Hazel Abraham, an absolute jewel of a physician—polite, curious, and calm as a cucumber—immediately delved into my medical history to figure out why my blood pressure had been so high. She got on the bedside computer and probably spent 20 minutes reviewing old records from previous admissions and asking me a ton of questions. She said, “I see you’ve had a blood pressure crises in the past. What’s this about temporarily losing your vision during that episodes?” I responded, “Yes, this isn’t my first Rodeo with sudden vision problems and blood pressure spikes. About 4 years ago while doing some shopping, the vision in my right eye suddenly got really bright and blurry– I couldn’t make out anything. I went to the ER as instructed, and it turned out that my blood pressure was sky high. They treated it pretty much the same way you are doing right now.” I then told her about the event (which I briefly mentioned above) that occurred just two days ago. I woke up that morning and couldn’t see anything through my right eye, everything looked like a bad oil painting. At first, I thought it might be allergies or maybe something got stuck in my eye. It was weird, but I wasn’t overly concerned about it, because my vision returned fully after about an hour and that was the end of that. It wasn’t until I went for my Fasenra shot two days later that I put two and two together. Additionally, she found notes from a retinal specialist from seven years ago that said there was evidence of an eye stroke caused by a high blood pressure spike. Lastly, she also noted an ultrasound of my right carotid artery done a couple of years ago that showed a blockage of 50-69% in that blood vessel. Could that has something to do with this?
So now I’m into my fifth hour in the ER with my blood pressure more stable, they sent me for a CT scan of my head to make sure I had not suffered a stroke, which I hadn’t. Just to make sure there was no cardiac damage or cause, she also ordered a cardiac echo and, the following morning, an ultrasound of my right carotid artery (ICA). My heart looked fine, no pulmonary hypertension, and the carotid artery was unchanged with an estimated occlusion of 70%.
So what does this all mean, and why does my blood pressure keep getting crazy high? This is something I really need to work on with my Cardiologist, but putting the tiny pieces of this seven-year puzzle together, Dr. Abraham surmised that I’ve had not one, but probably several high blood pressure events, which may have caused a tiny piece of plaque to break off from my right carotid artery and travel to my right eye, causing the temporary blindness/blurriness. This time around I probably experienced the precursor to a stroke, known as an TIA or Transient Ischemic Attack. Difficult to say for sure, but she thinks that rather than labeling this an “acute” event, that my blood pressure has probably been getting progressively worse over the years and not treated properly. Whatever the cause, I need to get my body to stop doing this.
Full disclosure, blood pressure issues are nothing new to me. Co-morbidities, like hypertension and diabetes come with the severe asthma territory. Even though I eat fairly healthy am not overweight and exercise daily, I’ve been hypertensive for a long time, probably because of all the years the steroids and asthma medications. Ive been on anti- hypertensive meds for almost 20 years. Im actually pretty diligent about monitoring my pressures regularly, but maybe not so good about following up with my doctors, as these secondary conditions always seem to take a back seat to my lung issues. Anyway, I spent the next two nights in the hospital, one night in the ICU and one on the wards. Not so much for my blood pressure, which resolved fairly quickly with the IV hydralazine, but mainly because of my asthma and my breathing, which was exacerbated by all of the above.
Out of the hospital now for 3 days, my blood pressures are lower and less labile, but I think are still too high being in the 150s/85s. Ive now connected with my Cardiologist. He wants me to record my BPs 4x day and share with him until we figure out what to do about this.
Folks, if you have a history of high blood pressure, make it a habit of checking your numbers regularly. High blood pressure is no joke, It can disable and kill.
Not to preach, but folk if you have a history of high BP, check your pressures regularly and work with your doctor to keep them in the safe zone. High blood disables and kills people everyday.
Lastly, a shout out to the wonderful care I received from all the Doctors and Nurses at John Muir Hospital Concord, California.
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