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THE BEAN:
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 Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication, including the use of emergency blood pressure medications. Let’s meet John and Jerry, two patients who are experiencing rebound hypertension.
John’s Story John Smith is finishing out his career as a police officer and is looking forward to retiring with his wife, Jenny. He is passionate about being a police officer and works diligently to maintain his health. John loves to watch football, hike with Jenny, or golf with his buddies when he is not working. Despite his efforts to stay healthy, John’s blood pressure continually increased and he was diagnosed with hypertension seven years ago. He was put on medications to lower it and he has since been stable. However, in the past year, he has experienced spikes in the 180s, well outside of his normal range of 120s-130s. With these spikes, he was experiencing headaches and his heart would race. His nephrologist prescribed him an emergency relief drug, Clonidine, a short-acting drug that reduces blood pressure quickly. The Clonidine seemed to work for John when he experienced his blood pressure spikes. His blood pressure would return to its normal range, as intended. Not long after that, John would begin feeling another headache. He would take his blood pressure again and his reading was back into the 170s. “That’s odd,” John thought to himself. “I just took my medication and it was back to normal.” This happened two more times in the coming weeks. He called his nephrologist and explained what he was experiencing. Jerry’s Story Jerry Williams is a retired accountant. She spends her days watching her 3 grandchildren, reading, and baking. She is diligent about looking after her health and overall wellbeing. Jerry was diagnosed with hypertension three years ago and was put on medication to control it. Along with her medications, she also implemented daily walks and swimming, when the weather allowed and worked to reduce her sodium intake. Jerry’s blood pressure did well on the medication regimen and she saw significant improvements when she added the recommended lifestyle changes. Her blood pressure has begun dropping into the 100s and she experienced dizziness and lightheadedness. At her next appointment, her nephrologist took her off of her blood pressure medication to help bring her blood pressure back up and stop her new symptoms. After her medication reduction, Jerry noticed her blood pressure was elevated, with readings consistently in the 160s. “We only adjusted one of my medications,” Jerry thought. “Why is my blood pressure acting like this?” She notified her nephrologist and went to be seen for another appointment. At their respective appointments, Jerry and John heard this from Dr. Munjal: “It looks like you are experiencing rebound hypertension. Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication. The good news is that this tells me exactly what I need to know.” For Jerry, the current dose is too much and zero is too little. She was put back on her medication and started the weening process. John had one of his other regular medications adjusted to reduce the potential for the spikes and saw a reduction in his emergency medication use. What we can learn from both John and Jerry is that blood pressure is not one size fits all. We expect changes to happen over time which is why rebound hypertension tells us just as much as the initial diagnosis. It helps us make adjustments to keep blood pressure stable as the situation changes. Not everyone needs the same types of changes, so it can take a few tries to get the medication dialed back in to meet each patient's specific needs and circumstances. If you are experiencing rebound hypertension, please contact your doctor to discuss or go to the ER if you experience a hypertensive crisis. As always, stay safe and healthy! Resources: https://medlineplus.gov/ency/article/000155.htm#:~:text=Rebound%20hypertension%20occurs%20when%20blood,like%20beta%20blockers%20and%20clonidine. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417  According to the CDC, approximately 129 million people in the United States have at least one chronic disease like cancer, hypertension, diabetes, or heart disease. That is almost half of the entire population. Many chronic illnesses are accompanied by a number of comorbidities as well. These illnesses require constant attention, both mentally and physically, to maintain balance in the patient's life. Let’s explore some of what reality may look like for some people.
Habits Having a chronic illness often means that patients have to develop healthy habits and routines to ensure they are staying on top of their healthcare between appointments. This can look like:
Appointments and Labs Chronic illnesses often mean additional appointments with primary care, a variety of specialists, treatments or infusions, and labs or imaging. We often hear that many of our patients have an appointment a day every week for themselves and their spouses. Can you imagine how limiting that can be on someone’s personal schedule? Remission and Relapse As we age, our bodies naturally change over time, whether we want them to or not. Blood pressure, especially, is an ongoing, ever-changing thing. It is only a matter of time. Seeing a decline in lab results or changes in blood pressure can be disheartening, especially when a patient has been “doing all the right things” to keep themselves on track. Importance of Monitoring Regular monitoring by patients and doctors together is vital to ensuring that we are able to catch trends and intervene sooner rather than later. Programs like Remote Patient Monitoring help us track changes more closely and identify trends early. Monitoring does not replace regular appointments, but is an incredible tool in assisting your care team in seeing the bigger picture of your health. However, a formal program isn’t always necessary. Tracking daily weight and blood pressure readings at home also help in the decision making process. We want to know what readings look like on average in a normal, day-to-day setting. In an office, there can be multiple other factors contributing to different weight and blood pressure readings, like additional shoes/clothing, eating/drinking, traffic, White Coat Syndrome, etc. This is not to say that these readings are inaccurate, but seeing the home-setting trends are equally important to avoid over- or under-medicating. Considering all these patients have to go through, manage, and keep track of, they deserve an award for handling their lives and continuing to push forward. Share a smile or warm hug and offer assistance to others when you can: you never know who may need it most. Resources: https://www.cdc.gov/pcd/issues/2024/23_0267.htm |
