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Mild ARTERIAL HYPERTENSION after CVA brain. Treatment?

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Hi,my mother has suffered from CVA brain in the year 2010 Sep.From there onwards she is on medicines :Nicardia R20 (2 times),Seloken XL50 ,Neuorobin and Ecosprin 75mg.She is also on diabetic medicines.We do all regular blood tests and she is having normal blood pressure,Lipid profile and sugar levels.Recently we have done regular 2D Echo of heart and reports have been attached.However there are some inferences which have been highlighted in reports.I just want to understand what is this Mild Arterial Hypertension and what should be our next steps for this.I have read very bad things in the internet.PLEASE GUIDE.

SHE IS 68 years old and also taking Atorva 5mg


Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
Regards from our team.
I had gone through the medical records, and I wish to assure you that everything seems fine and there is absolutely no need to press the panic button now.
I wonder if any evaluation was done for a stroke that happened at an age of 64, or was it presumed to be normal atherosclerotic ischaemic stroke?
By any chance have you calculated her body mass index? Is she obese? What about her neck circumference? Does she snore during sleep? Did she have any breathing difficulties/ on rest, with change in climate or day or seasons? Does she have any breathing difficulties during walking?
Why would I ask you to ignore the minimal pulmonary artery hypertension- because it's associated with age, it's still mild, and above all, it's measured by transthoracic echo, which is highly erratic for assessment of pulmonary hypertension.
What all would I suggest if you are still keen for evaluation??
1). Sleep study.
2) pulmonary function test, with diffusion capacity.
3). Chest x ray.
And based on above, if indicated, a hrct thorax.
A pulmonologist would be able to do a physical examination of lungs, and help you further.
The reports of pulmonary hypertension you read over net would be those of primary pulmonary hypertension, that begins in bit younger age, and progresses over time - which is not the case here.

Hope I might have cleared your doubts.
Regards,
Dr. Jacob George P
MD IDCCM FCCP


Patient replied :

Thanks a lot for replying so fast.My answers to your queries are:


I wonder if any evaluation was done for a stroke that happened at an age of 64, or was it presumed to be normal atherosclerotic ischaemic stroke? Yes brain MRI was done and she was admitted in hospital for around 7 days and it was ischaemic stroke.Fortunately she didnt have any physical disablement....some mild problem with vision....


By any chance have you calculated her body mass index? Is she obese? What about her neck circumference? Does she snore during sleep? Did she have any breathing difficulties/ on rest, with change in climate or day or seasons? Does she have any breathing difficulties during walking? No breathing difficulties but i do check her SPO2 levels which is around 94 to 96% and increase during exercise to 98 or 99%.snoring yes and she was very obese before stroke around 90+kgs but now she weighs around 70kg


Breathing problems are not there as of now and she is very active....


So there is nothing to worry....




Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Dear friend,

I suggest you try a sleep study to know if she is desaturating during sleep. I expect it. And if it's severe, a cpap might be required, and it will help to cut down further chances of stroke.
Else, we can ignore it..

Regards


Patient replied :

Thanks..so I will randomly check her spo2 levels during sleep tonight and share with you but could you please let me know what are the levels which could raise alarm?


Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Hi,

Suggest you do it professionally.. But any value less than 88 will be alarming. There is something called apnoea, hypopnea index which is difficult to detect randomly.
Regards


Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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