hypertension

Man shocks doctors with extreme blood pressure, stroke from energy drinks

Sometimes, downing an energy drink can feel like refueling your battery. But with too much, that jolt can turn into a catastrophic surge that fries the wiring and blows a fuse. That was the unfortunate and alarming case for a man in the UK several years ago, according to a case report this week in BMJ Case Reports.

The man, who was in his 50s and otherwise healthy, showed up at a hospital after the entire left side of his body abruptly went numb and he was left with clumsy, uncoordinated muscle movements (ataxia). His blood pressure was astonishingly high, at 254/150 mm Hg. For context, a normal reading is under 120/80, while anything over 180/120 is considered a hypertensive crisis, which is a medical emergency.

The man had suffered a mild stroke, and his extremely high blood pressure was an obvious factor. But why his blood pressure had reached stratospheric heights was far less obvious to his doctors, according to the retrospective case report written by Martha Coyle and Sunil Munshi of Nottingham University Hospital.

Upon examining the man, the doctors described him as fit and healthy. He didn’t smoke, drink, or use any drugs. His blood work was all completely normal. His cholesterol, blood sugar levels, markers for kidney and liver function—everything from routine tests came back normal. Specialized tests for things like autoimmune and clotting disorders were also negative. Heart tests found no problems. Urine tests and abdominal scans found no problems with his other organs.

Power surge

Still, a computed tomography (CT) scan of his head found evidence of spasms in arteries in his brain, which are strongly linked to high blood pressure. And magnetic resonance imaging (MRI) found an infarct (dead tissue) in his thalamus, a central, deep part of the brain, which, among many critical functions, relays sensory and motor signals. In all, it seemed his spasming arteries had cut off blood supply to this part of his brain, causing his stroke, subsequent numbness, and ataxia.

Your doctor’s office could be reading your blood pressure all wrong

blood pressure, health, hypertension, JAMA, Science / Rejus Almole / October 8, 2024

Under pressure

Before participants took readings in any of the positions, the researchers had them simulate walking into a doctor’s appointment. They walked for two minutes and then sat calmly in position for five minutes before taking the three readings. Before moving onto the next position, they got up and walked again and sat for another five minutes. The participants were also randomized into groups that took the first three readings (desk 1, lap, side) in different orders, with all groups ending on desk 2.

The researchers then compared the differences between desk 1 and desk 2 to differences between lap and desk 1 and side and desk 1 for each participant. The desk 1-desk 2 differences captured intrinsic variability of blood pressure reading within each participant. The comparisons to lap-desk 1 and side-desk 1 captured changes based on the improper arm positions.

In all, there was little difference in the desk 1-desk 2 comparison, with participants having a mean difference of -0.21 mm Hg in systolic blood pressure and 0.09 in diastolic. But, the improper arm positions had significant effects on the readings. Lap arm position resulted in a mean increase of 4 mm Hg in both systolic and diastolic readings. Side arm position led to systolic readings that were 6.5 mm Hg higher and diastolic readings that were 4 mm Hg higher. For those with high blood pressure readings—about 36 percent of the participants—the wrong arm position caused yet higher readings, with systolic readings about 9 mm Hg higher than desk readings.

The authors speculate that simple physiological mechanisms likely explain the increase in blood pressure when the arm is lower than the heart—more gravitational pull, compensatory constriction of blood vessels, and muscle contraction may lead to higher pressure. As for why health care providers are known to sometimes use these wrong arm positions, it may be a lack of awareness, training, equipment, and/or resources.

The authors of the study call for more training and education about proper blood pressure measurements, which are essential for appropriate management of hypertension and prevention of cardiovascular disease.

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