Ask a doctor on the topic of Internal medicine

High blood pressure, gastritis, ketone bodies, monocytes

December 20, 2010 | 20,00 EUR | answered by Dr. med. Ralf Berg

Dear medical team,

about 4 weeks ago, I suddenly started experiencing dizziness, a red warm head after eating (feeling like I had a fever but I didn't), which disappeared after a day of rest. However, a few days later, the dizziness worsened upon waking up, accompanied by cold sweats with minimal exertion, feeling faint and trembling, as well as inner restlessness, to the point where I wanted to run a few kilometers, tingling in the area of the sternum, hot flashes after every step. I decided to see a doctor.

Age: 26, male, 179cm, 78kg, relatively active (regularly running 5km in the summer, swimming and cycling 2-3 times a week for 1-2 hours each time for stress relief). In 2006, I weighed 67kg, then got an office job, gained weight within a year and maintained it since then (possibly due to regular after-work beers).

The GP measured my blood pressure at 160/100, normal ECG. He referred me to the hospital for further investigation. My medical history includes always having slightly low blood pressure and iron deficiency (I was always pale and tired, needing 9-10 hours of sleep per day), as well as bronchial asthma and allergies to various natural substances.

In the hospital, several tests were conducted including blood work, urine sample, blood gas test, sonography, echocardiography, 24-hour blood pressure monitoring, bicycle ergometry, chest X-ray, body plethysmography, and gastroscopy. All tests were inconclusive except for the following findings:

Urine: Ketone bodies 2 mmol/l, otherwise normal
Blood: Monocytes, rel. % 8.9 (norm 2.6-8.2)
Liver: small liver hemangioma
Erosive gastritis
Bicycle ergometry: Stopped at 175 W due to peripheral exhaustion and reaching maximum stress frequency. During the recovery phase, there was a significant drop in blood pressure with dizziness symptoms up to blood pressure readings of 88/68.

After a week in the hospital, I was discharged and my GP promptly referred me to a heart clinic due to concerns about the blood pressure drop. The heart clinic, after reviewing the hospital discharge report, did not conduct any further tests and sent me home. Additionally, an angiography of the renal arteries was performed, without any findings.

Medications I am taking: 2.5mg Ramipril and 1 Pantoprazole in the morning.

Currently, I am feeling much better, the fatigue has improved, and I can sleep through the night. My blood pressure fluctuates at rest during the day between 110/60 (morning, after taking the tablet) and 135/85 (afternoon). I experience mild headaches and dizziness throughout the day, but can

Dr. med. Ralf Berg

Hello, dear questioner.

I would like to start here quite philosophically with a saying:
Lord give me the strength to change the things I can change.
Lord give me the insight to tolerate the things I cannot change.
and Lord give me the wisdom to distinguish the former from the latter.

1. Statement No. 2 applies to your blood pressure. 95-98% of all people have "essential" hypertension, meaning it is genetically determined. You cannot change your genetic origin, you need to treat the blood pressure to prevent the consequences (e.g. heart attack) from occurring.
2. Many patients starting with hypertension therapy report fatigue. Especially when the blood pressure is effectively lowered by the medication, as in your case. The body needs to readjust to the new (normal) pressure level. Over time, the organism adapts and dizziness and tiredness subside.
3. Regarding Point 1, your weight and fitness are factors you can change, in the long term you can lower your blood pressure by about 5-7 mm Hg. Sometimes you can also significantly reduce the medication dose. The same applies to weight. However, as a reminder, in your case, there seems to be a genetic predisposition to hypertension, which needs to be treated repeatedly. (The investigation was very thorough, even with angiography ruling out a kidney disease as the cause of high blood pressure.
4. Concerning the blood values: you don't need to worry about ketones and monocytes. Bacteria produce ketones, so they can indicate a bladder/kidney infection. However, if the other urine values are normal, it is more likely that your own metabolism has produced some ketones. This is common in diabetes, but this has already been ruled out. Monocytes also need to be persistently elevated. Automated analysis can sometimes lead to counting errors. It is more likely that in the context of your allergic conditions, "increased stripes" are present in your blood, but this is not a cause for concern.
My practical suggestion: Check again in 3-4 weeks if you continue to worry. No other causes were found during the investigation (gastro, etc.).

Overall, I must say that you have been thoroughly and very purposefully examined. The result is a genetically determined hypertension that needs treatment, and you need to physically and mentally adjust to its treatment.
By changing your lifestyle and weight, you can make it difficult for your predisposition to prevail.

Wishing you a merry Christmas and all the best,
Dr. R. Berg