Your aunt needs to see a physician ASAP! She is at extreme risk for cerebrovascular accident (CVA) or stroke. If her primary care physician (PCP) cannot see her today, then take her to emergency room. If your aunt refuses to go to emergency room then call her PCP and request an order for home care. In mean time, sort through your aunt's medications and find out if she has been taking her blood pressure medications.

I would suggest to her that she discuss this issue with her primary care physician. When she has her doctor visits, does she bring a family member in to the appointment with her to make certain everything is being communicated to the doctor? As a former medical assistant, I highly recommend this. Many times the elderly do not communicate well with their doctors because they are 'awed' and/or fearful of taking up too much of the doctor's time and other such concerns. This matter certainly needs to be addressed either by her primary care physician or her cardiologist. If she has been on the same medication for many years, she may require a change or adjustment.

My other thought is that a near-by family member should probably make a visit daily to insure that she is indeed taking her medication as often as she should. I cannot tell you how many elderly people I encountered during my time as a home health aid who did not take their medication according to their doctor's instructions. Many wanted to 'save money' by taking it every other day. Many simply forgot. If forgetfulness is an issue, a family member should get her a pill case and set the pills out for her and then make a phone call to remind her to take her pills.

If all of this is already being done, then check into what type of diet she is following. Lots of elderly people tend to use convenience foods which are typically high in salt and can elevate the blood pressure. Make sure she is following a heart healthy diet.

If she has weight issues and is over the weight she should be, encourage her to lose a bit. It's amazing how much this can help.

Bottom line is, if this is all already being done, this may be as low as her doctor can get the pressure with medication. Sometimes it happens in the elderly. But definitely discuss this with her physician.

Thanks for caring -- from my experience so many family member don't.

Thanks for the reply. Yes she lives with me. She takes her medicine and I stopped using salt in my cooking. I guess she isn't supposed to use salt substitutes. The doctor said she is on the max medicine she can have. Metropolol,clonidine,linisopril,coreg,lasix, potassium,insulin shots. Oxbutunol for incontinence urgency. Her blood sugars are always over 200 and 300 at night. Back to 100the in a.m. they said she has diastolic heart failure,but her heart condition is mild. She had a stroke a couple years ago and has mobility problems from that. Other than these crazy numbers she holds her weight around 140. I don't know. I always thought these were very dangerous numbers. Is this pretty common for elderly people to have these numbers?

Oh I meant to say her blood pressure has been high the whole time she has lived here but her hp only rarely hit 200/60 in thethe eve,maybe like 2 or three times in a year. These numbers running consistently over 200 have been the norm since she had a possible mild heart attack in nov. We take her bp in the morning and eve. The morning was normally lower,forr the past couple of weeks it runs over 200 also.

Your aunt has severe chronic illnesses which cannot be cured but which can be treated. She is also pretty old, which means you are more worried than she is about her health.

She is on a number of blood pressure medications but her blood pressure is not controlled, at least not for the last few days. Her diabetes is not particularly closely controlled either, although it might be dangerous to get her sugars closer to normal, since she could bottom out, and that would be a disaster.

I think she should see her doctor and have her medications reviewed and improved. I am sure this can be done. Most elderly people can have decent control of their blood pressure, and as has been already pointed out, blood pressure in the malignant range is dangerous and can lead another stroke.

Based on all the information it sounds likely like she has advanced atherosclerosis and it may take more than medication to deal with this. Diabetes itself can lead to high blood pressure from the insulin and the damage it causes. But the isolate systolic hypertension and the wide pulse pressure are both characteristic of atherosclerosis, which can be induced by diabetes.

There are various supplements that can help with both the diabetes such as chromium polynicotinate and magnesium malate, and with atherosclerosis such as lecithin granules. These would be safe with the medications she would be on, but other supplements that could be recommended may not depending on what medications she is taking. For example, Coumadin (Warfarin) is often prescribed to patients after a stroke. Coumadin though interacts with virtually everything including numerous medications and foods such as green leafy vegetables, ginger, cayenne, cinnamon, vanilla, kefir, etc.

The rise in blood sugar overnight is also common and is referred to as "dawn phenomena". Glucose is still being produced by the body while the person sleeps, but less of it is being used up for energy so it tends to rise. Since type 2 diabetics have reduced insulin sensitivity the excess glucose is not removed properly from the blood.

Bottom line though is that the medications that the doctors chose do not appear to be working, so they need to readdress the situation in a different manner to get the blood pressure under control. It may even require surgery to open up the arteries to prevent another heart attack or stroke.