My aunt is on dialysis and her blood pre

Call the dialysis unit's own out-of-hours number now and say one sentence: she is on dialysis, her blood pressure is high, her pulse is already slow, and an extra blood-pressure tablet was taken today without advice. That call — not the cuff reading, not the medicine box — is what decides whether tonight is a clinic visit or an ambulance, and it is not something to sit on until the doctor rings back.

I can't diagnose, and I won't tell you to change any dose — that is a clinician's job, not a family's, and I don't know her medicines, her targets or her history. What I can do is give you the decision tree, the five facts the team will ask for, and the list of symptoms that turns this into an ambulance immediately.

The decision tree — screenshot this

```
Any red flag below (see list)?
├─ YES → call your local emergency number now.
│ Do not drive her. Stay with her, sit her up,
│ bring the boxes. Say "extra dose of her blood
│ pressure tablet, on dialysis, pulse already slow."
└─ NO → Dialysis unit / prescriber tonight.
Ask them one question: "given the extra dose and
the slow pulse, do you want her seen tonight,
and does the next scheduled treatment change?"
Do that one call, then keep her settled and recheck.
```

If the call-back you are waiting for is the prescriber's, make the dialysis unit the first call anyway — they see her numbers and her fluid and salt balance weekly, and they are the team that can say "come in" rather than "wait".

1. What you have already tried, and what to do instead

Sitting quietly and rechecking — keep going. That is the right instinct. Make it count so the numbers are usable: feet flat on the floor, back supported, arm bare and at heart level, no talking for a minute, three readings a minute apart. Write the time next to each one, and whether she was sitting or lying.

Writing down symptoms — right, but write these six, not just the numbers:

• the readings, with times and which arm
• her pulse, and where you got it
• which medicine, its name and strength on the box, how many were taken, and at what time — in your own numbers, that is the team's information, not something to estimate or trim
• whether she has taken today's usual prescribed dose, or is now skipping it out of fear
• what she says she feels: dizzy when standing, tired, sleepy, chest anything, breathing, headache, vision, any word she can't find
• what she has eaten, drunk and passed today

Calling the dialysis unit — do it now, and have the boxes out when you call. Put every medicine on the table, including anything from another doctor and anything bought without a prescription. The team wants the boxes, not your memory of them.

Taking extra blood-pressure pills without advice — stop there, and do not swing to the opposite error. From now until someone who knows her case tells her otherwise: no extra dose, and no skipped prescribed dose either. A person who doubles a dose and a person who stops a dose out of fear are both medication changes, and both need the prescriber's word, not the family's. Write down what was already taken today so nobody doubles it again on top.

2. Avoid list for the next few hours

• No extra tablet, no half-tablet, no "just to bring it down", and no biting open or crushing any capsule to make it work faster.
• Do not stop or delay her usual prescribed dose because she feels frightened of it.
• Do not use anyone else's tablets — including a relative's or a leftover from a previous prescription.
• Do not add anything from the cupboard for a headache or for dizziness: painkillers, cold remedies, anti-inflammatories and decongestants all push blood pressure and interact with what she already takes. Note them for the visit instead.
• Do not change her salt or her drinking between dialysis sessions to "help the pressure" — the dialysis team sets that, and on dialysis it is not a free choice.
• No herbal remedies, no powders, nothing bought online or without a prescription.
• No strong tea or coffee this evening on top of a day that already includes an unscheduled extra tablet.
• Nothing by mouth if she becomes drowsy or hard to wake.

3. Red flags — stop the home plan and call your local emergency number now

Any one of these, on its own, is the ambulance. Do not wait to see if the next reading looks better, and do not wait for the doctor to call back.

• New confusion, muddled speech, unusual drowsiness, or not being herself — for an older person this is the warning that can arrive instead of chest pain or fever
• Fainting, near-fainting, or dizziness when sitting or standing up
• Chest pain, chest pressure, or breathlessness at rest; in older people a heart problem often arrives as breathlessness rather than pain
• A sudden severe headache, blurred or lost vision, or weakness or numbness on one side, or speech going
• A pulse that feels very slow together with any of the above, or with her looking grey, cold or clammy
• A fall, or any time spent on the floor
• Much less urine than usual, or she stops drinking and cannot stay awake
• Severe belly pain, or a nosebleed that will not settle

When you call, say the age, that she is on dialysis, that an extra dose of her blood-pressure tablet was taken and roughly when, that her pulse is slow, and what you can see. Do not drive her yourself if any of these is present.

Which country and city are you in? I do not want to guess a number from the language you are writing in — name the place and I will look up the correct local door and check it.

Tonight, in the kitchen — under 25 minutes of actual work

1. Three readings, sitting, logged with times. Then set the cuff aside; frequent rechecking makes her anxious and the numbers less useful.
2. One call to the dialysis unit with the six facts above and the boxes on the table.
3. Keep her sitting supported, moving slowly to stand, and someone within earshot in the house.
4. Normal food and drink as she normally has them — no changes, no special diets tonight.
5. Note anything new every hour or so: a two-word line is enough. The change from her normal self is the thing worth recording, not the number.
6. Put every box by the door, glasses and hearing aid with them, and note who is at home tonight and who can be called if this turns into a transfer.

If that is more than you can hold on tonight, the two things that matter are the call and the boxes — skip the rest without guilt.

One page for the call

I have made a one-page handover sheet you can open in your file list: dialysis-call-sheet-120c47e6.pdf. Fill in the readings, the boxes' names and strengths, and the two questions at the bottom while you are on the phone. Read the questions off it rather than trying to remember them.

What success looks like in 24 hours

Not a fixed number and not a cure — a clear plan instead. Namely: the dialysis team or prescriber has heard about the extra dose tonight and has told you in words whether she should be seen, whether the next treatment changes, and what pulse or pressure or symptom should bring you straight back. You have a written log with times. Every medicine is in one bag with her. Nobody in the family is guessing about her tablets at 11pm again.

If the answer you get back is "it was nothing", that is a legitimate answer from the team who knows her — but it is only worth anything once it comes from them, not from a home cuff.

What I cannot check for you this turn, so nobody treats it as settled: what her own blood-pressure and pulse targets are; whether one extra dose matters for her specific combination of medicines, given her kidneys; and how long is safe to watch. All three are answers only her dialysis or prescribing team can give — which is exactly why the call above is the whole plan, and why nothing here should be read as "wait it out".