Blood Pressure

[Guenter]

I am so surprised that I am getting to post.  Just one question:  I have heart failure (BNP 177)  and I am taking diuretics and antiarrhythmics.  I have always run a blood pressure around 120/70 to 110/60 or in the area.  About three months ago when I went to the Doctor it was 160/100. They took it three times over an hour with different equipment. He did nothing about it.  This past week I went to see the Doctor again for follow up and it was still quite high between 150/90 and 160/100.  This time he really didn't even acknowledge it.  I am wondering if some treatment would be indicated for this.  I realize this may be due to fluid retention but with the heart failure isn't it a good idea to keep the blood pressure down?  What are the potential long term effects of an increase in blood pressure with heart failure?

[CCF-M.D.-RCJ]

Guenter,

Thanks for the post.

Q1:"I am wondering if some treatment would be indicated for this ... with the heart failure isn't it a good idea to keep the blood pressure down?"

You bet it is!  In my clinic, and indeed the CCF heart failure clinic, we strive for the lowest blood pressure that the person can tolerate without symptoms (dizziness, lack of energy, etc.).  It is not infrequent that the blood pressures in my heart failure patients are in the 90s/50s range, although this range may be too low for some.  I become physically excited when I see someone with heart failure and a blood pressure in the 150/90 range, because it means that I can offer them the state-of-the-art therapy: ACE-inhibitors, beta-blockers, diuretics, and aldosterone antagonists.  So many of our patients present with such low blood pressures that we have nothing to offer them.

Q2:"What are the potential long term effects of an increase in blood pressure with heart failure?"

Mainly that the heart failure will worsen, plus all the other long-term detrimental effects of elevated blood pressure: stroke, coronary artery disease, erectile dysfunction, peripheral vascular disease, impaired vision, etc.

As always, please remember that you provided very little information about yourself (not a criticism, just a fact), and thus I'm giving pretty generic information.

Best of luck.

[Guenter]

Thank you for your information.  I think my heart failure is caused by heart valve problems.  But, I am concerned about the increase in blood pressure.  I am no expert but this cannot be good thing.  What should be my next step?

[CCF-M.D.-RCJ]

You didn't tell me what type of doctor you see.  Some primary care docs may not know to treat hypertension aggressively.  I would recommend seeing a cardiologist.  If you already do, then discuss the hypertension with him/her, and consider a second opinion.

[Guenter]

Yes, he is a cardiologist.  I have been considering a second opinion. Thanks for confirming this for me.

[jan]

May I ask if you are in heart failure from valve problems why haven't you had some sort of corrective surgery?  

My mother had CHF from her mitral valve and by the time she was diag with this problem she was very bad off.  So bad that they had a team of drs. to discuss what they should do.  She was a bad candidate for medicine therapy and for open heart!  They opted to go through with the surgery (mitral valve replacement and 2 bypasses) and all the risks (diabetes added to that risk, I believe).  She made it and had 10 more yrs with us.

[Guenter]

I did see a surgeon who doesn't want to do the surgery right now.  Even though I have symptoms, he says I look good and am able to work full-time and another part-time job so I could be treated medically for right now.  However, I do not feel that its working particularly well so I have considered a second opinion.

[jan]

Hi,

BTW, why are you seeing an EP?

By "normal" I mean it is an expected response for a healthy person.

You say you feel healthy and comfortable, so I would say try and relax when you have the tachycardia.  Instead of focusing on it try to distract yourself.  I know it is easier said then done.  I didn't know I had tachy. I just wasn't feel'g well, tired and often dizzy. If you develop symptoms then discuss it with your dr.

Good luck.

[jan]

Hi,

BTW, why are you seeing an EP?

By "normal" I mean it is an expected response for a healthy person.

You say you feel healthy and comfortable, so I would say try and relax when you have the tachycardia.  Instead of focusing on it try to distract yourself.  I know it is easier said then done.  I didn't know I had tachy. I just wasn't feel'g well, tired and often dizzy. If you develop symptoms then discuss it with your dr.

Good luck.

[jan]

Sorry, my comp or my brain is acting very screwy today.  I have to say my comp to save face.  LOL  Actually, I know I am having comp problems today, dome of them very peculiar and mind boggling.