Drop of blood pressure who last since July...

Hi, i'm 35yo, weight 165 pounds (lost 55 pounds in the last 7 months), smoke 1 pack a day (try to quit), don't exercise cause of the weak blood pressure, eat healthy, have some anxiety disorders, extreme anxiety since more than 1 year (panic with ago, OCD, social phobia). My current meds list is : 6mg of Klonopin / day, 1 mg Xanax /day, 2.5mg of Inderal and lot of vitamins (calcium, iron, D, A + centrum complete) that I have to take cause I had a gastric by-pass to loose weight 10 years ago.

I'm following by a Cardiologist, always had a normal-bordeline blood pressure of around 135/85. Had first meet him last year cause I fainted 3 times and my pulse rate was low all the time (under 60). We run a lot of heart tests at the time to rull out the fainting episodes and the slow heart beat without finding anything wrong with my heart (stress test with an echocardiography, holter monitor 24 hours, blood tests, X-ray of the lungs...).

I saw him again in february cause I was rush to the ER for a supraventricular tachycardia episode and he RX 10 mg of Inderal to control the tachycardia. I start also having once in a while chest pain, but he wasn't very concern about it and said it was not cardio related. He Rx another holter monitor 24 hours, a blood pressure monitoring 24 hours, a stres-test on a treadmill, blood tests... no problems was found and my results was normal.

The main problem is that suddenly in the begining of July, without any kind of stressfull event in my life who happen, my blood pressure drop from the normal-bordeline range to a low blood pressure of 95-105/50-55. My pulse rate is always  fast the first 2 hours I get up in the morning and is around  90-100 and more at rest. BUT it will stop to be fast and drop to a low pulse rate of 50 in the afternoon and evening. I also start to have all the time the chest pain, not related to GERD cause I had a gastroscopy and it was ok, my left arm is numb most of the time, I have jaw pain and teeth pain (saw my dentist 2 weeks ago and the X-ray of my jaws are normal), I also have a chronic headache (pulsating vein on the left temple of my head) who is worse when my blood pressure drop too low. I also have all the time an orthostatic hypotension problem from a sitting position to a standing position, I got dizzy, my vision turn black and I have tinnitus in my ears who last 2-3 minutes and my pulse rate increase also at the same time, who is normal I think cause of the low blood pressure, but when I sit again the fast pulse rate stop rapidly and return to 50. I feel exhausted all the time and can't do anything physical. It's always worse in the evening.


I call my Cardiologist who said to increase my salt intake but it's doing nothing at all even after 1 month, it's seem that the more salt I add into my water and food, the lower will be my blood pressure. Smoking a cigarette will also lower my blood pressure who is weird cause in the past it was increasing it a lot! Even stress and anxiety will not make it higher like in the past. He said to decrease my Inderal to 2.5 mg in the morning only, that dose will not affect my blood pressure, but it's change nothing.

I don't know what to think about all of this. Is it possible that my anxiety lower my blood pressure like this? Is it possible that the Klonopin and Xanax reduce my blood pressure? I mean, I take those meds since more than 5 years and never had a low blood pressure because of them. The inderal even at 10 mg never lower my blood pressure before, just slow down my pulse rate.

I had recently some blood work for the sodium, potassium, magnesium, as well as some cardio markers, my cholesterol level is normal BUT my HDL is low (I know I can increase it by stopping smoking and taking fish oil). My adrenal glands was also tested and it's seem that my cortisol level is low, I don't have an addison disease, but it's low, same for the adrenaline-noradrenaline who is also low. We don't test the ATCH or the renin-angiotensin hormones cause normally it's the job of the Endocrinologist and I don't have that kind of Doc.

Is it normal to have  chest pain all the time, to have orthostatic hypotension all the time and to feel exhausted and tired like I am right now? What can cause a drop of my blood pressure? What bother me the most is the fatigue, the low exercise tolerance, the chest pain and also the weird headache. I also have weird blood pressure reading from a lying, sitting and standing position, my blood pressure drop from the lying to sit position and drop again when I stand.

Someone have an idea to what to do to return to my normal blood pressure?

[ed34]

All your medications can give the symptoms you are describing and it states that you shouldn't take a beta blocker such as Inderal if you have hypotenstion.
I think it may be wise for your Doctor to look at your meds again. Are you well hydrated? drinking plenty of fluids?

[erijon]

Let's not lose sight of the fact you have lost approx 1/3 of your body weight. That alone should drop your BP significantly especially on the meds you are taking. Ed is correct, you should look at you medications again with your doctor.

Jon

[TX35]

Thanks for your answer ;-)

That's what I told to my Cardiologist about the beta-blocker, since my blood pressure tend to be low since july, I should stop the Inderal, but he told me that a small 2.5mg of Inderal will certainly not have any effect on my blood pressure. I think he wanted to keep me on a low inderal dose just because i'm very anxious and he might think that be taking the small dose of Inderal, I will feel less anxious... but that's not the case... I was put on the Inderal, after several tries of other beta-blockers, most of them was too strong for me and lower my blood pressure too much, only the low dose of Inderal was able to reduce my fast pulse rate in the morning with no impact on my blood pressure.

Also, I loose 55 pounds in 7 months, but most of the weight I loose was between december 2010 and march 2010, and at the time my blood pressure was normal-bordeline...so I can't see why my blood pressure only drop in july because of the weight loose.

Yeah, I drink a lot of water, around 8 x 500 ml a day and sometimes more. I also add salt into my water 3-4 times a day to try boosting my blood pressure with no success.

I forget to mention that I have to thyroid problem as well, TSH, T3, T4 are perfect in the middle range, same for the antibodies TSH... I had an anemia problem in 2009 but it's ok since january 2010, my iron level is now normal also.

And for my medications, I don't understand why the Klonopin + Xanax will drop suddenly my blood pressure after 5 years on those meds!!! That's really weird...

Anyways, I have to figure out what happen cause my I feel very bad, the headache, chest pain-pressure and lightheaded feeling make me feel anxious and tired...

I will call again my Cardiologist this week and hope he will return my phone call, we will talk about my meds...

I also try today to not take my Inderal and my blood pressure was low all day long, between 95-105/50-55. My pulse rate was very fast this morning (140 at rest) and is faster tonight, around 65... the chest pain is also worse... The inderal have a very short half-life in the blood and don't stay in the system for more than 4-5 hours...

Well, thanks again for your answers ;-)

[TX35]

No thyroid problem... forget the to... lol

[ed34]

Maybe some kidney function tests would be advisable. Your headaches and fatigue will be due to the low blood pressure. Your systolic is still JUST within normal but diastolic is classed as Hypotension and they need to address this because you really don't want it dropping much lower.What about other aspects of your diet, are you consuming lots of calcium for example?

[jrbon]

By any chance are you suffering high temperatures in your area?

That makes my BP to drop easily 20mm.

Jesus

[TX35]

Hi ed34,
           Hummmm, some kidney functions test? What kind of tests? Blood tests?

Well, what surprise me the most is the fact that even if my blood pressure is low, when I get up in the morning I feel like my body is full of adrenaline, I sweat a lot from my feet and my hands, my legs hurt and they are red, the veins are big also and painful, my head hurt a lot, my jaw hurt, my left arm is totally numb, I have strong tinnitus in both ears, I feel like I will lost the control of my head and my heart and that I will die, very dizzy and spacy and I don't like that...that's feeling of high adrenaline level stop 2 hours after I get up, I have to wait 2 hours before doing something physical of something who will make me anxious like smoking my first cigarette in the morning OR taking my shower... Also, today I don't know why but the systolic number increase when I smoke, something who don't happen since july but my diastolic stay at 55-60... I know it can be only just anxiety in the morning, maybe it's because when I sleep I don't take my benzo meds to relax... so in the morning my body is leave without any benzo meds so i'm more prone to anxiety and panic?...

My diet is somewhat ealthy but not complete, I mean that I eat small meals but 5-6 times a day cause I tend to have a low blood sugar level in the morning only, I avoid all kind of raffined sugar, I don't drink coffee or soda's, I crave for foods like bread, rice, everything who is sweet but i'm very carefull and never eat sugar, with the exception of some fruits and slow carbs release like complete bread and brown rice. I eat also some protein (eggs, chicken, sometimes red meat but not often, I don't like sea foods or fish) and I always eat 2-3 times some vegetables, natural yogourt. I also try to avoid false sugar BUT use once in a while some splenda because I know that I don't react badly to it (Equal = aspartame is awful for my headache and anxiety). I eat also once in a while some cheese (trigger headache so I try to avoid it)...

For the calcium, since I read some studies lasts year about the fact that it was increasing the heart problems, I reduce my intake from 3 x 500 mg a day to 1 x 250 day and I always take it with a high dose of Vitamin D (50 000 units), I have no choice to take huge amount of fat solube vitamin cause of my gastric by-pass. So for the calcium, I take a total of 250 mg a day + the calcium in the yogurt, I always eat Activia yogurt, the one with a lot of probiotics inside it....

[TX35]

Hi ;-)
       No, we don't have a very hot and humid summer this year where I live (Quebec city in Canada). Also, I can't stand the sun and most of the time I stay inside the house cause we have a central air conditioning system in the house and the temp is around 70-72 celcius inside the house. I also sleep with 2 fans in my bedroom so that's very cold and I like it... in the winter I also sleep with my window open a little bit... so the high temperature is not the problem...

[ed34]

some kidney functions test? What kind of tests? Blood tests?

Well that would be a good start. Obviously the Kidneys play a HUGE role in maintaining blood pressure.

[TX35]

I see my Cardiologist in 2 weeks, what kind of kidney test should I ask to him? Should I ask to have a RX paper to see an endocrinologist Doc cause some of the hormones produce by the adrenal glands like the aldosterone who is important also for the blood pressure?

Also, if I well remember, the last blood work I had 2 weeks ago (didn't receive my results, will have them in 2 weeks) didin't had a lot of things we don't test in the past, we test almost everything possible...so it will be only an update of a lot of stuff that was already tests 4 months ago like the cardio markers APO-B, C-reactive protein, homocysteine... those 3 was perfect last april.

All the others regular stuff like the complete metabolic panel, Na+ K+ Cl + HCO3 + CO2, blood urea nitrogen, creatinine, calcium, magnesium, potassium, serum albumin, serum total protein, alkaline phosphatase, alanine amino transferase, aspartate amino transferase, bilirubin, CPK-MB, transferrin saturation + Serum iron + Total iron-binding capacity, ferritin, transferrin + transferrin receptor, acid folic + B12, transaminases (ALT, AST) , Gamma GT, CK + LDH, Amylase ·Lipase, TSH, T3 + T4, hemoglobin call myoglobin I think.. and many other things that I don't remember since the name of those tests in french is not the same than the name in english... I think that most of the kidney tests are include in those tests no? Maybe with the exception of the glomerular filtration rate test?

Well, what you think about that?

[ed34]

Yes kidney function can be tested using blood markers, but what you need are recent results, not ones that were before july when you say this started to happen.

[TX35]

Ok, my last blood work was done 2 weeks ago, when my blood pressure was low... do you see in the list of the blood markers I wrote yesterday some kidney blood tests? I will receive the results in 2 weeks...

Also, last evening I start having a sharp pain in the middle of my upper back and right into my sternum, and had and still have difficulty to take deep breath,  the pain last all night long and is still there this morning, my blood pressure, especially the systolic was normal 120 and react to stress agent like cigarette since after I smoke one cigarette this morning,  my systolic blood pressure was up to 128... the diastolic stay all night long in the 60-66 range and is the same this morning... who was not as low as in the past month... but surprise me cause normally when i'm anxious my diastolic increase more than my systolic... I remember that when I had my first supraventricular tachycardia episode, when I enter to the ER my blood pressure was 143/113!!! and i'm used to be in the 130-140/90-100 range when i'm anixous...

I go in bed and wake up 3 hours later cover of sweat with a rapid pulse rate of 165, had the sharp pain in my back and the sternum... at some point my pulse rate was so fast that I wasn't able to count it!!! Didin't had difficulty to breath but it was scary. I'm used to panic attacks, but they never give symptoms like sternum pain or back pain. I had 3 other panic attacks between 2:15 AM and 6 AM... I didn't sleep a lot. This morning i'm exhausted, I don't know what to do with all of this. Of course, I took 2 mg of Xanax in the middle of the night for the panic attacks, but it didn't help me at all. This morning I double my Xanax dose and I took more Inderal (around 7.5 mg) and my blood pressure is around 118/66 with a pulse rate of 65 sit and around 120 standing but not regular, mean that it can slow down very fast and jump again to 120 in less than 2 seconds, I attribute this to the high anxiety level, probably because of the sharp pain in the upper back and sternum...

Also, all my veins in my arms and my lower legs are big and they hurt, my lower legs are red-blue... the neck veins and the veins on my head near the temples are also dilated... really weird and painful....

Is it possible that it's all linked to my anxiety problem? I really don't know what to think about all of this. Should I go again to the ER and have a EKG done? I feel like if I go there again they will not want me to have another EKG cause the 3 last ones was ok...even if I had chest pain and very fast pulse rate...

I'm tired to call my Cardiologist cause he his rude with me, he only say things like it's anxiety OR you don't drink enough water OR put more salt in your food, stop smokingm take long walk, the usual stuff and I try to talk to him and explain that I have no energy and that i'm tired as hell and he don't listen to me... Sometimes I feel like they treat me like i'm only a guy with some psychiatric problems and they seem to trivialise my condition...

Anyway sorry if I ask a lot of questions, you are a nice person to answer to me like you do;-)

Have a nice day!!!

[bbxx]

Hey, I am sending you a link with information about possible interactions effecting your blood pressure. Please read the whole thing. Check your messages, I will send it there since we cant post links.

[bbxx]

Ps, I didnt even get all your info.. but just the 3 I did, showed some interactions ...

[ed34]

"Ok, my last blood work was done 2 weeks ago, when my blood pressure was low... do you see in the list of the blood markers I wrote yesterday some kidney blood tests? I will receive the results in 2 weeks."

Yes, a number of things are there related to being balanced by the kidneys and high levels could indicate kidney problems.

[TX35]

Hi !
    Thanks for the link, I already saw this, when I start a new med I always look for possible interractions. The fact is that I start the Inderal at 10 mg in february and was already on the Xanax and on the Klonopin and never had a low blood pressure... so this is not apply to me. Also, my Cardiologist told me that the benzo meds don't affect the blood pressure at all or have a MILD effect on the blood pressure when someone is under stress and that their blood pressure is high... who is not my case...

[TX35]

Thanks ed34, will keep you inform about my blod tests results... ;-)