High blood pressure and dizziness

[dv1]

I have been diagnosed with high BP recently (165/100).  I’m 42, optimal weight, and exercise religiously (cyclist, avg. 10,000 miles/year for past decade).   A workup with echo determined I had enlarged heart (35% EF).  Doctor suspects long-term high BP contributed to this.  I felt great up to that point.  I’ve had stress test, renal test, and EKG, since, and nothing additionally unusual was found.  I’ve been put on 150 mg Avapro and 50 mg Toprol-XL.  This has been increased as the initial effect seemed to wear off.

My issue is that I have had dizziness since taking the drugs (3.5 months now).  First, the doctor said it was due to getting used to lower BP from having high BP .  I've read about side effects for beta-blockers, though my doctor downplayed that.  Later, when the initial dosage began to wear off and the BP creeped up again, he suggested the high BP was causing the dizziness.  After 3.5 months you’d think that any of these potential causes would alleviate itself, but it hasn’t.  What could be the cause?  Am I still not used to the meds?  Is it related to the low EF?  Something else?  What other tests should be done?

Why the heck do I have a weak heart?  I have great stamina and endurance ability due to the large amount of cycling (2 – 2.5 hrs/day).  I’ve read a study that a minority of high-end athletes have enlarged hearts.  Could spending 2.5 hours/day at high BP (over 200 when you’re really exercising) over time be the actual cause of heart problems?

Last, he recommended that I switch to Coreg from Toprol as it may be better for EF improvement.  True?

[Cleveland Clinic]

What could be the cause?

There are a lot of different causes of 'dizziness' Low/High blood pressure, meds, other conditions can all cause it. Unless your blood pressure is markedly low or elevated when you have symptoms its probably not the cause. An ambulatory cuff could help you tell.  I would also recommend seeking a second opinion with a general internist.

Am I still not used to the meds? Is it related to the low EF? Something else? What other tests should be done?

A thourough history and physical exam should be the next step.  I would also recommend ambulatory pressure monitoring to rulle out blood pressure as a cause. Other test based on yoru history and physical.

Why the heck do I have a weak heart? I have great stamina and endurance ability due to the large amount of cycling (2 – 2.5 hrs/day). I’ve read a study that a minority of high-end athletes have enlarged hearts. Could spending 2.5 hours/day at high BP (over 200 when you’re really exercising) over time be the actual cause of heart problems?

Its great you have such good stamina.  It is a better prognosticator of outcomes than EF.  If you had long standing high blood pressure it could certainly have caused your symptoms. Other causes should also be ruled out.


Last, he recommended that I switch to Coreg from Toprol as it may be better for EF improvement. True?

Actually, there is a lot of debate over which is better. IMO,  Either are probably suffcient and should be titrated up to gain maximal effect.

good luck

[Momto3]

For what it's worth, it took me about that long (pushing 4 months) to get past the dizziness after being put on a very low dose of an ace inhibitor.  In my case, it was a side effect of the medicine. In fact, when I tried the medicine a few years earlier for a decreasing EF, but normal blood pressure, I was not able to take it....same reason.  Check with your doctor about side effects.  If that's a possibility, maybe you could try a different medicine. Hope you get some relief.

Kudos on the cycling!! WOW!!!

[LukeL]

I was put on betablockers Toprol XL due to anxiety which caused inreased heart rate and elevated BP. It has been 3 months now and I am still a little dizzy and lethargic at times but my heart rate is in the 80s instead of the 120s and my bp is 120/75 instead of 140/100.  It will take time for your body to adjust, especially if you are overweight but you indicated you aren't.

Also at first take time siting up from lying down and standing up from siting down this should diminsh the effects. Also you may need to adjust the amount of medication you are taking with the help of your docotr. Like instead of taking the 50mg of toprol once a day take 25 mg twice a day.

[LukeL]

One more thing the enlarged heart that an athelte gets is completely harmless and has nothing to do with cardiomyopathy or diminished ejection factor. This is a common problem cardiologist face while doing an echo. It is hard to tell an atheltes heart from a heart enlarged do to cariomyopathy.

[runnertom]

DV1,
   I also have a similar exercise history to yours except I spend a lot of time running also. I have done this since age 27 (30 years ago). My GP about freaked when he saw the size of my heart from a chest X-ray and when I suggested it was due to the exercise, he didn't buy it. An echo found nothing abnormal except mild atrial enlargement and normal ejection fraction.
   He may have the last laugh however since I was subsequently found to have a blockage in my LAD that was bypassed 2 years ago. It was really causing me no symptoms except mild shortness of breath in the first 1/4 of running. There was never any indication of a problem on the bike even though our group rides get pretty intense at times. The explanation of the lack of symptoms is my heavy collateral development that essentially bypassed the blockage internally.
   Pre-surgery, my blood pressure was high normal. Checking at home I would average 125/85 and it would be 150/90 in the docs office. Also, there was concern that it went quite high during exertion on the treadmill. (220/110 at 180 beats/min).
   Since the surgery, I have not been on any bp medication, only statins for cholesterol and folic acid for high homocysteine. BP is recently much lower, often 105/70. Don't know why. I have suggested to any number of cardiologists and other docs that maybe the extended high heart rates during long rides and runs had something to do with the blockage, since it occurred at the first lateral where there is a lot of turbulence. (My first tier risk factors prior to surgery were quite good-never smoked, normal weight, cholesterol within guidelines, benign family history, etc). I have had no one agree with this theory, although I have read posts from at least two other serious cyclists with similar problems to mine.
   If I were you, I would go along with the bp meds and maybe look into alternatives to lowering blood pressure. An ejection fraction of 35% would be worrisome to me as I don't think the athletic enlargement results in significantly reduced ejection fraction. High bp is one of the strongest risk factors for cardio vascular disease.

[Mantels]

Take the Toprol after dinner. You will not have the side effects all day.

Been running and cyclying for 2+ years with a 50mg dose and had no issues, unless I forget to take and take in AM. Then exercise is a lot more difficult.

[Mantels]

Sudden death in athletes will always be an emotive topic, for it suggests that athleticism may not prevent the development of heart disease and may actually increase the likelihood that the athlete will die suddenly during exercise. Persons who die suddenly during exercise have advanced heart disease of which they are frequently unaware. The commonest forms of heart disease associated with sudden death during exercise are coronary artery disease and hypertrophic cardiomyopathy. Less common cardiac conditions linked to sudden death in athletes include anomalous origin of the coronary arteries, aortic rupture associated with Marfan's syndrome, myocarditis, mitral valve prolapse and various arrhythmias. The incidence of these predisposing diseases in the athletic population is extremely low, possibly of the order of 1 per 10,000 to 1 per 200,000 athletes. Detection of some of these conditions in asymptomatic athletes may be difficult, if not impossible. Regular exercise reduces the overall risk of sudden death in persons with latent coronary artery disease, yet acutely increases the risk of sudden death during exercise for those with heart disease that predisposes to sudden death. In practical terms, only athletes with symptoms or clinical signs of, or risk factors for coronary or other forms of heart disease should undergo routine maximal exercise testing when they commence an exercise training program. However, once symptoms suggestive of cardiac disease are present in athletes, detailed cardiological testing is mandatory.

[454]

I recently was switched by my dr from atenolol 50mg to toprol xl 50mg for hbp.  The reason for the switch was pvc's.  I have had a few episodes of them.  I had a normal ekg, echo, bloodwork and a 3 week cardionet monitor.  Diagnosis was benign pvc's.  I have been off of the atenolol for a week now.  My BP and pulse rate have increased since the switch.  My bp had been runnin 120's or 130's/60's and 70's.  Pulse was consistently in the high 50's and 60's.  I've been checking by bp and it has creeped up to the 140's over 80's and low 90's and my pulse rate is now in the 70's and low 80's.  My question is, is this normal when switching medications and how long shold I give it before I let my Dr. know?  How long should I give the toprol xl to kick in so to speak?  Thanks. Please help