Is my HBP Medication working 'Too Well?'

[jerry1978]

History:  43 year old male w/ history of anxiety and panic disorder.  These emotional disorders were in remission until a flare-up last August.  At that time, I began psychiatric treatment with cognitive therapy, along w/ Klonopin .25 mg X 2, and Zoloft 25 mg. X 1. (I am still on this treatment, and the anxiety and panic is well under control.)
Last August, during the height of my panic, my BP was at 150/95 and heart rate at 100.  My cardiologist was convinced this was due to my emotional state, and said once my anxiety is under control, my BP will subside also. (I always had good BP and low HR in the 60's.)

Cardiologist prescribed Toprol XL 25 Mg a day, and Hydrochlorothiazide 25 mg a day.....Now, with my anxiety under control I am getting morning readings of 115/70 with a HR of 56, and evening BP of 106/60 with HR as low as 49.

My questions:

1) Is a HR that low dangerous? I'm feeling fine-perhaps a little more tired than before, but no fainting spells.

2) I see my cardio in November, and I'm sure he is going to take me off the meds.....Is there a weaning process involved ?

3) Can uncontrolled Anxiety really cause HBP?

Thanks, Jerry

[CCF-M.D.-RCJ]

Jerry,

Thanks for the post, and the courage to write to us.

Q:"1) Is a HR that low dangerous? I'm feeling fine-perhaps a little more tired than before, but no fainting spells."

No, a HR in the range of 40 or higher (and lower for some people -- Bjorn Borg reportedly had a resting heart rate in the low 30s) is perfectly safe for the vast majority of people.

Q:"Is there a weaning process involved ?"

Most doctors will slowly withdraw beta-blockers, perhaps over a 3 to 4 week period.  The period used depends on the person and their ailments(s).

Q:"Can uncontrolled Anxiety really cause HBP?"

ABSOLUTELY.  In fact, I've seen anxiety nearly kill people, literally.  Their are apocryphal stories of previous generation cardiologists that could talk/reassure persons out of pulmonary edema.

Hope that helps.

[jerry1978]

Thanks for the insight, Pluto.  It's good to converse with someone that has a similar problem.  Anxiety and Panic is sometimes misunderstood to a person who has never experienced it.

[Poli3]

Jerry,good luck in your battle with anxiety and panic problem.I have the same problem with hypertension and now LVH,I understand your concern.
Your BP seems under good control,and I think that with some meds you have to be weaned off them,but I was on a calcium channel blocker that my Doc just took me off  but did not start another for a week.
My meds are good,angiotension drug,but if my anxiety level gets high even they can't control Bp.
Unfortunately,I have a sister who is always trying to goad me into an argument or puts me down,so I have had to sever contact with her and my BP is much better,as I don't have that kind of anxiety around me.
keep your chin up,you are doing good!

[Poli3]

Good to see your Bp that low.What I would like to know is thIs 110 systolic the target number for lowering Bp,with LVH?

My diastolic is under 70,pulse okay,but Systolic is 130.mind you it was much higher 3months ago,and is slowly coming down.Just wondered if there was a target number for people with LVH.My Doc seemes to think 130 is okay,but if I can get it lower,that would be better.
Also,at 110,do you feel fatigued at all?
Thanks

[Poli3]

Well thanks you two for all the good info.My BP used to be in the 160 systolic,but as you say,back then they seemed to concentrate on the diastolic pressure more.
My Doc said that this medication I am on is a slow acting one,but the fact that I have a BP of 130 is good for me now,but I want to get it down further.Just have to hang in there!

I find if I feel like I am going to have an anxiety episode I go for a walk,and it does help the Bp also,I discovered.I am going to join a gymn with a walking track.In the winter it is too bitterly cold here,and too humid in summer to walk comfortably,not to mention mosquitoes.I live in Manitoba, canada.
If I get a treadmill for home I know I won't use it very much because I like being out with people,so the gymn will be good.

Take care,God bless!

[fizzixgal]

Hank, do you know what problems specifically are associated with a greater than 40mm spread between systolic and diastolic? On verapamil, I typically get diastolic readings of 56-62 but my systolic numbers are usually 120-130. Before starting verapamil and on minimal beta-blockers, I would more often see 130-140 and 80-90. I am thinking that verapamil is a stronger vasodilator than a reducer of contraction force, at least for me, and wonder if I should be concerned about the increased spread.

[fizzixgal]

Thanks. Still not too clear from that on whether high pulse pressure is an *independent* risk factor, or only in the presence of isolated systolic hypertension. But I found other references cautioning doctors not to treat hypertension to the point of diastolic hypotension that also mentioned pulse pressure. Even from those, it was not clear on whether the phenomenon was considered more a possible cause of problems, or an indicator of existing problems (mainly arterial wall inflammation and stiffness).

[nansim]

A related discussion, Regulation  of  BP was started.