Wild swing in blood pressure - Hypotension to Hypertension

Hello,
Diagnosed with variable blood pressure. If I take my BP while seated or reclined - after relaxing, it is always hypotension (ie 68/40; 56/38)It gets even lower at night.

If I've just walked in to do so, without relaxing first it always quite high (ie 168/135;  172/139) and takes a long while to come down. Given HCTZ (25mgs) for hypertension. Unable to tolerate Ace Inhibitor (Altace) and Beta Blocker (Inderal). (I take thyroid replacement hormone for hypothyroid and Inderal blocks the conversion of T4 to T3 hormone.  The Altace raised creatinine levels).

Being hypothyroid I really have to be vigilent about exercise, or the weight piles on. But, I'm really nervous about exercising now that I have this wonky BP. I always thought with hypertension a person's BP was up ALL the time.

Are these kinds of WILD swings, common?  Should I be limiting activity? I really don't have to do a lot to really raise it from hypotension to hypertension-just walk across the room - so what will exercise do to it?  

What causes such wide swings? I've struggled to finally get the hypothyroid meds optimized and within range, and I feel pretty good. Now I find out I have this weird BP thing too.

What hypertension meds will not interfer with thyroid meds?
Would you recommend a stronger diuretic (furosimide)? Does furosimide interfer with thyroid hormone replacement? Is there a hypertension med you'd recommend?

Can thyroid CAUSE this variable BP problem? Can thyroid meds cause it?
Should I be as scared as I am that my BP is all over the map?

Thanks so much!
little0ne

[CCF-M.D.-RCJ]

littleOne,

Sorry to read of your troubles.  Thanks for your interesting questions.

I have never heard of isolated supine (laying) hypotension (low blood pressure) outside of the third-term pregnant female.

However, a small percentage of patients with hypertension will have orthostatic hypertension (standing high blood pressure).  Causes for this finding include diabetes, autonomic dysfunction syndromes, and other rarer diseases.  In the geriatric literature, patients with your degrees of hypertension swings are called "extreme dippers".

I can best put your description together by conjecturing that you have orthostatic hypertension that has been treated aggressively, now leading to hypotension when you are supine or sitting.  I am not aware of any association between hypothyroidism and orthostatic hypertension.

I would recommend that you seek guidance from an autonomic dysfunction center, such as at the Cleveland Clinic or at Vanderbilt University.  Your medication regimen will require careful thought by someone who has evaluated you.  In the mean time, the surest way to see if exercise is safe is to undergo exercise treadmill testing under the supervision of a physician.

Also, I'm assuming that the blood pressures have been evaluated on multiple days and that we are not discussing a one or two day phenomenon.

Hope that helps.

[MistyEve]

Thank you so much for answering my questions.I'm a 48 year old female.

Along with the hypothyroid problem -I take metformin (500mg with meals)for insulin resistance. I was told it was
'borderline type II Diabetes'. So, would that be the problem then? Is so how would I handle that?

I've also had a diagnosis of Fibromyalgia -though a lot of the symptoms have eased (if not abated yet),since starting thyroid med.

The only BP that I take is HCTZ diuretic(hydrochlorothiazide) 25mgs in the morning. Would you consider that aggressive enough treatment?

I was prescribed Inderal initially, along with the diuretic. But it caused a problem with worsening hypothyroid symptoms,(blocks conversion of T4-T3)- so I was put on the Ace Inhibitor Altace (with HCTZ). After 2 weeks I was tested and showed a marked problem with creatinine levels.

I wonder -if I'm only able to tolerate a diuretic (as it would appear) - whether a change to a stronger one like Lasix (Furosemide) might do some good in dropping the extreme BP spikes?

Its good to know hypothyroid doesn't cause the BP problem. I'm wondering if levels of thyroid med might - even though levels are presently optimized?

BP readings done on multiple days - over more than a year's time.

Thanks so much
little0ne

[Mel22]

Hi littleOne,

Can you describe this problem with creatinine? I am also hypertensive and hypothyroid. I've taken levothyroxine since I was 12 (41 now). When my hypertension was discovered at about (at 30), I was prescribed HCTZ initially but experienced a bit of an increase in BP so I was changed to Hyzaar with HCTZ. I am doing well on that. I do find that I have to supplement with Magnesium and Potassium or I will be tired and sometimes dizzy, especially after strenuos exercise and perspiration.

I have a healthy heart (with some trace MR and TR), and I do suspect the thyroid meds may contribute to my BP. But there doesn't seem to be an alternative solution to the meds.

[Mel22]

I forgot to add that Hyzaar is an Ace Inhibitor.

[MistyEve]

Hi Mel,

After I'd been on the Ace Inhibitor Altace for only a short time, I went in (as the dr suggested) for a blood test.

He phoned me that EVENING (which never happens around here believe me - scared me half to death to hear his voice on the phone) - to say that they'd gotten a 'bad creatinine' level back on me and that I was to stop the Altace immediately, and to come right in and see him.

When I asked him about it at that appt, he said my levels (creatinine) were really HIGH.

I've hesitated to say this, because I'm not 100% positive - but I think when the creatinine is elevated there is a problem with renal (kidney) clearing. (Forgive me, I'm not sure if its kidneys or liver clearing - but I *think* I remember reading that the Altace is processed through the kidneys).

Hope that helps,
little

[Mel22]

Interesting!

Well I've had  quite a few blood tests since I've started the Hyzaar, plus a renal artery ultrasound (to try to determine the cause of the high BP), so I guess I'm OK.

How much thyriod hormone are you on?

Thanks!

[MistyEve]

Hi Mel,
Sorry to be so long with a reply - haven't been online for a while.

I take Parke Davis Thyroid (called Armour in the USA)
375mgs (6.25 grains).

I think your Hyzaar is an Angiotensin II Receptor Antagonist, and not an ACE inhibitor - though I might be wrong. AII's are supposed to be better for renal function - and a lot of other things according to what I've read. (I've been researching the different hypertension meds in preparation for my dr's appt).

Hope this helps - take good care ...
little

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