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How do you stop spikes in blood pressure when stopping metoprolol and n...
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How do you stop spikes in blood pressure when stopping metoprolol and norvase?

I am about to begin withdrawal of 50mg Metoprolol after 5 years addictions to it for blood pressure only. No heart issues. It has been used with 5mg Norvase - Calcium Channel Blocker. PCP's instructions are:
1. Stop the Norvase for 20 days to see if BP spikes. If not then proceed to:
2. Reduce from 50mg of Metoprolol twice a day to 25mg twice a day for one week.
3. Then, 1/2 a 25mg tab twice a day for one week. There was the expectation that there could or would be BP spikes.
WHY?!
I thought the reason for gradual withdrawal was to prevent spikes. Please help me understand whats missing here.
7 Comments Post a Comment
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875426_tn?1325532016
Why does your doctor feel it is okay for you to go off of it- or does he/she?  Was your blood pressure only mildly elevated prior to starting the medication or ?

  Addiction and bodily dependence on a drug that is reducing your risk of stroke or migraines, etc. should not be confused with one another here.

I think there's a strong possibility the doctor was expecting spikes in your blood pressure with even a slow withdrawal from the medication because your body has a problem with hypertension (was this why you went on the drug?) and when you begin taking away what is controlling the problem, the problem would be expected to rear its ugly head as it did before you started the medication.

Not having a problem with your heart does not mean a person automatically would have no problem with high blood pressure.
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Thank you for your response and interest in raising questions with answers that may shed some much needed light on this dilemma.

The Metoprolol and Norvase were introduced in "08" along with discovery of a congenital kidney disorder that was corrected by a surgical procedure ultimately in about 6 months. During the 6 months lead up to the surgery I began with 25mg 1 x per day of Metoprolol with no decline in BP. At the end of the 6 months up to the surgery date I was at 170 BP with Metoprolol 2 x per day 50mg and 2 Norvase 5mg each a day. Still no response. My urologist believed that the BP would come down only after the surgery. Following the successful surgical procedure BP was normal.

Over the 5 year period since the surgery my PCP has normal BP readings during office visits 2 x per year. My annual checkups with urology show normal kidney function continues. During these 5 years of visits there has never been any discussion by my PCP about experiences with the drugs nor did I raise any concerns for the side effects. Rather each time the visit included questions from the office tech "do you need a new prescription." It seemed to be left up to me to decide. I always chose to continue because in my own mind I thought it was not possible to seperate out the kidney malfunction from the emotions I felt associated with the situation. Naturally I would relax after the fact. So it seems it was left up to me to ask to be taken off these drugs after the BP came down in "08" late.

Why now am I eager to get off them? The side effects noted by the manufactures of the drug that accompany each refill from the pharmacy have never gone away as is suggested. My quality of life is compromised by interrupted sleep patterns and sleep that is never "real." Its like being in some unconscious zone and with dreams that are bizarre. My metabolism is diminished to less than half of what it used to be. the insulin resistance is forever present and calories are limited down from 1000.

This winter I had periods of feeling faint after lunch on occasion. My home BP readings then were in 90 - 60 areas. This is when I began charting my BP with a home monitor 4 x a day from Feb. 7 to March 21 the day of my appointment for the regularly scheduled 6 month checkup.My 2 morning readings before I left the house for the 9:30 appointment were 113/75, 110/69 typical of what I was getting during this time frame beginning in Feb.

My post on March 26, 2013 included the time frame given to me at that time following my request to withdraw these drugs from my body. All my readings were given to my PCP to review and I felt she listened to my reasoning for doing this. But I did not think from the statement of her expectation for spikes that she had indeed given me a time schedule that would prevent them. I actually felt it was a set up for failure.

Am I proceeding with a more gradual schedule for withdrawal on my own? No. I'm still coping with the side effects and continue to read the books and testimony on-line from those who have become free of the drugs. Dr. Houston, Vanderbilt University, etc. I am also following up currently with a sudden issue the last few days concerning my right ear including hearing loss, nausea, strange sounds and balance issues. Might any of this be causing me to be more aware of the Beta Blocker baggage or be caused by these drugs?

Thank you for the opportunity to have this dialogue. I look forward to your response.
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875426_tn?1325532016
To start with the last part of your reply here, I hope you will get with an ear, nose, and throat specialist and have them see if they can rule out an acoustic neuroma.

So, do I understand that after your kidney surgery, despite the urologist's asserted belief that your blood pressure would normalize at that time, that they did not attempt to get you off the blood pressure medication to see if his hypothesis turned out to be correct?

Since your kidney function continues to be normal (and of course, if it were not, high blood pressure can be an issue for some with decreased kidney function), it seems to me it would be worth a tapering down attempt with your medication.  

If your urologist was correct that your malfunctioning kidney was the cause of your hypertension in the past and your kidney function to this day remains normal, it would seem there should be an excellent opportunity to get off of medication no longer necessary to your body.  

But there is another question- it is five years later now... have you advanced in that time into your senior years?  If so, as a person ages, the blood vessel walls become less thick, causing blood pressure to rise naturally.  If you are a senior, it might be this experiment of discontinuing your blood pressure medication altogether would prove in the end that your blood pressure is, at least part of the time, elevated to an extent where your primary care physician might want to consider trying a different blood pressure medication that might not have the same side effects as your current regime.

It would be great that even if you did have hypertension once off the medication, that you could take steps toward a natural lowering of your blood pressure without resorting to medication.  While you say you have no heart issues, how is your triglyceride level?   Are you exercising regularly and maintaining a healthy diet?    

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On Monday 04-01 we requested a referral to an ear specialist and were given a 1pm time. A screening exam was completed with follow-up tests scheduled for 04-29. So I will know more then about the likelihood for acoustic neuroma to be the cause. I read about acoustic neuroma at a major clinics website. The questions the DR raised at the screening exam focused and refocused on low-functioning thyroid "hypo". Blood test have been done in years past and were negative. It sounds like its time for a follow-up one. Does a simple blood test tell us conclusively "Yes or No" for low thyroid?

Yes, You understand correctly that no one discontinued the BP meds. This was my reasoning for my request to withdraw their use in 03-21. That is, since the BP came down only after surgery and there have been no BP issues since, there should be reason to believe I could support a normal BP with a proper regime of diet and exercise.

Actually what has never been noted is the total failure of the BB's to be effective when I needed them in "08". Why was my BP at 170 after 6 months and leading up to the surgery? The question of age was considered by me each time I agreed to have my meds continued. But I never raised it because I thought  if my PCP didn't bring it up, I didn't want to create it. And even on 03-21 it was not noted as a reason for her belief that I "would or could have spikes during withdrawal." My age at the time of surgery was 67. Now 72. So the Senior issue has always been with me in this situation.

My exercise routine throughout has been two-hours a day aerobic cycling, four 30-minute periods. Height is 5.5. Weight at time of surgery 125, 3 months following surgery 140. This 15 pounds of weight gain is not accounted for by dietary indulgence. Current weight is 130. The trip down to 130 from the 140 was long and my body burned muscle not fat. I went from Osteopenia to Osteoporosis with calcium supplements. Very little if any fat on the hips responded to my efforts.

Triglycerides are routinely checked and there have been caution flags raised over the 5 years once or twice. Each time exercise brought everything back in balance. Diet maintains my weight, however 800 calories is less than generous for a completely balanced range of nutrition and food groups. During the 03-21 appointment I raised the possibility of changing from the BB's to another type of BP control. The response was "yes there are other types" to use but none were offered at that time.

Your mention that my BP could be elevated for part of the day from the usual normal profile was evident from time to time in the charting I did from Feb. to March 21. There were 8 days out of that period where they were above 120, the highest, a 133 for 1 of the 4 daily readings. Each time I responded with day to day exercise and no "table salt." For all of the other days the readings were normal to low. No question, salty foods are good for 5-10 points to the upside. Staying away from the cycle for 7 or 8 days gets a slight move up. At the same time it illustrates the benefits that exercise and salt restriction can bring.

I'm glad we are on the same page about controlling BP without drugs. Actually my reason for charting BP from Feb. 7 - Mar. 21 was to learn what could be accomplished with a rigorous program of exercise and diet. And to see if I wanted to be dependent daily on this regime for the rest of my life. Actually I think it would be a piece of cake compared to carrying the BB baggage and without ant evidence of benefit from the drugs. Why do you think my BP was 170 after 6 months of their use? To say that the BP wouldn't come down without surgery doesn't say much for the role the B's were suppose to play.  

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875426_tn?1325532016
I'm glad you are pursuing things with an ENT!  Please let me know the outcome?

If you look at the people experienced with hypothyroid on the thyroid forum here on Medhelp, they have their opinions about how to thoroughly test for it.  Most primary care doctors will probably think a TSH (thyroid stimulating hormone produced by the pituitary gland in the brain) and a free T4 (an indicator of what the thyroid is actually doing, I believe) is sufficient and an endocrinologist might throw in a free T3.

I'm guessing there is a possibility your diminished kidney function was causing the high blood pressure and they should have tried another class of blood pressure medication while you waited for your surgery since the one they had you on was not efficiently controlling your blood pressure.

So, there could be a concern then about the thinning blood vessel walls with your age right now as to how your blood pressure might do, regardless of how great your diet and exercise regime is- so taking it slow in diminishing the blood pressure medicine would seem a wise course to take.  You might even want to do it a bit more slowly to allow your body to adjust to the new amount of medicine in your system.  It takes longer at a mature age for the body to eliminate medication so perhaps giving the body plenty of time to be really sure that it is at the new therapeutic level and see then if your blood pressure is still fine before cutting back more.

I'm a bit confused about your paragraph beginning with "My exercise routine".  You lost muscle mass while exercising apparently.  You had your bone density worsen while taking calcium supplementation according to what you put there- is that right?  Were you taking calcium citrate with vitamin D3 during that time?  What was your blood calcium level at that time when your bone situation deteriorated from osteopenia to osteoporosis?

I wonder if an increase in cortisol from the stress of having surgery might account for a gain in weight.  I wonder what your cortisol level is like now.  I also wonder if a build up in muscle with regular exercise might account for a weight gain (muscle weighs more than fat) prior to the long struggle to lose the added weight.  But of course, hypothyroidism can also cause a person to gain.

I was told sugar intake is what contributes to high tryglycerides.  Additionally, I was told that triglycerides is what causes plaque formation in the blood vessels.  

Eight hundred calories I believe is too low of a calorie count also.  To starve oneself to that extent might actually lead to your body going into survival mode.  In survival mode, the body slows down its metabolism and a person could gain weight from that.

  Aside from seeing if hypothyroidism is a problem, do you have symptoms that might point to trying to rule out Cushing syndrome also?

It sounds like your current numbers for blood pressure would not warrant needing to take prescribed blood pressure medication... I hope you will find the same is true as you ween off of it!
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Enormous Gratitude to you for your interest and concerns expressed in both responses! The one on 04-04 will receive a thorough response in a day or two. One of your conclusions raises a very major concern for the kind of care that is not forthcoming presently with the PCP and dealing with it could be a trip down a bumpy road. To know that someone else can look at this issue and recognize it and articulate it is an enormous source of support. Before all of this is resolved successfully many months will probably have passed.

Thank You. Thank You. Thank You. I hope you will be there with me on this journey.

Morgan GFP
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875426_tn?1325532016
Looking forward to your response to my 4/4 post.  Today's PCP is additionally harried by the cumbersome unaffordable Obama doesn't care act that burdens them with added paperwork while promising to reduce their medicare reimbursements if you happen to be on that.  

There are a couple of sites I like to look on when trying to choose doctors, if you are considering switching.  (See private message.)

I'm not a doctor, so I don't always get things right, but have long had an interest in medical things, and many years ago, got vocational nursing training, and have learned a lot from researching (lots of medical issues in my family, etc.).

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