symptomatic hypotension

[banglamom]

If not well medicated, I am always tachycardic.  The medicine makes me hypotensive.  I get super nervous when I go to the doctor too.  So, it seems like empty words when I complain that the meds make me dizzy hypotensive.  They take my bp at the doctor when I'm so nervous I could cry.. or throw up... or both.  At the doctor, sometimes it is as high as 110/60, so it isn't at worrisome numbers.  I doubt it will ever be 80/30 while I am at the doctor, but in my day to day life, it is problematic.  I generally run 90/50 almost all the time anymore on all these meds.  So, when it gets much lower, I can get to feeling yucky.  Being so close to start with means anytime I don't drink enough, get a fever, have diarrhea, sweat too much in the summer heat... then I totally bottom out my bp.

At what kind of pressure do other people feel symptomatic?

[NTB]

> Bystolic... but then for some odd reason that the doctor's could never figure out was sending my BP through the roof 168/115 range.

Hi, DH. I just did a web search for--> nebivolol paradoxical hypertension

and see mention of two case reports that might be the same as you. But unfortunately, that site wants money before they let you read the article. (Bless the AHA, they publish their journals online for free.)

[NTB]

> So far so good, but I can feel my heart start racing every so often.

you might try using the beta blocker only as needed, Silver.

in that case, you might want a different one, with a faster onset of action - maybe propranolol. It should be out of your system faster after the stressful event, too.

Musicians, etc have been using propranolol for years, right before performances. I believe that BBs are also banned from the Olympics, otherwise they'd be used in events like pistol shooting where a steady hand is paramount.

It'd depend if you wanted overall suppression of adrenalin response, or if you wanted a cardio selective BB.

Note that atenolol is associated with a higher incidence of CV events (in those who were taking it for hypertension).

[banglamom]

Ok... those are strange responses.  Mine are really the IST/ SVT/ a-fib, a-flutter, 1 and 2nd degree blocks, bigeminy... every rhythm BUT VT and VF.  BP was always pretty good except where the meds, which are necessary, take me.  By the event moniter, mine were not rhythms that anyone suggested that I just get used to.  Have they tried rhythmol.  Toprol is generally pretty good.  Maybe 100 is too much for you.  When I was taking 300mg of it, it was too much for me- practically nailed me down.  It has been a lot of.. more of this, less of that experimentation.  Some with my md and some on my own.  Understand I really am super independent, not particularly nervous,  and have years of nursing experience.  I will not go to the hospital as long as I am able to still say no.  My husband only has the go ahead to call if I am already unconscious. I never recommend that to my patients but if things don't go all well... I don't do THAT again.  I never had too much problems except some hypotension as they added more and more.  It also didn't slow me down ratewise too much until they added flecainide.  At that point, my heart stopped.  Thankfully, I WAS at work that day.  So, I dropped over in front of 3 nurses and a dr who already knew the problem.  There are rarely such prompt well orchestrated codes.  Some of the medications absolutely should be started in the monitered hospital setting.  When they start something new... ask if you could be/ should be monitered.  Ask you dr before making any changes on your own.  I would look into half doses of each to see if that works better in a meeting halfway approach.  Let me know how it goes.  Don't let failed experimentation go too long with your changes, BUT many meds take a but of time to  adjust to so you can't give up in just 3 days.  When my cardiologist was getting aggressively serious about stopping the rhythms, he reached the point of every two weeks, while will and or changge meds or dosages until we either get it or get through 3 months of failed attempts and approach it surgically instead.  It was in that window that we came upon the devastatingly successful addition of flecainide.  Sometimes it makes me about sick, but it works for me and nausea is better than 200 beats/ min.  There are certain amounts or compromise I have learned I need to live with.  You have to work with your docs to figure out what you can live with.  Hope that helps.  I'll write more later.

[dancingheart]

I too am taking Toprol XL 100 mg for IST and SVT.  And not for blood pressure... Works great for the rhythm issue but I am bottoming out at 92/48, 95/52, and etc.  The doctors have seen me this way.  I can't get out of bed in the night and must use a bed pan.  The best I have ever used for Tachy was Bystolic 2.5 mg 2x's a day, but then for some odd reason that the doctor's could never figure out was sending my BP through the roof 168/115 range.  I never had problems with my blood pressure being high before Bystolic...never had had problems with blood pressure going low before Toprol... Go figure!

[banglamom]

I'll do that.  It has not worked well at all to decrease the meds because my rhythms run away.  I have already damaged my heart from letting it go SUPER fast for way to long.  I do tolerate the fast rate fairly well... until I go into heart failure.  I have been advised not to do this.  I can see where I work what the option is to just let the damage continue.  I take a LOT of medicine, but letting up on any of it has not worked for the last year.

So you get woozy in the 80s.  Thanks you for the validation.  I am trying to figure out what to do with it.  I try not to go out with a bp less than 90/50 so as not to be in the wrong place when I am too dizzy.  I have passed out at work a few times and really try to avoid that.  I will go on FMLA soon so that I can call in and have it count towards that if I have to call in hypotensive or tachycardic.  I am trying to avoid having to go on disability for this mess.

Thanks and I hope YOU get your issues figured out to.  A lot of the complicated probs I hear of involve bystolic.  I'll have to read more about that one.  I take flecainide, lisinopril, diltiazem, and coreg... among others.

[SilverLining00]

About a month or so ago, I was under an enormous amount of stress.  When stress, my bp spikes as high as 190/90 give or take (but it comes down within an hour or so), and my heart rate also spikes.  Docs are funny about that, apparently they don't like it. ;)  I normally run in the 110s/70s.  Anyway, long story short, I was put on Bystolic 5 mg. to control the spikes in HR.  I felt like a new person!  until the stressful period ended... then my bp came back to normal and so did my HR.  It hovered in the 90s/50s.  I was more or less okay there.  Last week it dropped lower and I nearly passed out at work.  By the time I had the opportunity to take my bp, it was at 83/47.  I was lightheaded and felt as if I'd collapse at the slightest provocation.  I decided that since my stress was gone for the time being, I'd go off the meds and see how I faired.  So far so good, but I can feel my heart start racing every so often.  I haven't decided yet what I'll do.  So in answer to your question, I feel similar symptoms at just about the same levels of BP.  I think NTB has a good idea, to bring in your monitor (or output) and let him/her see for him/herself.  

[bigfraidycat]

Oh how well I know where you are coming from. I went to the doctor the other day and my blood pressure was 160/78 and my doctor had a fit. I told her my blood pressure has
been running low 90/58 and she said the at home devices are not as reliable. But I know how I felt, faint and dizzy and extremely fatigued. So she made me sit there for awhile and it came down. But I tried to explain to her that while in the waiting room I kept having hot  flashes and dizzy, little short of breath and I get scared when that happens.
I take 50 mg toprol xl, supposed to take a 100 mg but it totally wipes me out.
So its like you don't know what to do.I  have mild hypertension but was prescribed this for fast hear trate and palpitations. What do we do?

[NTB]

yes, I understand that you have problems caused by the meds, you are not taking meds because you have a bp problem

one day ivabradine will be available, that's for pure rate control - but only in Europe so far

[banglamom]

Like I said I don't HAVE blood pressure problems.  So, my bp is great if I don't take the meds, BUT they aren't my bp meds.  It is all for my cardiac rhythms and functions.  If I dont take them, my rate is WAY too fast and starts to lose cardiac output.  

I do sometimes take on more salt to increase my pressure.  A little caffeine can help with the pressure but can do bad things to the rhythms.  I have a couple cups of tea and a dr pepper per week.

I'll take my home bp cuff with me to the md.  Either the maching itself or a log of recorded pressures.  I would not feel good at 72/58.  If I had a pt with a pressure that low, I would be in action.  Good to know some can tolerate it.  I am kind of looking for what other acceptable lows are.

I've had a couple episodes of collapsing at work.  At home, I know when to just kick back and drink water and eat something salty.  Thanks for answering my question.  Maybe others will too.  Hope all is well with you.

[NTB]

I know a woman who is small and thin, her BP is usually 72/58, but she says she feels faint if she gets much lower than that. She once had a MAJOR problem coming to from dental anesthesia, so keep that in mind.

I'd take my BP monitor with recorded measurements right in to the doc so he can see your home BP directly. Many more docs are putting increasing importance in home BP rather than office BP anyway.

You can try consuming more salt, more caffeine, less K.

Or better yet, just decide on your own to take less Rx.



An unrelated side note: something like 40% of people don't take their BP meds, and maybe half of those never even get their prescription filled.

[banglamom]

I work where people have BADLY failing hearts.  Many of them have desperately low blood pressures because the heart isn't strong enough to do much pumping.  Cant really judge hypotension by them because they also have weak hypokinetic big boggy hearts.  Are there any other folks living life out there getting dizzy with bps in the 80s, 70s...?  What do you do with it?