Reduction of dosage - atenolol

[satya55]

I take atenolol .25mg and amlodipine 5mg every night around 7p.m. Though I don’t have issues, during night time my heart rate is as low as 49 or 50.  My BP is around 100/55. Should I reduce my atenolol dosage to half of what I take now ie .12.5mg to increase heart rate as I feel heart rate of 49 is too low. During day time my heart rate rages between 55 and 62. Please advice.

[Dr Santos]

Hi,
Thanks for the updates. For more accurate blood pressure reading, it is recommended that you do not measure your blood pressure right after you wake up and have it before eating breakfast, exercise or medications. Avoid food, caffeine, tobacco alcohol for 30 minutes as well as full bladder  and talking before taking a measurement .Also, sitting quietly for three to five minutes beforehand with comfortable position with  legs and ankles uncrossed and back supported against a chair is recommended. Each time you measure your blood pressure, take two or three readings to make sure the  results are accurate and take your blood pressure at the same times of day ( morning and evening). Check with your doctor if you have any unusual or persistent increases in your blood pressure.  Hope this helps. Take care always.

[satya55]

Dr Santhos,
While I thank you for the suggestion, am really sorry for the delayed response. I have reduced the dosage of atenolol from 25mg to 12.5mg that has significantly increased the heart rate to near normal.  As expected this had corresponding effect on blood pleasure and during day time both systolic and diastolic pressure is near normal. Please correct me if my understanding is wrong. Earlier with the dosage of 25mg my reading during day time would be around 100/60 with heart rate ranging between 55 and 60. The present reading while resting during day time after reducing the dosage is 110/77 with pulse around 65. This adjustment is thought over as the pulse rate during night time used to be as low as 48 and 50. With this adjustment the night time pulse rate has risen to 58. Well, the problem now is when I wake up at 5 am in the morning and take the reading immediately it’s 110/85. I walk my way to the other room that is about 25 feet away and take the reading immediately. When I take the second reading after 5 minutes it’s normal and shows around 105/75. Throughout the day during day time the reading is within 115/80. Is it, while in sleep and when the limbs are resting, it’s the heart that takes the entire load to circulate resulting in diastolic pressure of 85 or should I always sit and wait for 5 min before taking fresh reading?  I do brisk walking for one hour all seven days and also perform yoga exercise. Please advice whether I should take reading when I wake up in laying position. Thank you once again for the suggestion and advice.  

[Dr Santos]

Hi,
I understand your concern regarding your symptoms. Cardiovascular side effects of atenolol such as bradycardia, hypotension, and even cold extremities may indeed occur. In these cases, dosage reduction or discontinuation of therapy may be done. However, for proper management, it is best that you talk to your attending physician about this also. Take care and regards.