Blood Pressure Issues

[Larry]

I have been dealing with high blood pressure/anxiety related problems all summer and now into early autumn. Plus, my chiropractor has been trying to help out with shoulder area/pectoral muscle scar tissue and pain for about a month. The muscle thing seems to be healing.....light weights and Therabands.

I have been taking Toprol XL (25 mg.) twice daily for about 6 weeks.
I seem to have very little strength in my legs. Walks as little as a half mile push my blood pressure up tp 154/96, perhaps a bit higher on the diastolic.
This seems high to me for such a short distance, and I am not walking at a fast pace. Does anyone have any knowledge about how high your b.p. should be when you are actually working out at a moderate level? I do not mean at a fast pace or long periods of working out. I am referring to 30 minutes of walking, jogging, or easy riding.

This is preventing me from going on longer walks or light jogs, and yes, it is creating anxiety issues....... sometimes feeling panic attacks about to overtake me.

Also, is there a most beneficial time to take blood pressure medicine during the evening or daytime. This medication is supposed to slow down the heart
and smoothen out the slightly irregular heartbeat (not dangerous according
to cardiologist), but I am feeling that it really does sap the strength and fire out of your body.

I did a stress test July of 2003, and actually the resting b.p. was 140/94, which is borderline, but the doctor still put me on the Toprol. The strange thing is that during the stress test my b.p. remained at 150/90 (170 heartrate) for the most intense period of exercise. It makes me feel that the elevated b.p. was anxiety. I did have an issue with PVC, but the cardiologist said my heart was fine. My regular doctor has checked me over several times, and he is not concerned about an issue with heart disease.

Any info or suggested readings or website would be welcomed.
Thanks. Larry

[spiderman]

i have folks take toprol at night
to minimize the fatigue
and optomize the early morning coverage of the bp...
...you should be able to mount a blood pressure response
with exercise...
yes, both your resting and exercise levels are
in a treatable range...
and the dosage seems appropriate
(not knowing your mg/kg specifics)
and helps with a nice calming effect as well.
cut out the salt,
eat a banana every day (they have tryptophan
a serotonin precursor that helps minimize anxiety)
make sure your getting enough quality sleep
and exercise daily...

you should see your blood pressure normalize.
if not, a mild thiazide-type diuretic may help the pressure...
...or your doctor may consider adding
meds to enhance your serotonin/neurotransmitter levels.

sounds like you're on the right track...
...there are other things that might help
if you follow the above and are still having trouble.

[gasman]

You are taking Toprol twice a day so it will be hard to avoid the fatigue issue. I think beta-blockers ( a class of drugs of which Toprol is one) are lousy for athletes. It is a common side effect to feel fatigue with beta blockers and if you are trying to exercise it feels worse. There are a lot of other drugs that can be used to control your blood pressure and not effect your ability to exercise. You might ask your doc to try you on another drug, Spideys' suggestion of a thiazide diuretic is a very good place to start. Anxiety can certainly make your blood pressure more an apparent problem to control, probably not a real problem.
There are a number of good drugs that can be used to control anxiety but won't sedate you, most of those drugs are prescribed by psychiatrists from what I have seen (I'm not a psych. so I don't know really know them)In additon there are lot of non-medication approaches like meditation, yoga,etc
Or you drink heavily like bostondrunk.

Good luck, you have a ton of options. :banana: :banana:

[Desibhai]

Larry,

I currently take Toporol XL (75 mg) at night, I have been taking this drug for last 3 years, out of curiosity why has your cardiologist recommended toporol XL twice a day. This particular form of Toporol (XL) is a sustained release tablet that should last for 24 hours, you may want to consult your clinician again about the dosing frequency and when during the day you should take it.

Good luck with your treatment,

Utpal

[Larry]

Utpal,

Originally, my doctor had me taking 25mg. daily.
But, in the heat and humidity of the summer, I was having high spikes,either from anxiety or this pectoral muscle issue. Also, the air quality was orange and red fairly often. So...... he suggested that I go to the 50 mg. daily dosage. I more or less assumed it would mean twice daily. But, I suppose it makes more sense to take it only once.

Typical readings have been around 108/65 in the early morning. Actually, there are times when pressure goes even lower. But, I tend to feel really sleepy and a bit groggy in the early morning. Perhaps, I may try splitting the pills, and try a one and half daily dosage.

So..... 50 mg. really is not a high dosage? Is this correct? And, it makes sense to take it at night. I am getting the impression that during mid-afternoon, I am having a tendency towards anxiety, and this can indeed elevate b.p. He has prescribed Ativan, which I think is a mild depressent, and really makes you sleepy.

Actually, the whole h.b.p. issue is a bit depressing. I feel like I am beginning the slide downward at age 51.

Thanks for the advice and encouragement.

Larry

[Jeff N.]

As from a previous post, ask your doc about Diltiazem. Jeff N.

[Desibhai]

Larry,

I have taken as high as 100 mg a day. One thing about all medicines is that what's good for one person may not be good for the other. I know some folks who don't tolerate Toporol XL at all. As Jeff N and some other folks suggested consult your doctors and see what they advise including discussions on alternate medications. High BP is one thing that you need not stress about. There are many options to control it.

Utpal

[spiderman]

that take 200 mg of toprol
and some that take 12.5...
as has been said, everyone's different...
...and there are certainly different indications
for prescribing this beta blocker...
headache prophylaxis is another use for example...
interestingly enough...
...a beta blocker is probably one of the only bp meds
that has a positive preventive benefit
protecting against not only heart muscle
morbitity but also mortality...
ie) people taking beta blockers
may live 'better and longer'.
as far as treating the anxiety goes
...an antidepressant would be a much better way to go
than taking ativan alone...
specialty referral for either of these problems
is usually not necessary...

[dave.delano]

I am currently taking 16 mg of Atacand and 5 mg of Norvasc every morning. My cardiologist tells me that my BP tends to lower during exercise. I have been having problems with (quads &/or hammies) cramping during triathlons. I have offset the cramps with salt tabs (SUCCEED), but conditions can make an accurate dosage iffy. Finally hit upon the idea of waiting to take my meds until after completing the event. Seems to work, but will have to wait until next season to confirm with more than one race. Any other people out there coping with this?

[Dekonick]

I agree with Jeff - beta blockers suck for athletes.
there are many good options you can try that work just as well (if not better)
the suggestion for HCTZ is a good place to start, especially if in conjunction with other meds.

For anxiety issues - there is no single magic pill. You (unfortunately) are going to need to try several, give em time to work, and find what works for you. There are a bunch of really good SSRI's (Paxil is a good starting point but it can cause ahem - erection problems...well- your will have one, but ye might take a bit longer than usual to ahem - climax. - it is still a great starting off point. (there are a ton of good meds, best place is to talk with your MD and a psychiatrist as they are most up to date on new drugs)

My personal favorites for hypertension are ace blockers, or ace inhibitors. Nothing wrong with the Ca++ blockers Jeff was mentioning above, and they often play well with others..

Regardless of what you do - get checked out for other causes of hypertension - ie have your kidney's x-ray takes, renal function tests, etc...

you only get 2! (Kidneys) take care of em!

From what I have read salt can play a part, but not everyone is sodium sensitive.

Good Luck!

Search the forum, I remember this being discussed many times before. It seems to be a common issue. (personally, I have been hypertensive since my 18th birthday - discovered in a routine physical. No biggie now, just take your meds! - and be honest with your MD - they can only help you if you give good information.

:D

[ajs122]

Very interesting topic. My experience: 8 years ago feeling poorly I went to the emergency room as was told I had high blood pressure at age 54. I was put on accurpil. Over the years my blood pressure gradually began to rise again until it became borderline. Then about a year ago I read in the newspaper about a government study that stated that none of the modern drugs were as effective as a dieuritic in reducing blood pressure. I asked my doctor and he put me on one and it had immediate results. They take some time getting used to and slow you down, but work. Now I take both.

Now you would think that after 7 years and at least 5 different doctors that one of these guys would have figured this out by now.They don't have a clue, they just prescribe what the drug companies tell them.And drug companies are not going to tell doctors to use what is inexpensive effective and been around forever. Thats the way we're treated in this country, the latest and the most expensive is what you get unless you know better.The bottom line, you had better be your own caretaker and know your own body and your history. Otherwise you're at the mercy of the money grabbing SOBs. I would also encourage you to use the internet to check prescriptions and side effects.You can bet your doctor doesn't.

[Dekonick]

well said. Sad but true about Doc's - some are great about keeping up with new rx's but many don't.

Diovan hctz is a good mix - ask:) Benicar is another but its a bit strong to start out with. I still say make sure you are honest with your MD - and have a MD that understands cycling (many think its just a trip round the block at 10mph and have no idea that we torture ourselves for fun)

[Sandy]

My identical twin brother got all the brains at birth. He is a cardiologist. I read him your post and he had a couple of questions and a comment.


When did you start taking any kind of blood pressure medication?
At the time of your stress test in July of 2003, were you on any blood pressure medication? Any medications?

You stated that your resting bp was 140/94. Was that at the time of the test? If so, he is a little surprised that your bp only went up to 150/90 (with a pulse of 170). A significantly higher systolic number would be expected. To only go from 140 to 150 could possibly indicate that there was a problem with heart contraction.

I even noticed that your bp on walks went to 154/96, but you had a bp of 150/90 during the most intensive portion of the test. That doesn't even make sense to me, since one would expect that under intense stress to the heart (in the stress test), the bp would be higher than when you were walking. My brother agreed. Please tell what meds you were on with both the 154/96 and the 150/90. It is confusing to my brother with what I read him.

My brother, in my humble opinion, is a superior diagnostician, and perhaps, if you wish, he couild give you some advice. I didn't ask him, but I feel that he would be most willing.

From the heart,


Sandy

[geezohwiz]

I am currently taking 16 mg of Atacand and 5 mg of Norvasc every morning. My cardiologist tells me that my BP tends to lower during exercise. I have been having problems with (quads &/or hammies) cramping during triathlons. I have offset the cramps with salt tabs (SUCCEED), but conditions can make an accurate dosage iffy. Finally hit upon the idea of waiting to take my meds until after completing the event. Seems to work, but will have to wait until next season to confirm with more than one race. Any other people out there coping with this?

I, too, take Atacand (twice daily) and have been experiencing quad/hammy cramps as well. I chalked it up to the diuretic I am taking (I'm sure it contributes) but now that I think about it, the cramping started before the diuretic. I asked for some advice on the cramping issue a few days ago (see "Help! Leg Cramps!!! thread). But now you've got me thinking it might be the other meds. Salt tabs would appear to be a no-no for hypertensive patients?!?!? I almost always take my meds after a ride/race, but it hasn't seemed to make the cramping issue any better. I'm going to continue to research and work with my nephrologist on a solution.

[Larry]

Brother Sandy,

I will get the copy of the stress test results tomorrow at the office.
I can communicate the results more effectively if I have the document in front of me.

This whole ordeal has been going on for about 16 months.
If I could get an email address or a phone number, I would be interested in presenting my situation to your brother. There are many details and events that have transpired, and it is a bit scarey to start working out again. I do have panic attacks and occasional b.p. spikes.

Again, the Toprol tends to make me sleepy and saps the strength out of the legs, so ........ I feel destined to getting more out of shape and to continue to decline in health. I am only 51.

Larry

[malcolm]

ajs 122 you need to spend a day with a busy physician. I know and work with many both good and bad, few are money grubbing and even fewer I know pay any attention to drug reps. Probably the most pressure to prescribe comes from ill informed pts. that spend too much time on the internet and show up with 20 minutes of knowledge assuming they know more than you. Hctz is a great drug and cheap, not well tolerated by some folks especially those aerobically active for long periods, hydration issues, cramping etc.. Many folks if placed on hctz for bp would look for another doc because you did not use the new high tech stuff. I do agree with the statement that there is no reason for most people to have uncontrolled bp these days because there are too many benign choices out there. An interesting study was done with beta blockers and activity, some and I can't recall the exact ones really had no measurable effect on performance, however all tested had a perceived increase in exertional effort for the same level of performance. Any way good luck with your bp. I suggest you find a good doc that you like and that will listen to you and stick with him.

[Dekonick]

I agree that most Doctors (especially family practice / internal medicine / pediatrician types) do not work just for the almighty buck. I know this from most of my good friends (and if you ask many of them if they would do it again the resounding answer is a loooonnggg pause, often followed by a no.)

[malcolm]

Dekonick, I agree except I don't have to take the long pause. Many good things but the frustration is not worth it.

[Sandy]

My brother is somewhere in Vermont or New Hampshire today and will be visiting friends in NY on Saturday. He will be going home on Sunday. It is probably best that I wait to call him on Sunday. I will be back you on the matter. Certainly, I think, that the way for you to go is to call him directly.

Sandy

[Sandy]

Sorry for the delay. I am often too slow in getting things done. I spoke to my brother. He is most willing to talk to you about your problem. Please email me, and I will give you the phone number.

Sandy

[Kane]

Larry,
There seems to be a lot of research on Omega 3 Fish Oils and cardiovascular health. In addition to your medication, please consider doing a clinical trial with fish oils for 3 months. Other than a minor bump in calories and fish allergies there are few reports of side effects and no drug contra-indications that I am aware of at this time.

The fish oils may help the anxiety if you take about a third of an ounce. This nine gram portion has been used in clinical trials for people with manic/depression. Specifically, of the three 'Omega 3's', DHA is the one that crosses the blood brain barrier. These fats are called 'essential fats' because your body can not manufacture them so you have to get them from your diet. **Important, make sure that you buy 'distilled' fish oils because this eliminates the potential heavy metals of the fish. Start off with a low dose 1000mg for a few weeks while your body gets used to making enough fat enzyme (lipase) to digest this stuff. The flavored liquid is the economical way to use this nutrient, but I would start off with capsules and than use both as necessary for convenience. Don't forget to refrigerate them after you have opened the container.

Russel Blaylock Phd. has a book called, "Health and Nutrition Secrets that Can Save Your Life." This is a good start. Ask you doctor or your chiropractor to run a heavy metal panel on your blood. Everyone's got some, but some people have more than others.

There is an anti-inflammatory effect, (prostaglandin inhibition), which will likely help out your shoulder. Unlike NSAIDS (aspirin, motrin, alleve et. al.), there are no negative kidney or liver side effects. NSAIDS kills more people than AID's from GI bleeding, so avoid them like the plague. Fish oils are have a blood thinning effect.

Truly if these were a patentable drug, they would be the number one drug in the world for their powerful and safe effects.

Cheers,

Kane

(Well researched and documented to still be a slow rider.)

[BumbleBeeDave]

. . . and I don’t even play one on TV! ;)

But I am a consumer, and if you are going to use the Internet to search for health related information, beware that almost any of the search engines you may use--Yahoo, Google, etc.--will have search results influenced by clients who have paid handsomely for the privelege of turning up at the top of the list on popular searches. This has turned out to be a problem for me on almost any search for info on specific medications or diet supplements. Be very careful what you believe, because it may not be at all obvious from the website you are consulting that the poster has a vested interest of some sort.

That being said, I think being an informed consumer and searching for your own information CAN be useful as long as you don’t shove it in your doctor’s face. My doc is easy to talk to and has been very forthright in admitting there is no way possible for him to be read up on the latest and greatest in every area he has to work with as a GP. We have both learned a few things.

BBDave

[ajs122]

Just another follow up on this topic. Again not feeling my best I did some more research on heart desease on the web. One artical by a doctor on societies that have much lower rates of heart desease then what we experience in this country centers around the differences in diet. The diets in these countries were higher in Omeg-3 fatty acids. The natural foods containing fatty acids are fish oil, faxseed, and wallnuts. Well, what do I have to loose? So I tried it, note I haven't given up my medications, but I have added fish oil and wallnuts to my daily diet. Well I can't believe it. After one week, I'm no longer having shortness of breath, no more ED,not all tired all the time but more importantly I'm just feeling great. Now I'm getting back on my Serotta instead of thinking of selling it. I'm able to take on the hills better than before. So let me ask you, what have you got to loose?

[Dekonick]

One more addition - when buying over the counter supplements - check the label and make sure it has 'USP' - this is the only way to know that they are checked and provide you with what they say on the label.

I agree, if omega 3 fats could be pantented, oh boy! There are other examples of meds that would fall into a similar category. Asprin comes to mind! I can not think of many medications that have such a benefit to man - or that are as dangerous unregulated - as Asprin! Be glad its been around for a long time or it would cost $500 for a month supply v.s. $5....

I rant again...

Hey! What happened to the nice dry weather???? Seems to me that fall just never happened this year! - summer to winter; bypass fall.
:confused:

[Larry]

O.K. Gentlemen,

I went to the local health food store and bought Omega-3 Norwegian Fish Oil
in a soft gel form...... plus walnuts, which I like anyway.
I will give it a try and find out if things improve a bit.

If it gets me back on the bike, HOORAY! That means I will slowly lose the unwanted beef through the middle!!!

Larry

[ajs122]

Oh, and by the way I have cut out beef all together not because of heart deasese but because of mad cow deasese. Our government is not doing sufficient amount of testing on our beef supply.

[jora1]

ya its good that u are going for stress test by this report dr. can understand that what treatment is nessary for u but according to your situation i think that with medicin u have need to take some precautions like
avoid the oily food and non veg and dont take unexpactional tension in ur mind u have need to use fresh vegitable and ulse in ur dite and take Dibenzyline drug[/URL] regularly.

[rpm]

Larry, I've walked a moon in your mocassins. The problem is that you get caught up in a vicious cycle of worrying about your blood pressure, which in turn, makes it worse. I think my doctor and I went through about every drug in the Physician's Desk Reference, even trying some awful prehistoric drugs like Clonidine and Menoxidil. What's worked is a triple combo of Diovan (max dosage), HCTZ, and Hytrin, an alpha blocker, which doesn't have the athletic and sexual side effects of beta blockers. If I have side effects from these three drugs, I don't know what they are.

The frustrating thing is that everybody is different, and you may be messed up by drugs that most people think are fine, and you might do fine with drugs that mess up a lot of other people. The usual strategy is to start with a single drug and up the dosage until it either works or the side effects become intolerable. It's sounds like you've hit that point with your beta blocker.

You may need to back off the dosage a bit and try adding another drug, with HCTZ being the first choice. Then if that's OK but doesn't work, try adding a third drug, with Diovan, which seems to be tolerated by many people, being a good choice.

One thing you should do is to rule out serious kidney disfunction, and you may need an MRI to do that. Beyond that, it's a task of making educated guesses. Since genetic testing isn't advanced enough to predict individual side effects, you're into trial and error. You and your doctor should collaborate on this. His or her guesses are likely to be more educated than yours, but they'll still be guesses.

And don't worry. Eventually you'll get it figured out.

[soulspinner]

I can speak to the change Lexapro has made for me with panic disorder. I take 10 mg once per day and it has completely stopped them. Although designed as an ant-depressant, it works well with panic disorder. Also, stop blaming yourself for the panic attacks. My doc says at some point your brain learns this and its more than you just being nervous. Also learn active relaxation techniques, it takes time but helped me. Keep pumping positive messages into your consciusness. Get excercise. Good luck. God bless.

[Larry]

Gentlemen,

Thank you all for your comments and suggestions.
Health issues have continued to be a concern, but matters have toned down significantly.

I had a Nuclear Stress Test done......cardiologist detected that a blockage was occuring at high heart beat rate. He stated that I could have a heart attack.
Next step......Heart Catherization Test......result indicated that there was no blockage to be found anywhere. Nuclear Test has 10 per cent margin of error. The heart was fine.

In the meantime, through a lot of turmoil, it has been determined that I have Bi-Polar Disorder. My medications are Celexa 20 mg. with Lithium 300 mg. in the morning, and Klonopin 1 mg. with Lithium 300 mg. at night.
In addition I have ridden over 1000 miles since March and returned to the gym for light weight training, light jogging, and taking long walks near home.
Weight has dropped significantly, muscle tone is much improved, and resting heart rate is between 55 and 60.

I am still having an issue with what seems to be anxiety attacks, if I ride with more intensity. (Same with jogging.) I will start to feel weird in the head, and slowly the HR monitor will climb to 173. I try deep breaths and within a short time the heart rate slows back down to normal. I do not know how to solve this issue.

Thanks to All.
Larry in Dallas

[Sandy]

Relative to you anxiety attacks, I would suggest that you talk to the doctor that you are going to for your Bi-Polar disorder. I believe that Celexa is an anti-depressant, Lithium is a mood stablizer, and Klonopin is helpful for panic disorder.

Note that I am not in the medical field, but have had some experience with bi-polar and depression problems with people that I know.


Sandy

[Dekonick]

one more thing -

panic attacks can not be treated only with medications. You NEED to work with a therapist, and your doctor - preferable a psychiatrist.

one without the other is like pissing in the wind. You get relief - but only for a little bit... :D

[bostondrunk]

Or you drink heavily like bostondrunk.




Ahh....actually I've been having some BP struggles as well. 32 years old.
Took it a few times the last few days and it is around 179/99.
Never been on any medication. Only thing i can think of at the moment is that I've probably only averaged about 3-4 hours sleep per night the last 2 years, usually split up between waking up 4 times...
Time to see the doc...

[William]

Ahh....actually I've been having some BP struggles as well. 32 years old.
Took it a few times the last few days and it is around 179/99.
Never been on any medication. Only thing i can think of at the moment is that I've probably only averaged about 3-4 hours sleep per night the last 2 years, usually split up between waking up 4 times...
Time to see the doc...

Or get a Basset Hound. ;)


William

[Larry]

Ahh....actually I've been having some BP struggles as well. 32 years old.
Took it a few times the last few days and it is around 179/99.
Never been on any medication. Only thing i can think of at the moment is that I've probably only averaged about 3-4 hours sleep per night the last 2 years, usually split up between waking up 4 times...
Time to see the doc...

Dear Boston,

Try Trazodone 50mg. for sleep. 100 mg. will really make you sleep!!!
It was the best sleep med I ever have taken.
And please......see a doctor for BP. You are young and should be able to get control of this with proper treatment.

Larry

[Larry]

Relative to you anxiety attacks, I would suggest that you talk to the doctor that you are going to for your Bi-Polar disorder. I believe that Celexa is an anti-depressant, Lithium is a mood stablizer, and Klonopin is helpful for panic disorder.

Note that I am not in the medical field, but have had some experience with bi-polar and depression problems with people that I know.


Sandy
Sandy,

My Doctor has prescribed these meds for Bi-Polar (it seems to be mild),
and I hope to reduce the dosages (negative sexual side effects.)
The fire is burning low for right now!!!!!!!!

Larry