Poll on blood pressure

[MeSci]

I had been thinking of trying atenolol for my hypertension, but have changed my mind after finding this 2009 paper.

I have always suspected that my hypertension is due to excessive vasoconstriction, and atenolol can actually increase this. When I was first found to be hypertensive, I asked my GP what the reason for it might be. His reply astonished me: "The most common reason is no reason."

That proved to me that there can be a huge difference between being a doctor and being a scientist!

What I want to to is identify the cause of my hypertension and address it directly if possible, not just try a drug that is no more than a sticking-plaster solution that may cause further imbalances, for example in electrolytes, as it looks as though my ACE inhibitor has.

I was particularly struck by this paragraph in the above-linked paper:

Newer beta-blockers with vasodilatory properties may overcome the adverse effect of increased peripheral vascular resistance that occurs with older agents such as atenolol.

I am wary of trying new drugs, as all-too-often the latest 'wonder drug' turns out to have serious adverse effects that are not discovered for a long time, or at least fail to reach clinical practice for a long time, as is now emerging with regard to ACE inhibitors and ARBs, as discussed in this thread.

But from what the paper says, I like the sound of Carvedilol, or perhaps better still - Nebivolol, which increases levels of nitric oxide, as I have a strong sense that I have arterial stiffness.

Need to check them out a bit more though, as I know there are different types of nitric oxide, as discussed here and here.

 

[Jonathan Edwards]

@Jonathan Edwards

I'm not sure that this poll tells you any more than that our blood pressure readings vary as a group but some of the comments may be of interest?

Mmm... I think we would need to have figures and standardise the conditions of measurement to make much of it.

 

[Marco]

Mmm... I think we would need to have figures and standardise the conditions of measurement to make much of it.

I appreciate the problem and it looks as if measurements routinely taken by nurses may not be any better than self monitoring. What struck me was the degree of rapid fluctuation many report.

Subjectively I experience rapid changes in heart rate with minor postural changes but whether or not this is normal and I just notice it more I can't say.

 

[charlie1]

@Gingergrrl - Yes, I tried Midodrine at a low dose twice, several months apart. Both times my heart rate fell to low 30's and stayed there for 8-10 hrs and...did nothing to raise my BP . Very scary both times and won't be trying again!
Apparently its rare to have this occurrence but it does happen to some people. My ANS is very messed up.

 

[Gingergrrl]

I had been thinking of trying atenolol for my hypertension, but have changed my mind after finding this 2009 paper. I have always suspected that my hypertension is due to excessive vasoconstriction, and atenolol can actually increase this.

@MeSci If I am understanding this correctly, you are saying that Atenolol causes vasoconstriction? If so (in my case) this is good b/c I take a low dose of Atenolol to control my tachycardia, which can go into the 160's or 170's without it, but I take Midodrine as a vasoconstrictor to increase my low BP. I had thought these two must be working against each other but maybe they really are not!!! Can you let me know if this makes sense?

 

[Gingergrrl]

@Gingergrrl - Yes, I tried Midodrine at a low dose twice, several months apart. Both times my heart rate fell to low 30's and stayed there for 8-10 hrs and...did nothing to raise my BP . Very scary both times and won't be trying again! Apparently its rare to have this occurrence but it does happen to some people. My ANS is very messed up.

@charlie1 Wow, I am sorry that your heart rate fell so low with Midodrine and this has never happened to me. But I have had all kinds of other weird and rare occurences with meds so I totally understand! It sounds like Droxidopa would not work for you either and it is the same mechanism as Midodrine if I am understanding it correctly from another post. My ANS is very messed up too but it sounds like a different version of mess-up than yours! This is one crazy illness.

 

[MeSci]

@MeSci If I am understanding this correctly, you are saying that Atenolol causes vasoconstriction? If so (in my case) this is good b/c I take a low dose of Atenolol to control my tachycardia, which can go into the 160's or 170's without it, but I take Midodrine as a vasoconstrictor to increase my low BP. I had thought these two must be working against each other but maybe they really are not!!! Can you let me know if this makes sense?

I'm a bit foggy today and can't remember where I read about the vasoconstriction, so have just done some fresh searches.

This page says

May increase the number and duration of angina attacks in patients with Prinzmetal's angina due to unopposed alpha-receptor mediated coronary artery vasoconstriction.

but my foggy brain can't quite make out what that means. One perhaps needs to read more info from the page. Maybe it just means that it doesn't prevent the vasoconstriction caused by alpha receptors because it is a selective beta blocker.

This page says

It works by relaxing blood vessels and slowing heart rate

But this pdf says

Atenolol possesses numerous mechanisms that may contribute to its efficacy in preventing migraine headaches. Possible mechanisms of action are beneficial
vasoconstriction

 

[Gingergrrl]

@Me Sci Thank you so much for posting all that info re: Atenolol but most of it is over my level of comprehension as well! I only take 12.5 mg of Atenolol per day (1/2 pill) and it controls my tachycardia completely which is debilitating without it. I was just curious when you mentioned the vasoconstriction aspect but didn't see it in the link (but I am sure it was there and my brain just missed it.)

I for sure do not have Prinzmetal's angina (which occurs at night lying down with rest) and what I have occurs exclusively during exertion when I am walking around or lifting something. It is still being determined if it is microvascular angina vs. due to low blood volume and BP. I know the atenolol may be slightly lowering my BP which could work against the Midodrine but both of my doctors feel this is the right combination for me (and I do not disagree) but still trying to learn more info.

Thanks again!

 

[MeSci]

@Me Sci Thank you so much for posting all that info re: Atenolol but most of it is over my level of comprehension as well! I only take 12.5 mg of Atenolol per day (1/2 pill) and it controls my tachycardia completely which is debilitating without it. I was just curious when you mentioned the vasoconstriction aspect but didn't see it in the link (but I am sure it was there and my brain just missed it.)

I for sure do not have Prinzmetal's angina (which occurs at night lying down with rest) and what I have occurs exclusively during exertion when I am walking around or lifting something. It is still being determined if it is microvascular angina vs. due to low blood volume and BP. I know the atenolol may be slightly lowering my BP which could work against the Midodrine but both of my doctors feel this is the right combination for me (and I do not disagree) but still trying to learn more info.

Thanks again!

You're welcome, but if I hadn't been so foggy earlier I would have thought to look in the paper I had linked to in the message where I mentioned atenolol causing vasoconstriction!

Here is the relevant quote from that one:

Older beta-blockers, and especially atenolol, have well-known metabolic adverse effects, particularly impairment of glycemic control. This adverse effect appears to occur only with beta-blockers that do not possess vasodilatory properties and thus increase peripheral vascular resistance, which results in lower glucose availability and reduced uptake by skeletal muscles.

This message by @DanielBR in another thread has encouraged me in my wish to try Nebivolol, and might interest you too if there is any possibility that atenolol may have any adverse effects for you.

 

[Gingergrrl]

@MeSci The paper you linked was really helpful and I think I actually understood it correctly! It sounds like that Atenolol is not great for lowering BP b/c it actually constricts blood vessels which in my case is what I want. I am trying to raise my BP with Midodrine and am taking low dose Atenolol strictly to control my tachycardia which it is doing. Now it makes sense to me why (in my case) this is the right beta blocker but in your case it is not. Thank you again.

 

[MeSci]

@MeSci The paper you linked was really helpful and I think I actually understood it correctly! It sounds like that Atenolol is not great for lowering BP b/c it actually constricts blood vessels which in my case is what I want. I am trying to raise my BP with Midodrine and am taking low dose Atenolol strictly to control my tachycardia which it is doing. Now it makes sense to me why (in my case) this is the right beta blocker but in your case it is not. Thank you again.

Did you look at the message I linked to? It says that Nebivolol also controlled tachycardia and palpitations. And the

lower glucose availability and reduced uptake by skeletal muscles

cited for atenolol sounds rather negative, especially for someone with ME. It sounds as though it could increase muscle weakness.

But I don't want to put you off something that helps you or recommend something that might not suit you. Just pointing out things in case you missed them.

 

[Sherlock]

Without clicking the links, I know you must be taking about Cockroft. He was all over theheart.org back then.

BBs I tried (not nebivolol) did nothing at all to lower my BP. But once I got hold of a nitroglycerin tab and wooooshhh! My BP dropped like a rock and I felt this new sensation very very strongly in my aorta. I knew then I didn't have stiff arteries.

Sometimes I got a similar (though lesser) sensation and BP drop from niacin. But not lately.

Pre-CFS, I used to get a pronounced NO BP-drop from exercise - but not lately.

3 years ago, when my eyes were burning (inflammation), my BP would be up. But my BP has been up for a year every day now. 140/90

 

[Sherlock]

Btw, visual distortion from high BP is a medical urgency or worse.

 

[MeSci]

Without clicking the links, I know you must be taking about Cockroft. He was all over theheart.org back then.

What links are you referring to?

 

[Research 1st]

Maybe we can add to the poll, or make another thread as I'd like to add the question are good, re:

Low, Normal, High BP.

However I think the OP might consider having a section for BP 'during a POTS/Autonomic Episode'. This could give some interesting data to compare the results to the existing poll.

E.g. One can have normal BP, but when standing can become hypo/hypertensive for example. The poll as it stands doesn't allow for that or might get people responding who are responding when experiencing a POTS/dysautonomia event thus not giving an accurate poll reflection to the question asked by the OP. E.g. cognitive confusion as I have (I tend to misread things on first reading).

Does anyone else find this with their condition, they have generally normal BP but during an exacerbation it can go wildly in one direction?

 

[Sherlock]

Does anyone else find this with their condition, they have generally normal BP but during an exacerbation it can go wildly in one direction?

Yes, my BP goes higher during inflammation.

 

[MeSci]

Maybe we can add to the poll, or make another thread as I'd like to add the question are good, re:

Low, Normal, High BP.

However I think the OP might consider having a section for BP 'during a POTS/Autonomic Episode'. This could give some interesting data to compare the results to the existing poll.

E.g. One can have normal BP, but when standing can become hypo/hypertensive for example. The poll as it stands doesn't allow for that or might get people responding who are responding when experiencing a POTS/dysautonomia event thus not giving an accurate poll reflection to the question asked by the OP. E.g. cognitive confusion as I have (I tend to misread things on first reading).

Does anyone else find this with their condition, they have generally normal BP but during an exacerbation it can go wildly in one direction?

I don't think the poll can be changed now, and it would confound the results if it was - some participants might not know it had been changed and so couldn't change their answers.

See if there is another poll which includes these options; if not, it's easy enough to create a poll - just click 'Post New Thread' in the relevant forum and fill in the poll details.

 

[Countrygirl]

I haven't read all of this thread recently, but I don't know how to vote as my very low BP that plagued me for 30 years of ME has now become malignant hypertension. I wonder if this is a regular feature of long-standing ME?

 

[MeSci]

I haven't read all of this thread recently, but I don't know how to vote as my very low BP that plagued me for 30 years of ME has now become malignant hypertension. I wonder if this is a regular feature of long-standing ME?

Are you sure about malignant hypertension? It is described here as a medical emergency.

 

[Countrygirl]

Are you sure about malignant hypertension? It is described here as a medical emergency.

Yes, I have been taken as an emergency into A&E on three occasions so far and kept in the stroke ward. My BP suddenly rockets and 'blows my fuses' leaving some permanent damage and three months of apparent severe ME on each occasion. It is of interest I think that the effect on the brain which I gather is called hypertensive encephalopathy is so similar to that of a hefty dose of ME. It even triggered an exacerbation of MCS. At the time, it produces the symptoms of a stroke and on one occasion I was out-for-the-count for some hours. It was quite unexpected to suddenly develop this after so many years of hypotension. I wonder if it is a consequence of ME or could it be an entirely separate condition? It is rather scary!

(I have mentioned this on another thread recently, so sorry about the duplication)