Beta-blocker saga continued

[MikeHeim]

A couple weeks ago, I posted that I had been slowly weaned off of beta-blockers due to a low HR and some SOB that seemed to be related. My post at that time was about how my resting HR had jumped from the mid-50's to around 80, and my exercise recovery time had gotten terrible (HR still around 100 three hours after finishing). Well, there's now a new wrinkle added in: by BP is now sky-high as well. I've measured it at several different automated machines (like the ones you find at Target, we also have a couple set up here at work), and I seem to be getting an average of 150/80. When I was on the beta-blockers, my BP was typically about 120/60. I'm going to the Cardiologist later this afternoon for a checkup, and obviously this is the first thing that is going to come up. I have a couple questions for the group:

1. Prior to my surgery and before I took and drugs to counteract it, my BP and pulse were always pretty low (HR-60, BP-120/60). From every measurement you can get from an echo, my heart is now a completely normal size and shape. Why would it now take drugs to keep my HR and BP around those levels? I'm not is quite as good of shape as I was before surgery, but I still hit the gym 4-5 times per week, so I don't think that's the problem.

2. My beta-blocker (Atenolol) dose was 50mg per day when I was having the low HR and SOB issues. Dropping it to 25mg seemed to help me some, but not completely. Does anyone know the difference between beta-blockers? I know of Atenolol, Metoprolol, and Toprol (mighta missed some spellings there), and I'm pretty sure that they are not just different brand names for the same drug, even though they act similar. Is one more potent than the others or something like that? I'm obviously going to need to strike a balance between high beta-blocker levels, which seem to give me SOB, and no beta-blockers, which leave me with a pretty unacceptable BP. I'd like to at least have an idea about what to do before I visit my Cardio this afternoon.

Thanks for any input!

 

[Rush20]

A couple weeks ago, I posted that I had been slowly weaned off of beta-blockers due to a low HR and some SOB that seemed to be related. My post at that time was about how my resting HR had jumped from the mid-50's to around 80, and my exercise recovery time had gotten terrible (HR still around 100 three hours after finishing). Well, there's now a new wrinkle added in: by BP is now sky-high as well. I've measured it at several different automated machines (like the ones you find at Target, we also have a couple set up here at work), and I seem to be getting an average of 150/80. When I was on the beta-blockers, my BP was typically about 120/60. I'm going to the Cardiologist later this afternoon for a checkup, and obviously this is the first thing that is going to come up. I have a couple questions for the group:

1. Prior to my surgery and before I took and drugs to counteract it, my BP and pulse were always pretty low (HR-60, BP-120/60). From every measurement you can get from an echo, my heart is now a completely normal size and shape. Why would it now take drugs to keep my HR and BP around those levels? I'm not is quite as good of shape as I was before surgery, but I still hit the gym 4-5 times per week, so I don't think that's the problem.

2. My beta-blocker (Atenolol) dose was 50mg per day when I was having the low HR and SOB issues. Dropping it to 25mg seemed to help me some, but not completely. Does anyone know the difference between beta-blockers? I know of Atenolol, Metoprolol, and Toprol (mighta missed some spellings there), and I'm pretty sure that they are not just different brand names for the same drug, even though they act similar. Is one more potent than the others or something like that? I'm obviously going to need to strike a balance between high beta-blocker levels, which seem to give me SOB, and no beta-blockers, which leave me with a pretty unacceptable BP. I'd like to at least have an idea about what to do before I visit my Cardio this afternoon.

Thanks for any input!

Sorry Mike that I don't have any input, however I am also interested in replies to this topic. Like you, I had no High BP prior to my AVR surgery and am struggling with the side effects of the BP/Beta Blockers as a result.

My next cardio appointment is Monday and I know he will be frustrated (again) that his miracle drugs aren't working. Post surgery, my BP is clocking in at 140/85 and sometimes higher. The side effects (tiredness, lack of energy, etc.) is what's getting to me. I know I can't go cold turkey and stop taking the meds, however I'm really going to push to try and ratchet these down. My career is crazy with stress, however my lifestyle is good in terms of diet, exercise and other heart-healthy reports - good cholosterol and triglicerydes (sp?).

 

[Adrienne]

Although I don't know the reason for what's happening, I do know that for high blood pressure, there are other medications, in particular ACE inhibitors which dilate the blood vessels and rarely cause side effects. You might want to bring that up when you speak to your cardio.

 

[Ambience]

My best guess? Your body has adapted to using Beta Blockers, and now requires them to maintain your current physiology. Regardless having your BP up that high is bad for your mechanical valve, I'd imagine it would be bad for a tissue valve. Taking blood pressure meds may just be something you have to adapt to, as the wonderful package that is open heart surgery.

Another idea bouncing around in my head is that you may just be genetically susceptible to high BP as you age, and the work you recently had triggered its onset. Either way, getting it in control is key at the moment.

 

[Bina]

All my life before OHS, my BP was great 120/70-- pulse 65.
I never went to a gym, but owning horses and dogs, etc. was a good workout.
Now postop, I take metoprolol to keep my HR and BP in check. I am down to a very low dose and split it up into 4 doses during the day to avoid the high and low pitches of twice daily dosing. I take 60-75mg per day. Here in Canada we dont have the slow release formula in low doses.
Metoprolol and Toprol are the same, maybe you could try one of these.
Many VR members take Toprol XL

 

[Marguerite53]

You may already be at the cardio's, but here's another 2 cents....

I was surprised by how well I adjusted to being off of beta blockers. However, lately I am tired all the time and wondering if there are some palpitaions that I can't feel contributing to that. If so, I'll cave and go back on the beta blockers.

My cardio said that there were literally hundreds of kinds of BP meds out there. I suspect you should just try something else. And keep trying until you find one that your body will adjust adequately to.

Why can't we be normal now that we're fixed? I don't even know if there is an answer to that. Our systems had learned to compensate so long with the problems we had....could it be that once fixed we would have had these kinds of problems anyway? Could it be that our "engine" is now to big for the vehicle and idling too fast...or whatever engines do.

Sorry you are frustrated. I know you will find a solution....just be persisitent and don't settle until you are satisifed.

Good luck!!

Marguerite

 

[Rich]

Hi Mike,
My wife was on Atenolol for several years. It was determined the beta blocker triggered her immune system and caused a bad case of psoriasis.
Now she is taking Altace for her BP. In addition she takes Tekturna (it's a relatively new drug) which is a direct renin inhibitor for hypertension. Also she takes Verelan PM which is a calcium channel blocker, again to protect her heart. This combination (she is not thrilled about having to take all these meds) seems to be working well and allowed her to throw the beta blocker in the garbage.
Rich

 

[leecrowley]

Hi Mike,

Toprol XL and metoprolol (brand name is Lopressor) are very similar, but not quite the same. Toprol XL is the Extended Release version of metoprolol. I believe the generic name for Toprol XL is metoprolol succinate (sp??) and the one for Lopressor is metoprolol tartrate (sp??). Either one of these is different compared to Atenolol. If I remember correctly, the Toprol XL and the Lopressor do cross the brain-blood barrier, where the Atenolol does not. Someone please correct me here if I have that wrong.

I take Toprol XL. My surgeon believes it will increase the longevity of my valves after my Ross Procedure. My dose was 50mg 2X per day for the 1st year post-op. I play a lot of high-level tennis, and had major stamina issues with this dose. A couple of months ago, we went to 25mg 2X per day. This has not cured the stamina issues, but it is better. Before my surgery, my BP was 140/70 and my resting pulse was 68, usually. At 6 months post-op (after I was back to my regular tennis routine), my BP was 115/62 and my resting pulse was 52. After being on the 25mg 2x per day dose for 2 months, my BP is 122/70 and my resting pulse is 62. It does take about 3 hours for my pulse to get back down that low after playing tennis for a couple of hours.

Other than that, my side-effects from the Toprol XL are minor. I have some really weird dreams every once in a while. And my hands and feet get cold a lot easier than before the surgery. My weight has finally crept back up to my pre-surgery level, and it is nearly impossible to lose weight on this medication, as I'm finding out. Those are things I can live with.

My cardiologist says there is no documentation that the beta-blockers will make my valves last longer, so he says I don't need to take them. My surgeon has done well over 200 Ross Procedures with very good results. I trust his judgement on the beta-blockers.

Do you know if you are taking the beta-blockers strictly for BP regulation?
My surgeon told me the BB's were more to regulate how hard and fast my heart pumped, with the BP regulation a welcomed by-product........i.e. that BB's are not primarily for BP regulation. I wonder if you could take a low dose of the beta-blocker (say 12.5 mg) and take a low dose of an Ace Inhibiter like Lisinopril for your BP. Maybe running that by your Cardio would be worth a shot?

Good luck to you, and I hope you can get it straightened out.

Lee

 

[hensylee]

my dr's nurse told me atenolol & toprol were the same - except the toprol xl lasts longer.

 

[OldManEmu]

Beta Blockers

Beta Blockers

Mike I think there are two issues here. Blood pressure and heat rate. Beta blockers I found are good with heart rate and to a lesser extent blood pressure and ACE inhibitors are good with blood pressure. 1 year post surgery after heart remodelling I was able to stop beta blockers on my cardio's advice. My resting HR now is low 60's, high 50's without beta blockers. I feel much better since I stopped beta blockers. I hope I never have to go on them again as I was bad the whole time I was on them, however this was a price I had to pay to get the heart remodelling. I still however take ACE inhibitors to lower my blood pressure as I target <120/80.

 

[RobThatsMe]

Hi,

I am on Atenolol, a betablocker, and have been for 7 years.

I have a mechanical heart valve and an ascending aortic dissection that goes from my aortic valve all the way down to my left knee.

It is true that the beta blockers of the Lopressor family do cross the blood-brain barrier and will effect the central nervous system. Many people will feel more lethargic or depressed due to this. Atenolol does not cross the blood-brain barrier.

My doctors explained to me the reason that they want me to stay on a beta blocker. These drugs accomplish two things. They lower your blood pressure, and they also slow your heart rate, (pulse).

These 2 things help reduce the force of each pulse though my system, and my heart valve, (lower blood pressure). And, as a result of the medicine slowing my heart rate, this reduces the number of times per minute that my system, (Aortic artery with the dissection & the valve), gets hit with the stress of the pulsing of blood against it during the high number, (systolic level?), of your blood pressure.

Anyway, it's what I was dealt, life is good, and hey... how many people can walk on a treadmill at a brisk 4 mph pace, and not have their pulse rise above 98!

Another thing that I notice mostly, is that due this drug lowering my heart rate, that means my metabolism is slower, thus have to watch what I eat, as I do not burn off as many calories as I used to, and also that with the pulse staying low, there are not as many highs and lows in my feelings, So.. just call me Mr. Excitement! NOT.... more like Mr. EvenKeel!


Hope this helps shed some info on the topic from my personal experience with it.

Wishing you all good health,
Rob

 

[Rush20]

Hi,

I am on Atenolol, a betablocker, and have been for 7 years.

I have a mechanical heart valve and an ascending aortic dissection that goes from my aortic valve all the way down to my left knee.

It is true that the beta blockers of the Lopressor family do cross the blood-brain barrier and will effect the central nervous system. Many people will feel more lethargic or depressed due to this. Atenolol does not cross the blood-brain barrier.

My doctors explained to me the reason that they want me to stay on a beta blocker. These drugs accomplish two things. They lower your blood pressure, and they also slow your heart rate, (pulse).

These 2 things help reduce the force of each pulse though my system, and my heart valve, (lower blood pressure). And, as a result of the medicine slowing my heart rate, this reduces the number of times per minute that my system, (Aortic artery with the dissection & the valve), gets hit with the stress of the pulsing of blood against it during the high number, (systolic level?), of your blood pressure.

Anyway, it's what I was dealt, life is good, and hey... how many people can walk on a treadmill at a brisk 4 mph pace, and not have their pulse rise above 98!

Another thing that I notice mostly, is that due this drug lowering my heart rate, that means my metabolism is slower, thus have to watch what I eat, as I do not burn off as many calories as I used to, and also that with the pulse staying low, there are not as many highs and lows in my feelings, So.. just call me Mr. Excitement! NOT.... more like Mr. EvenKeel!


Hope this helps shed some info on the topic from my personal experience with it.

Wishing you all good health,
Rob

Interesting comment of feeling lethargic and depressed. I am currently on 25MG of Toprol XL and 10MG of Altace. Although I showed a little improvement, my BP is still works back up and is clocking in at 140/90. My next cardio appointment is Monday and I'm sure the result will be a new cocktail to try and get it down. They already performed an echo on my kidneys to make sure I wasn't blocking the meds and everything checked out OK. My cholesterol/other numbers are great.

Since I've been on the various BP meds, I have had bouts with insomnia, weird dreams and anxiety. Some of the anxiety is caused by not being able to sleep with random thoughts popping into my head whenever I try to sleep. Meaning - it's not like I'm lying there worrying or thinking about anythink specific. More, just the inability to turn my mind off. As a result, I am then tired in the afternoon (not hard to figure out why), only to return to the viscious cycle the next night. It's getting to the point, I get anxious about trying to fall asleep which adds to the frustration.

I know there are many therapeutic activities, relaxation exercises, etc. that can be performed, however this anxiety never happened before I took the BP meds. Even post op four years ago.

 

[maestrorn]

Beta Blocker Issues

Beta Blocker Issues

Sounds like the best option would be to try some different medications in order to find the right fit for you. I am taking 50mg of lopressor in the AM and 25mg at night. I haven't noticed any problems except for light-headedness when I get up out of a chair to quickly.

The key to remember is that each of us is different in how meds affect our body. So don't be to quick to try something out just because it works for someone else.

I wonder if you have Hypertensive genes in your family? It might be worth a little digging into your family tree.

Here's a little basic pharmacology that may help. There are two kinds of receptors that beta blockers work on in your body. Alpha receptors cause vasoconstriction of your blood vessels which indirectly raises your blood pressure. Beta receptors increase your heart rate when stimulated. So beta blockers stop (or block) the stimulation of those alpha and beta receptors. coincidentally those receptors are located in your carotid arteries and your aorta.

I know this is probably more than you wanted to know, but thought I would share it.