Frustrated - Stubborn High Blood Pressure

[Rush20]

I'm curious if anyone on this forum has struggled with high blood pressure and what remedies have worked?

I never had high BP (140/95 avg.) prior to my AVR three years ago. I'm relatively young (43) and I'm frustrated that this is causing me so much stress (which probably contributes to the high BP in a viscious "chicken or the egg" cycle).

I'm sure my new St. Jude bionic valve has got to have something to do with it. Isn't it logical to assume that after years of a natural bicuspid valve, that suddenly a new, stronger valve would have an impact on how forcefully the blood is circulated?

Over the last year I have been on Toprol XL, Altace and now Lotrel in various dosages. After taking each med for a few weeks, the BP creeps back up. I am trying to make some lifestyle changes, however I already exercise religiously, eat well, don't smoke and limit my sodium and alcohol intake.

I do have a Type-A personality and a corporate job, however since I am in the prime of my career (age wise) and I have a home and family to support, simply doing nothing and watching sunsets is not an option.

Can anyone recommend a particular medication after experiencing similar frustration? I currently take the Lotrel during dinner and it seems I get hyped up right before bedtime. I try to relax but sometimes if feels like there is tension in the middle of my chest. To make it more frustrating, I never felt this prior to taking medication to help control it. ???

According to my cardio, all my annual post-op tests are fine, i.e. echo is fine, kidneys, liver functions, etc. After reading the other posts especially those referring to aortic dissections and anneurysms (sp?) I know high BP is not good for valve replacement patients so that only increases my frustration and anxiety.

Any help, guidance, feedback, etc. is appreciated. Any wonder drug?

 

[Nan]

Hi Allen, sorry to hear that you are having BP problems. I have had them over the years, not just after my AVR, but what I have discovered is that sometimes it takes a "cocktail" of bp meds, not just one, to control my bp. And it is also a matter of trying new meds until one (or more) is found that works for you. Each person is different, and what works for one may not work for another.

You mention that you are a type A. That may mean that you might be one of the lucky ones who can benefit from some alternative therapies such as meditation or biofeedback.

You didn't mention how high your bp is and whether or not your pcp or cardio have expressed concern. If they are concerned, you might ask them what their game plan is.....and also if they know of someone/somewhere you could try biofeedback....

Just my thoughts. Sure hope you can get things under control.

 

[Rush20]

Thanks Nan. "But I Don't Have Time for Relaxation and Meditation" - typical Type-A Response.

My BP was averaging 140/90 when my cardio decided to put me on meds. Outside of my Coumadin, that's the only med I'm on with the exception of suppliments/vitamins.

What is really frustrating is the my BP has gotten higher after the initial new medication reduction. I had a 145/100 reading last night while "relaxing". I really think the current med-Lotrel is making it worse. In reviewing the possible side effects; palpitations, anxiety and insomnia are all listed. Prior to the meds, I used to be able to fall asleep at night pretty easily. Now, my mind doesn't shut down and my heartbeat is so strong it feels like it's pounding out of my chest.

I can't blame my job or anything else. Actually "things" are going pretty well, nothing out of the ordinary. It seems like the medication to help my BP is causing me to think about my heart more consciously, thus in return causing more stress/anxiety over the valve.

The other night, while lying in bed trying to fall asleep, I actually thought about how many times this piece of carbon was going to open/close throughout my life and what would happen if it broke. Again, never thought about this stuff until on the BP meds.

I've decided to call my Cardio tomorrow and tell him I'm ready to move on to the next med on his list. The current med - Lotrel isn't working and appears to be causing more problems than results.

I'm not too familiar with the biofeedback approach. What is that?

 

[PJmomrunner]

Hey Rush:

Would it help to compare doses? Maybe you need more. I "only" ever had labile hypertension--the type where stress (a la "white coat syndrome", etc...) would cause my BP to spike dangerously high, yet my average was 120/80. High BP + aneurysm= bad news, hence the meds. Anyway, I started at lower a lower dose, but I now take 100 mg. Toprol XL and 2.5 mg Altace and my BP averages 107/74. I'm just a tad older than you and I'm 5' 10" 170 mad: ). Oh, and the dangerous spikes are gone.

 

[Rush20]

Hey Rush:

Would it help to compare doses? Maybe you need more. I "only" ever had labile hypertension--the type where stress (a la "white coat syndrome", etc...) would cause my BP to spike dangerously high, yet my average was 120/80. High BP + aneurysm= bad news, hence the meds. Anyway, I started at lower a lower dose, but I now take 100 mg. Toprol XL and 2.5 mg Altace and my BP averages 107/74. I'm just a tad older than you and I'm 5' 10" 170 mad: ). Oh, and the dangerous spikes are gone.

Thanks! Any negative side effects? The Lotrel has a beta blocker mixed into a Ace Inhibitor so it's like taking two pills in one capsule. My current mix is 10MG Beta Blocker and 25MG Ace Inhibitor. It seems as though my current cardio likes the added benefits of the Ace Inhibitor towards total heart health.

What is really puzzling is that up until I started taking the BP meds, I often forgot about the valve and my heartbeat. Now it seems like it dominates my feelings and emotions as I'm constantly aware of it. That doesn't help with the stress, etc.

I also found your Toprol XL comment interesting. My former cardio back in Chicago had me on Toprol XL (25 mg) not so much for high BP, but mostly for post-operative heart care. Upon transferring/moving to SW Florida I talked him into moving me off all meds as I wanted to test my overall health post-op. I guess the stress of the move, career, etc. was part of the cause in my higher BP. The good news is we did catch this relatively early so I'm hoping to find the right mixture to fix it. It's just frustrating.

 

[Dustin]

Besides hard work, do you relax enough? My personal favorite is the sauna, or a nice warm bath. This allows your veins to "widen" so that the BP can drop a little. I've noticed that my BP increases when I have cold feet and legs, hence the sauna and bath 'therapy'.

Experiment with relaxation techniques, good massage, some quality time with your family. Meds and good food can only do so much, but don't forget the mind!

Best wishes,

 

[BackDoc]

"But I Don't Have Time for Relaxation and Meditation" - typical Type-A Response. "

There is your answer. Either you decide to take control of your situation or it will take control of you.

"The Relaxation Response" by Herbert Benson, MD (Harvard educated cardiologist) is a must read.

Another excellent book on diet is the "Omega Zone", by Barry Sears, PhD.

I recommend these two books to all of my patients. Everyone can find 10 minutes 2x a day to practice the Relaxation Response.

this combined with a Zone type diet for 3 months will more then likely find you pleasently surprized at the the results.

 

[Rush20]

"But I Don't Have Time for Relaxation and Meditation" - typical Type-A Response. "

There is your answer. Either you decide to take control of your situation or it will take control of you.

"The Relaxation Response" by Herbert Benson, MD (Harvard educated cardiologist) is a must read.

Another excellent book on diet is the "Omega Zone", by Barry Sears, PhD.

I recommend these two books to all of my patients. Everyone can find 10 minutes 2x a day to practice the Relaxation Response.

this combined with a Zone type diet for 3 months will more then likely find you pleasently surprized at the the results.

Thanks! My response was intended more as tongue in cheek, however my wife says the same thing. I need to learn to relax. With laptops, cell phones, blackberries, email, instant messages, etc., etc. it does get tough as I tend to fill every waking hour with some type of activity. I'm hoping I can learn to help heal the mind and spirit and not just medicate the body.

I'll check out those books. I read about the Zone diet a few years ago, however never fully enacted it. Any quick tips?

 

[BackDoc]

Zone Quick tips: divide your plate into thirds. 1/3 lean protein, and 2/3 vegetables and or low glycemic fruits. Eat a small handful of almonds, cashews, walnuts and you have a perfect Zone meal.
Try to limit carbohydrates such as pasta, rice, bread, to no more then 25% of your total carbohydrate consumption for the day. Include a high quality fish oil supplement and you're there. The "Omega Zone" by Sears tells it all.

 

[Rush20]

Zone Quick tips: divide your plate into thirds. 1/3 lean protein, and 2/3 vegetables and or low glycemic fruits. Eat a small handful of almonds, cashews, walnuts and you have a perfect Zone meal.
Try to limit carbohydrates such as pasta, rice, bread, to no more then 25% of your total carbohydrate consumption for the day. Include a high quality fish oil supplement and you're there. The "Omega Zone" by Sears tells it all.

Thanks! And this dietary mix lowers BP naturally? The only tough part will be the pasta limitation. My wife is Italian and a great cook!

 

[BackDoc]

it will help. I have a patient who is cardiologist (he happens to also be my doc) and he is sold on the Zone diet as well as fish oil.

Funny thing about italians. Native Italians do not cook using pasta as a main dish. In Italy it is always just a small side serving., if served at all. Full plates of pasta is an American thing. Same thing in the far east. Rice is just a small portion of the meal. If you ever take a trip to Italy, or the South Pacific rim you'll see what I mean.

 

[Rush20]

it will help. I have a patient who is cardiologist (he happens to also be my doc) and he is sold on the Zone diet as well as fish oil.

Funny thing about italians. Native Italians do not cook using pasta as a main dish. In Italy it is always just a small side serving., if served at all. Full plates of pasta is an American thing. Same thing in the far east. Rice is just a small portion of the meal. If you ever take a trip to Italy, or the South Pacific rim you'll see what I mean.

Yep, and they are big on the olive oil. Her grandfather lived well into his 90s and he ate pasta, olive oil and red wine on a regular basis. More importantly, he really enjoyed life and laughed a lot.

 

[Nan]

Hi Allen, if you "Google" biofeedback you will get a much better explanation that I can give you, but one example is a person being able to learn to relax muscles, s/he is hooked up to a monitor that picks up signals from muscles and flashes a light rapidly when the muscles are tense. The person then tries to slow down the flashing light and learns how to relax those muscles...by getting feedback from their own body's reponses.

Hope this is helpful!

 

[tobagotwo]

The new valve won't cause higher blood pressure. You'll find plenty of others who had the opposite effect, or whose blood pressure wound up about the same as before the surgery.

Weight gain, lack of exercise (these are probably not your issues), stress/tension, age (43 is also the age where vision often begins changing), prescription or other drugs, time you take drugs (how about taking them in the morning?), inherited tendencies, or health issues like blockages or kidney problems are some of a number of possibilites.

If you're having "hammer-heart," you may have too much beta blocker. What's your heart rate? If it's around 50 BPM or lower, consider lobbying your cardiologist for a change.

Best wishes,

 

[Susan BAV]

Wow - just reading your posts, which scream TYPE A!!!TYPE A!!!TYPE A!!!, is exhausting!

I've been hypertensive off and on for awhile but I've been on meds for it for about twelve years, although I didn't need any bp meds after the AVR for a little while.

I've been put on several different ones over the years: some cause heartburn; some cause coughs; I swear some caused my heart to POUND; others had minor side effects or even no noticeable side effects. I don't think any of them really got me down to a good range like they should have.

I take something called Micardis now and my bp has never been better. It's not an Ace Inhibitor but similar I think; I forget how the cardio described it but he said it was a newer generation or type or whatever.

All the bp meds work differently and cardios will put you on whatever is supposed to work with the assumed cause of your hypertension.

There are also some home remedies, one of which combines apple juice and grape juice and cider vinegar, which I've always planned on trying but still haven't yet. You mix them by certain proportions, store in the fridge, and drink a couple of ounces each day. I don't know if they work; just mentioning it. That one probably can't hurt and might help, unless you took your meds with it.

By the way: did you know that some meds are wrecked if you take them with grapefruit juice? Maybe, if you are doing something like that, it is negating the potential of your meds?

 

[Sherry]

Hi, Allen. Don't know that I can offer any new advice, but my story was similar. I'm 43 with a high stress job (high school teacher) and absolutely no weight issues, and I was struggling with borderline high bp. Then wouldn't you know it - the month of June last summer, when I was actually not working because of our break, eating well, exercising every day, my bp started spiking into the 140s over 90s. (I bought a home monitoring device and was able to track it daily.) I was just flabbergasted that I couldn't bring it down using natural means. I put in a call to the cardio, and he put me on 5mg and then eventually 10 mg of Altace (ace inhibitor), and the readings came right down. I take the 10 in the morning, and so far, 4 months later, my readings are still very normal. I truly hope you can get a handle on this, and maybe a different approach to the meds might work.

 

[Rush20]

Hi, Allen. Don't know that I can offer any new advice, but my story was similar. I'm 43 with a high stress job (high school teacher) and absolutely no weight issues, and I was struggling with borderline high bp. Then wouldn't you know it - the month of June last summer, when I was actually not working because of our break, eating well, exercising every day, my bp started spiking into the 140s over 90s. (I bought a home monitoring device and was able to track it daily.) I was just flabbergasted that I couldn't bring it down using natural means. I put in a call to the cardio, and he put me on 5mg and then eventually 10 mg of Altace (ace inhibitor), and the readings came right down. I take the 10 in the morning, and so far, 4 months later, my readings are still very normal. I truly hope you can get a handle on this, and maybe a different approach to the meds might work.

Thanks Sherry. My cardio thought my high BP was reactionary as well as it tended to come down while on vacation, etc. I was on 5mg and then 10 mg of Altace as well and the BP crept back up. Too bad because so far, the Altace was had the least amount of side effects.

I currently take my BP meds in the evening with my Coumadin and vitamin suppliments. Easier to remember taking them all at one time and my Cardio told me that it is OK to do so. Maybe I should experiment with taking my BP in the morning.

 

[Rush20]

The new valve won't cause higher blood pressure. You'll find plenty of others who had the opposite effect, or whose blood pressure wound up about the same as before the surgery.

Weight gain, lack of exercise (these are probably not your issues), stress/tension, age (43 is also the age where vision often begins changing), prescription or other drugs, time you take drugs (how about taking them in the morning?), inherited tendencies, or health issues like blockages or kidney problems are some of a number of possibilites.

If you're having "hammer-heart," you may have too much beta blocker. What's your heart rate? If it's around 50 BPM or lower, consider lobbying your cardiologist for a change.

Best wishes,

Thanks for the feedback. You mentioned age 43 is where vision begins changing. Is this linked to high BP. (or just staring into a computer screen too much?!)

 

[tobagotwo]

It was an offhand comment by my eye doctor, who had guessed my age by my eyesight.

Apparently just age - and perhaps it has something to do with the average amount of UV rays people's eyes have been exposed to over that time. If that's so, the "age of change" should start getting older, due to UV-blocking sunglasses, etc.

It could also be hormonal. That's about the time for some changes to begin for women, and less recognized changes for men. If it's hormonal, its effects could easily extend to the heart and circulatory system. As blood pressure increases with age, perhaps this phenomenon would be worth studying in relation to age instead of just the chemical/mechanical components common to all ages.

Best wishes

 

[Superbob]

We're all different, so I'm not prescribing. But my former cardio (before we moved) swore by Caduet and prescribed it for me and I continue to take it -- one pill just before bedtime. My BP as well as cholesterol levels have been just about perfect. It's a 2-in-1 pill: BP and cholesterol.