Inconsistent BP. Med changes?

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LoveMyBraveHeart

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Happy Monday, folks!

Mathias is 8 weeks post op this week and doing remarkably well. The only concern we are having is with his blood pressure. After surgery, systolic was being stubborn about coming below 140-150. At discharge from the hospital, he left on 20mg Lisinopril, 100 mg Metoprolol tartate, and 5mg amlodipine.

Upon being home for a few days, his blood pressure ended up decreasing more than what was necessary (and quite frankly, too low for comfort!) to 80s-90s/40s. After talking with the cardio, she dropped his amlodipine. This resulted in a perfect 120/65 BP (or thereabouts) for weeks.

After his last post-op echo and follow up cardio appt, he was switched to Metoprolol Succinate 100 mg. He has also since stopped his Amiodarone and is taking his Warfarin, Metoprolol Succ, and Lisinopril and baby aspirin SID. Since changing to this long acting Metoprolol, his BP has risen back into the 140s-150s systolic. Unsure of the cause, so that's why I'm here.

Is it because;
a. Amiodarone has been discontinued and is finally starting to work it's way out of his system (long half life), and is having an affect on his BP
b. All narcotics, muscle relaxers and pain killers have been discontinued, all which contributed to a lower BP
c. This new Metoprolol is not agreeing with him/takes longer to start noticing affect on BP
d. something else entirely

I bring this up because the sudden shift in BP happened after his last AVR when we discovered that there was a perivalvular leak. This is and will always sit at the back of my mind because the timelines are matching up to the last bad news. However, he had a high BP reading at his follow up echo that was higher than it had been and everything on his echo was good...EF back up to 55%, normal LV function, slight decreased RV function (they feel due to the tamponade), all volumes and measurements were normal.

Thanks in advance all, you guys are my safe zone!
 

rich01

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You are probably on the right track looking at the drugs he is taking, but also look at diet. Has he increased salt or red meat in his diet? Does he snack now and didn't before? Look at the drugs but don't forget the big picture. All these things are really taxing his liver.

Longer term, figure out what is causing the high blood pressure and see if it can be addressed without drugs.
 

LoveMyBraveHeart

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You are probably on the right track looking at the drugs he is taking, but also look at diet. Has he increased salt or red meat in his diet? Does he snack now and didn't before? Look at the drugs but don't forget the big picture. All these things are really taxing his liver.

Longer term, figure out what is causing the high blood pressure and see if it can be addressed without drugs.
We have considered diet as well, as the last 2 or 3 readings in offices, he had salty food the day before or the day of. I am hoping that's all that was causing the fluctuation. Which is why I am here instead of calling the cardio. I don't think we are at a point where I will call them yet...I am monitoring for now as the high readings aren't alarmingly high and have only bee over the last week or so. Diet and natural remedies are always at the forefront of my mind...I hate taking medication, or having doctors that push pills as a solution to everything. I am hoping this is a false alarm and things will relax soonly.
 

Protimenow

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I've run into some interesting blood pressure measurements -- on myself, and on my wife.

I'm curious about the accuracy of the meter (or method) that you're using to test blood pressure. If you're using the 'standard' method, with sphygmamanometer (pump) and stethoscope, this is probably very accurate. The machines aren't always as accurate as the writing on the box leads you to believe.

Is your machine able to take three readings and report on the average? Have you taken your machine to the doctor's office so you can compare the results?

Although an inaccurate meter or method may contribute to the problem, this may not be it. But if it was me, I'd test against what SHOULD be a more accurate method (the one in the doctor's office?) just to get some idea about the reliability of your machine, and the doctors. And, if the doctor uses a machine, ask for a test with cuff and stethescope.
 

LoveMyBraveHeart

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We have both an auto cuff and I will take it myself with a sphygmomanometer and steth. I haven't done a manual BP on him since discovering the fluctuation, only used the auto cuff. One of the readings was with an auto cuff at the Dr., and one was manual. Not really sure what I should and shouldn't trust anymore. I will continue to check it make sure it evens out. When I do a manual BP, I take it bilaterally, and the systolic can be as much as 20 pts difference!
 

Paleowoman

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I couldn’t figure out from your posts if you are doing your own readings inbetween the doctor’s….just seen you do it. The problem with measuring blood pressure is that even with your own monitor you can get anxious about getting a high reading which actually then produces a high reading. I take my own blood pressure and I wouldn’t do it with anyone else in the room, even my dearest. Has Mathias done readings on his own ?

I once read a very interesting study, which I am unfortunately unable to find right now, half the study participants held an arm in iced water to produce pain and half had to subtract a number, three, or maybe it was a seven, from 100 and carry on subtracting from the results in their heads. Their blood pressures were taken - the ones doing the subtraction had higher blood pressures than the ones in pain. They reversed the test candidates so that the ones previously in pain were doing the subtracting in their heads and vice versa. The result was the same, those doing the subtracting had higher blood pressure readings than those in pain.

The study showed that the stress of just thinking about something problematic can raise blood pressure.

Whenever I am seeing my cardiologist I take blood pressure readings on my own monitor (which has been checked at doctor’s) several times a day for two weeks before the appointment which I record for the cardiologist as he knows that his readings are always higher - significantly higher - simply because I am seeing him. I still get ‘stressed’ taking my own blood pressure thinking it will be high which is why I take several readings per day as I will usually find some very low - too low for anyone to be prescribed antihypertensive medication.

Here’s a good list of other things that can affect blood pressure readings at the moment they are done which are good to bear in mind, just the way you are sitting can affect it, and certainly talking: https://www.suntechmed.com/blog/entry/4-bp-measurement/49-10-factors-that-can-affect-blood-pressure-readings
 

LoveMyBraveHeart

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I couldn’t figure out from your posts if you are doing your own readings inbetween the doctor’s….just seen you do it. The problem with measuring blood pressure is that even with your own monitor you can get anxious about getting a high reading which actually then produces a high reading. I take my own blood pressure and I wouldn’t do it with anyone else in the room, even my dearest. Has Mathias done readings on his own ?
Thank you! He took his BP today while I am at work and it was a perfect 124/65. Really put my mind at ease. Though, I don't like it if my being around raised his blood pressure! That could either mean good things or it could mean I aggravate him! 😂

I hope people continue to reply to this thread. Its very informative to read about other's experiences with medications and such. We are hoping to get to the point where he can be on a lower dose of the beta blocker so he isn't so tired.
 

DDT77

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Am presently on warfarin, aspirin, and Metoprolol Succinate (50mg). Upto ~ 6 months ago I was on 2x 25 mg Metoprolol Tartrate instead of Succinate. My bp was lower than present with Tartrate, and pulse would drop to ~ 35 bpm. Let's say I was sluggish during the day, which may have also been from seemingly constant vivid dreams. With the vivid dreams, I would feel as if i had no sleep during the night, despite 8+ hours. With Succinate, my systolic will be 125-130, and pulse down to 45 bpm. Far less of a roller coaster with the longer half life Succinate compared to Tartrate. However, if I want a night at the movies, I'll still pop an extra half tablet of tartrate :)...
 

Eva

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I’m sure you’re aware of how best to take your BP. This is taken from NIH:

How to use a home blood pressure monitor.
  • Be still. Don't smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure. Empty your bladder and ensure at least 5 minutes of quiet rest before measurements.
  • Sit correctly. Sit with your back straight and supported (on a dining chair, rather than a sofa). Your feet should be flat on the floor and your legs should not be crossed. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level. Make sure the bottom of the cuff is placed directly above the bend of the elbow. Check your monitor's instructions for an illustration or have your healthcare provider show you how.
  • Measure at the same time every day. It’s important to take the readings at the same time each day, such as morning and evening. It is best to take the readings daily however ideally beginning 2 weeks after a change in treatment and during the week before your next appointment.
  • Take multiple readings and record the results. Each time you measure, take two or three readings one minute apart and record the results using a printable (PDF) or online tracker. If your monitor has built-in memory to store your readings, take it with you to your appointments. Some monitors may also allow you to upload your readings to a secure website after you register your profile.
  • Don't take the measurement over clothes.
 

Keithl

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Kudos. Even doctors suck at taking BP. I can’t tell you how many times I walk in to DR exam room and sit on table and first thing nurse does is take my BP. When they tell me the number I counter with it was .... when I measured it correctly that morning. I use Omron units as they are very accurate and usually take 3 samples 1 minute apart then show you the average and allow you to view each reading.
 

Protimenow

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If the doctor's BP measurements were always accurate, they couldn't get perks from the manufacturers for prescribing BP medications, or make money by having you return for re-examinations to check your BP or adjust your dosage. Personally, my wife and I have had issues with the electronic meters.

But, as noted, even with the classic sphygmamanometer, readings are not especially reliable. A doctor friend noted that if he says 'uh oh' when taking a patient's BP, it increases by 20 points or so. Eva's post (two posts before this) looks pretty good. I'll have to remember it the next time I take a blood pressure reading.
 

carolinemc

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Thank you! He took his BP today while I am at work and it was a perfect 124/65. Really put my mind at ease. Though, I don't like it if my being around raised his blood pressure! That could either mean good things or it could mean I aggravate him! 😂

I hope people continue to reply to this thread. Its very informative to read about other's experiences with medications and such. We are hoping to get to the point where he can be on a lower dose of the beta blocker so he isn't so tired.
Did you figure it out what was causing the BP rise? Diet is not always the case. I have anxiety when I go to any doctor and if I am too nervous, is shows on the BP, or if I am in any pain, BP goes up. Or too much sodium. Hope you have it figured out. It is not you causing his BP to rise, it can be tension also. Good luck cause 124/65 is not a perfect reading, it is a borderline reading of hypertension. I have diabetes and a on a good day I get a reading of 120/80. Normal for a diabetic. Good luck.
 

carolinemc

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If the doctor's BP measurements were always accurate, they couldn't get perks from the manufacturers for prescribing BP medications, or make money by having you return for re-examinations to check your BP or adjust your dosage. Personally, my wife and I have had issues with the electronic meters.

But, as noted, even with the classic sphygmamanometer, readings are not especially reliable. A doctor friend noted that if he says 'uh oh' when taking a patient's BP, it increases by 20 points or so. Eva's post (two posts before this) looks pretty good. I'll have to remember it the next time I take a blood pressure reading.
I would never go by a doctor doing a BP, cause they do not always know how to do it correctly. I had a quack cardio tell me, as I was sitting on the table, he takes my BP and practically tell me it was 500, over what, who knows. I felt my BP rising cause I was thinking, shouldn't I be dead with that BP without the lower number? I was so glad to get away from this mixed up, uneducated baffoon. Never will I allow a cardio to take my BP again.
 

LoveMyBraveHeart

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Did you figure it out what was causing the BP rise? Diet is not always the case. I have anxiety when I go to any doctor and if I am too nervous, is shows on the BP, or if I am in any pain, BP goes up. Or too much sodium. Hope you have it figured out. It is not you causing his BP to rise, it can be tension also. Good luck cause 124/65 is not a perfect reading, it is a borderline reading of hypertension. I have diabetes and a on a good day I get a reading of 120/80. Normal for a diabetic. Good luck.
It was likely diet. He rarely has his BP rise because of doctors (one of the lucky ones I guess). 124/65 is perfect for him considering it used to run in the 160s/40s before his valve replacement. His cardiologist wants it to remain below 130/80, which he has been aside from the two higher readings we got a couple weeks ago. He stays in range which makes us breathe a sigh of relief.

Next battle is getting a new, married-in member of the family through mitral valve replacement in November, then getting them both on to home INR testing. Of course, I have given the new patient that is "in the waiting room" the info for this site in hopes he will be able to ask his questions to you knowledgeable folks.

As usual, thank you all!
 

carolinemc

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kansas city, mo
It was likely diet. He rarely has his BP rise because of doctors (one of the lucky ones I guess). 124/65 is perfect for him considering it used to run in the 160s/40s before his valve replacement. His cardiologist wants it to remain below 130/80, which he has been aside from the two higher readings we got a couple weeks ago. He stays in range which makes us breathe a sigh of relief.

Next battle is getting a new, married-in member of the family through mitral valve replacement in November, then getting them both on to home INR testing. Of course, I have given the new patient that is "in the waiting room" the info for this site in hopes he will be able to ask his questions to you knowledgeable folks.

As usual, thank you all!
It is good that you are checking with the doctor for what he/ she wants for the BP reading. I have been a type 2 diabetic since 2002 and it has not been easy, still is not. I have a bad sin, sodium(salt), which is my main weakness. But soon be taking my new rescue, Zoey, to the park and be walking everyday. I have to build up her muscle tone and I have to get the cardio exercise. We will be going to the park this afternoon, which is just down the street from my house. So excited. Yeah. And good luck with the new family members' surgery.
 

tom in MO

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It is good that you are checking with the doctor for what he/ she wants for the BP reading. I have been a type 2 diabetic since 2002 and it has not been easy, still is not. I have a bad sin, sodium(salt), which is my main weakness. But soon be taking my new rescue, Zoey, to the park and be walking everyday. I have to build up her muscle tone and I have to get the cardio exercise. We will be going to the park this afternoon, which is just down the street from my house. So excited. Yeah. And good luck with the new family members' surgery.
Sodium was a big bugaboo 30 years ago. Not so much anymore. For some of the newer thinking see: https://www.medicalnewstoday.com/articles/317099.php
 
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