BBs and BP/HR

[Delta]

Hello!  I hope all are feeling good today. 

Would anyone have any advice to offer on taking a beta blocker when your BP and/or HR are normal?  My doc recently (about a week ago) prescribed a pretty low dose (non-selective) once a day, which I basically quartered and spread out throughout the day because it's a fast-acting version and I haven't taken a lot of meds so didn't know how I would react.  But I have to constantly monitor my BP and HR.  The thing is that I really think the BB helped, because for the first two days I felt so much better.  But then I started backing off (didn't cut out completely) because I didn't like how low some of the BP/HR #s were.  They weren't super low, just low enough to make me nervous and I've been dealing with so much dizziness lately (with normal numbers), I'm not sure I could tell if something was too low without actually getting a reading!  I have a message in to my dr. about this but I am wondering how others deal.  Thank you for any thoughts and feel free to ask me any questions/clarification!  - Delta

[StayAtHomeMom]

I have normal BP (120/80). When I take my Beta Blocker (Metoperlol) my BP run a little lower at 110/70. Currently I take 25mg 2X a day. I have permission from my cardiologist to up my dose a little to 3X a day because it doesn't seem to be helping much anymore. I just haven't had enough bad days in a row to up it. 

You can get a blood pressure machine to check it at home to ease your mind but the low doses of beta blockers shouldn't lower you too much.

My dad was taking 100mg of Metoprolol 2X a day for A-Fib so 25mg is definitely a low dose. 

When I first started taking a beta blocker I was taking propranolol 3X a day. Even with the dizziness it helped. I don't know what it did to my blood pressure I wasn't paying attention. All I know is I was feeling mostly better. 

I vaguely remember my first PCP saying beta blockers can be used to treat dizziness. 

[Delta]

20 minutes ago, StayAtHomeMom said:

I have normal BP (120/80). When I take my Beta Blocker (Metoperlol) my BP run a little lower at 110/70. Currently I take 25mg 2X a day. I have permission from my cardiologist to up my dose a little to 3X a day because it doesn't seem to be helping much anymore. I just haven't had enough bad days in a row to up it. 

You can get a blood pressure machine to check it at home to ease your mind but the low doses of beta blockers shouldn't lower you too much.

My dad was taking 100mg of Metoprolol 2X a day for A-Fib so 25mg is definitely a low dose. 

When I first started taking a beta blocker I was taking propranolol 3X a day. Even with the dizziness it helped. I don't know what it did to my blood pressure I wasn't paying attention. All I know is I was feeling mostly better. 

I vaguely remember my first PCP saying beta blockers can be used to treat dizziness.  

Thank you for responding!  Your PCP may have been right because those two days I was talking about = no dizzies!  I do have two BP/HR machines (cuffs) at home - one for the arm and one for the wrist - so I check often.  Maybe too much, LOL.  Wow; if you are normally 120/80 and go to 110/70 with 25 mg twice a day - it doesn't sound as if it affects your BP much at all . . . mine went to something like 98/60-something and that made me a little nervous.  Can I ask why you switched from Prop. to Met.?  I actually tried metoprolol (sp.??) a few weeks ago but stopped after three tries because boy, did it mess with my head.  I woke up with the worst brain fog ever and it felt as if my head were, like, stuffed with cotton balls or something!  Propranolol is what I have now. 

[GasconAlex]

Unless the low BP is causing problems (fainting or other serious low BP issues) it's fine if it is low. Obviously if it is causing problems or dropping when standing then it needs investigating. For myself when horizontal I normally have fairly low BP this drops as low as 80/50 sometimes a touch lower (the measurements were all taken during an extended hospital stay) but for me it's normal. Later on in the day my BP normally rises into 'normal' but has on occasion dropped on standing (biggest drop on medical records is a systolic drop of 50, diastolic 30), but I still function with the low BP so don't have any treatment for it.

 

My father (who I get a low BP from but not POTS) recently scared the doctors with  a BP of 70/45 .  The neuro's believed that this was causing him problems standing upright so started the midrodrine. This caused lots of extra problems and needless time in hospital and lots of time sorting out the drugs. For him the problem was a broken hip (which he told them about) and once they'd CT scanned the hip and treated that he got lots better. He's always had very low BP, doesn't cause him problems and his GP is happy with it there. The scared neuro just complicated everything and made matters worse. 

 

So if you function fine with a low BP, don't worry about the numbers! A high BP is dangerous but a low BP is nearly always beneficial IF it doesn't cause you any problems.

 

[yogini]

Have you been diagnosed with dysautonomia? Did your dr explain why he or she prescribed the beta blocker?  Usually your BP and/or HR would not be normal if you have a diagnosis dysautonomia and a BB would be prescribed to stabilize HR and BP.   Also BPs and HRs normally fluctuate during the day and you wouldn't adjust a medication based on that, unless your doctor advised you to.   I would also ask the dr about cutting the pill and whether that makes sense.  Some medications can be cut, others can't.

[Delta]

1 hour ago, GasconAlex said:

Unless the low BP is causing problems (fainting or other serious low BP issues) it's fine if it is low. Obviously if it is causing problems or dropping when standing then it needs investigating. For myself when horizontal I normally have fairly low BP this drops as low as 80/50 sometimes a touch lower (the measurements were all taken during an extended hospital stay) but for me it's normal. Later on in the day my BP normally rises into 'normal' but has on occasion dropped on standing (biggest drop on medical records is a systolic drop of 50, diastolic 30), but I still function with the low BP so don't have any treatment for it.

 

My father (who I get a low BP from but not POTS) recently scared the doctors with  a BP of 70/45 .  The neuro's believed that this was causing him problems standing upright so started the midrodrine. This caused lots of extra problems and needless time in hospital and lots of time sorting out the drugs. For him the problem was a broken hip (which he told them about) and once they'd CT scanned the hip and treated that he got lots better. He's always had very low BP, doesn't cause him problems and his GP is happy with it there. The scared neuro just complicated everything and made matters worse. 

 

So if you function fine with a low BP, don't worry about the numbers! A high BP is dangerous but a low BP is nearly always beneficial IF it doesn't cause you any problems.

 

Thanks for response!  I guess that low is normal for your Dad . . . and wow, that really does seem pretty low.  I get a little nervous about it because sometimes I get dizzy/lightheaded, and when I check my BP, it's normal.  I have felt dizzy/"brain foggy" in the past when BP was high (and the dizziness went away when it came down) but the flavor of the past few weeks has been more normal with occasional highs (systolics in 140-150 range).  I think my dizziness may be stemming from blood flow issues, because it has gone away if I lay down with the "feet end" of the bed raised.  I recently got a pair of compression panty hose to try, but as of yet, I haven't been able to get the rackum-frackum things on. 😣  But that's another thread . . . !!

[Delta]

1 hour ago, yogini said:

Have you been diagnosed with dysautonomia? Did your dr explain why he or she prescribed the beta blocker?  Usually your BP and/or HR would not be normal if you have a diagnosis dysautonomia and a BB would be prescribed to stabilize HR and BP.   Also BPs and HRs normally fluctuate during the day and you wouldn't adjust a medication based on that, unless your doctor advised you to.   I would also ask the dr about cutting the pill and whether that makes sense.  Some medications can be cut, others can't.

Thank you for responding!  My dr. prescribed the BB due to tachycardia; sorry I didn't make that clear in my post.  He dx'd me w/POTS following a "Poor Man's TTT"; my resting HR when he examined me was over 100.  But that's not always the case!  Sometimes the resting is normal.  Up and about or standing, less so.  It has gone into the 120s just walking through my house and higher in other circumstances.  He then sent me for the actual TTT, which confirmed.  He probably also figured in the anxiety angle, although he didn't say that, but I understand propranolol can be used for that. 

Re: the BP - when this first started earlier this year, my BPs were normal with some highs.  Then they were more highs than normal for a few weeks.  For the past few weeks, they have been normal the way they used to be before POTS most of the time, with a few highs thrown in.  I don't remember what my BP was doing at the time I first saw this dr.!  So my concern is, I'm assuming the BB can't tell if and when my body is going to decide to be normal or not . . . so the BB will do its job anyway, right?  It's impossible to predict.  And I get concerned that it will do its job even if its not needed, and cause problems.

Re: the TTT - something about it I don't understand:  How is the TTT the "gold standard" of diagnosing POTS when one is leaning against/supported by the table during the test?  Wouldn't free-standing be more diagnostic?  Because I have become symptomatic while standing, say, in a grocery store and, when I couldn't find a chair, leaned against something which helped to a degree.  I did my own poor man's at home one time and got warm, woozy and elevated HR standing unsupported after less than three minutes - that was all I could take before I sat down.  Even at the poor man's at the doc's office, they had me hold on to a chair while I stood.  It would actually seem to me that the "poor man's" version would be more accurate than the actual TTT.  I guess maybe they want the patient to be supported for safety reasons.

[GasconAlex]

@Delta I agree that blood pressure swings really do your head in, I suspect that BP issues might be causing some of the fatigue and headache problems I have. I do my best to stay vertical as long as possible, sometimes several hours, but ... my feet tend to go purple and at some point I have to lie down and be horizontal. For my TTT I ended up with a +50 BPM and a BP that went from about 130/75 to  180/105. At home I have managed to double my BP (and by double I mean *2 on both the systolic and diastolic) within half an hour by the super human activity of having a shower. 

The TTT is meant to be more accurate as it removes (as much as possible) the increase in HR because of muscle activity. If you find standing unsupported difficult due to other issues the TTT should still show the problems. When I did mine they ran the TTT, followed by freestanding, Valsalva, conduction, breathing and grip tests together then (when I was feeling particularly half dead) the neuro consultant for another 45 minutes. All the tests were conducted wired up to the heart rate and pressure monitoring.

I find that sometimes the compression stockings help, and sometimes they can make the swings even worse.

[Delta]

2 hours ago, GasconAlex said:

@Delta I agree that blood pressure swings really do your head in, I suspect that BP issues might be causing some of the fatigue and headache problems I have. I do my best to stay vertical as long as possible, sometimes several hours, but ... my feet tend to go purple and at some point I have to lie down and be horizontal. For my TTT I ended up with a +50 BPM and a BP that went from about 130/75 to  180/105. At home I have managed to double my BP (and by double I mean *2 on both the systolic and diastolic) within half an hour by the super human activity of having a shower. 

The TTT is meant to be more accurate as it removes (as much as possible) the increase in HR because of muscle activity. If you find standing unsupported difficult due to other issues the TTT should still show the problems. When I did mine they ran the TTT, followed by freestanding, Valsalva, conduction, breathing and grip tests together then (when I was feeling particularly half dead) the neuro consultant for another 45 minutes. All the tests were conducted wired up to the heart rate and pressure monitoring.

I find that sometimes the compression stockings help, and sometimes they can make the swings even worse. 

Right; my dr. did all of those tests too (Valsalva, etc.), connected to the BP and HR monitors.  Although I don't think I did freestanding; they asked me to hold on to a chair with one hand.  Ha - I have to laugh at your comment about "the super human activity of having a shower."  At one point I was trying to figure out why washing my hair made my heart race (I prefer baths so generally only use the shower when I'm washing my hair) and then I realized it wasn't washing my hair that was doing it; it was *standing* in the shower.  I bought a shower chair and we already have one of those extra-long shower head hose things so those are very helpful!  I guess I will find out if/how the compression hose work if I ever get them on.  😄

[StayAtHomeMom]

8 hours ago, Delta said:

Thank you for responding!  Your PCP may have been right because those two days I was talking about = no dizzies!  I do have two BP/HR machines (cuffs) at home - one for the arm and one for the wrist - so I check often.  Maybe too much, LOL.  Wow; if you are normally 120/80 and go to 110/70 with 25 mg twice a day - it doesn't sound as if it affects your BP much at all . . . mine went to something like 98/60-something and that made me a little nervous.  Can I ask why you switched from Prop. to Met.?  I actually tried metoprolol (sp.??) a few weeks ago but stopped after three tries because boy, did it mess with my head.  I woke up with the worst brain fog ever and it felt as if my head were, like, stuffed with cotton balls or something!  Propranolol is what I have now. 

98/60 is nothing to worry about. I sometimes dip that low. Depends on what I have been doing. If it is a lazy day it is usually low like that. 

My POTS started with a short run. I haven't been able to breathe right since (3 years now this month). All my other symptoms cycle. But the breathing issue is always there at varying degrees. I feel like I need to take a deep breath but the bottom of my lungs won't move to give me a satisfying breath.  

When I was first diagnosed my cardiologist knew nothing of POTS. So he did some research and started me on the propranolol. It helped the dizziness that I was having. Even helped my HR but my breathing got so much worse over the course of 3 weeks. So we tried a calcium channel blocker which helped a little. Then at the advice of my pulmonologist we tried the metoprolol. 

About 6 months after that I seen my specialist, who wanted to switch me back to the propranolol. I refused so he added the midodrine. When I take both my blood pressure is normal. Right now the midodrine works better than my Beta Blocker. Not sure why.

I am still searching for my underlying cause. I suspect I have had POTS since I was a teenager. But something else is making it flare. Until then I just try to keep my heart rate low-ish. 

I would try not to worry about how low the numbers are unless you don't feel good. And make sure your legs are not crossed. You want as little bending in the body as possible when you take your blood pressure. 

[yogini]

23 hours ago, Delta said:

Thank you for responding!  My dr. prescribed the BB due to tachycardia; sorry I didn't make that clear in my post.  He dx'd me w/POTS following a "Poor Man's TTT"; my resting HR when he examined me was over 100.  But that's not always the case!  Sometimes the resting is normal.  Up and about or standing, less so.  It has gone into the 120s just walking through my house and higher in other circumstances.  He then sent me for the actual TTT, which confirmed.  He probably also figured in the anxiety angle, although he didn't say that, but I understand propranolol can be used for that. 

Re: the BP - when this first started earlier this year, my BPs were normal with some highs.  Then they were more highs than normal for a few weeks.  For the past few weeks, they have been normal the way they used to be before POTS most of the time, with a few highs thrown in.  I don't remember what my BP was doing at the time I first saw this dr.!  So my concern is, I'm assuming the BB can't tell if and when my body is going to decide to be normal or not . . . so the BB will do its job anyway, right?  It's impossible to predict.  And I get concerned that it will do its job even if its not needed, and cause problems.

Re: the TTT - something about it I don't understand:  How is the TTT the "gold standard" of diagnosing POTS when one is leaning against/supported by the table during the test?  Wouldn't free-standing be more diagnostic?  Because I have become symptomatic while standing, say, in a grocery store and, when I couldn't find a chair, leaned against something which helped to a degree.  I did my own poor man's at home one time and got warm, woozy and elevated HR standing unsupported after less than three minutes - that was all I could take before I sat down.  Even at the poor man's at the doc's office, they had me hold on to a chair while I stood.  It would actually seem to me that the "poor man's" version would be more accurate than the actual TTT.  I guess maybe they want the patient to be supported for safety reasons.

There isn't a "gold standard." Usually dysautonomia is diagnosed based on a lot of factors. If you have a positive TTT you are generally thought to have dysautonomia, but many people have it without a positive TTT.  I don't believe the beta blocker is meant to be taken in the way you are taking it or adjusted based on normal fluctuations of HR and BP throughout the day, so please make sure to coorindate with your doctor.