How to manage high blood pressure and low heart rate?

Question

Hello doctor,

I am 34 years old and weigh 185 pounds. I have been on high blood pressure medication for the past six months. Initially, I was prescribed Telmisartan 25 mg for two months, during which my blood pressure was 120/80 mmHg. Then another doctor prescribed Telmisartan 40 mg and instructed me to stop Telmisartan 25 mg. With 25 mg, my blood pressure ranged from 140/80 mmHg to 160/90 mmHg. As a result, I resumed taking Telmisartan 25.

My blood pressure initially returned to 120/80 mmHg, but in recent readings, it has been 150/90 mmHg. My resting heart rate is typically around 50 to 60 bpm. I also take Levothyroxine 50 mcg daily. At times, my heart rate increases to over 100 bpm in the morning, between 9 a.m. and 10 a.m., due to anxiety. I recently had a heart checkup, and all results were normal. However, I am concerned about my heart rate increasing suddenly.

Please let me know the following:

Am I on the right treatment for blood pressure?
Is a blood pressure reading of 150/90 mmHg too high?
Why is my blood pressure not controlled despite taking medication?
Is a resting heart rate of 50 to 55 bpm normal?
Why does my heart rate increase to over 100 bpm due to anxiety? Is there something wrong?
Do I need medication for anxiety?
My latest ECG showed no abnormalities, but my resting heart rate was 99 bpm. Is that a concern?
A visit to the hospital also raises my heart rate and anxiety levels.
My latest blood test showed a bilirubin level of 1.2 mg/dL, and I was diagnosed with fatty liver.
Despite regular walking and exercise, my blood pressure is still not coming down.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

Your heart rate is low. You need to stop the current medications. I would advise you to take a combination of Telmisartan 80 mg and Hydrochlorothiazide 12.5 mg once a day in the morning. This combination is commonly available as Telista-H 80. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent. I am hopeful that this will help control your blood pressure. For fatty liver, continue your exercises and get tested for Hepatitis B and C. Also, avoid alcohol if you consume it.

Regarding anxiety and your pulse rate, this variation is not acceptable. A heart rate increasing from 50 to 100 bpm is very unlikely to be caused by anxiety alone. Thyroid disorders can also play a role in this. Please repeat your TSH (thyroid stimulating hormone) test and also get an ECG (electrocardiogram) and fasting blood sugar test. Once you have the results, we can review them together.

In the meantime, start the medication I have recommended. I am hopeful that your blood pressure will start to improve and your pulse rate will stabilize within a week. Please schedule a follow-up after one week, including your reports, blood pressure, and pulse rate readings.

Stay healthy.