Why does blood pressure fluctuate despite taking medication?

Question

Hello doctor,

For the past three years, I have been taking 12.5 mg of Atenolol and 80 mg of Valsartan to control my blood pressure. My readings over the years have been stable and within a good range, with an average blood pressure of 120/60 mmHg and a pulse rate of 55 to 60 bpm. I use a reliable blood pressure monitor and take readings three to four times a day. Last month, during a regular check, I noticed a reading of 136/60 mmHg for blood pressure and a pulse rate of 32 bpm. A few minutes later, the blood pressure was 141/68 mmHg, and the pulse remained at 32 bpm. We went to the emergency room at the local hospital, a 25-minute drive away. By the time we arrived, my pulse had increased to 60 bpm, and my blood pressure readings were within the normal range. I stayed in the emergency room for about 12 hours, where several blood tests, an ECG, and a chest X-ray were performed. I was discharged the next day with the assurance that my condition was fine. The doctors recommended discontinuing the 12.5 mg of Atenolol completely. (I am attaching a 24-hour Holter monitor report from two or three days later).

I had also taken 0.4 mg of Tamsulosin for 18 days for BPH (benign prostatic hyperplasia). The readings remained normal from the last month until the middle of this month. Then, one day, I experienced an increase in both my pulse rate and blood pressure, so my family doctor recommended resuming Atenolol at 12.5 mg. After four days, we noticed that my pulse rate had dropped back to the low 30s, so my family doctor advised reducing the Atenolol dose to 6.25 mg. However, this caused my pulse rate to remain in the high 30s, and my blood pressure increased to 191/85 mmHg. As a result, my family doctor suggested taking 6.25 mg of Atenolol on an as-needed basis if my pulse rate or blood pressure started to spike. Now, I monitor my blood pressure and pulse rate each morning before going out to determine if I need to take Atenolol, which has become quite stressful.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

The problem you mentioned involves two issues: high blood pressure and heart rate. For blood pressure, continue taking 80 mg of Valsartan. Regarding Atenolol, it does not have much effect on blood pressure but does help lower the heart rate. If your blood pressure remains elevated, you can increase the Valsartan dose to 120 mg. Take 6.25 mg of Atenolol if your heart rate remains above 80 to 90 bpm without it. If the heart rate is below 90 bpm, there is no need to take Atenolol. Additionally, count your heart rate manually by feeling your pulse, do not rely on the blood pressure monitor. Keep in mind that suddenly stopping Atenolol can cause an increase in heart rate beyond normal for a few days, but it will eventually settle down. So, be patient.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Congratulations, as both your blood pressure and heart rate are normal now. I have reviewed your ambulatory blood pressure and ECG (electrocardiogram) monitoring reports, and both are normal. There is no need for Atenolol, as your heart rate is within the normal range. Occasionally, heart rates can increase as a normal physiological response to exertion, fever, stress, fear, panic attacks, etc., and these typically settle once the underlying cause is resolved.

Regarding the TURP (transurethral resection of the prostate), the choice of anesthesia depends on the type used. For general anesthesia, you may need an echocardiogram, chest X-ray, and other basic tests. For regional spinal anesthesia, your blood pressure and heart rate are fine. It now depends on your urologist and anesthetist to decide the preferred type of anesthesia. If they opt for general anesthesia, they may recommend an echocardiogram, chest X-ray, and other tests.

Do not worry, and feel free to consult me anytime once your urologist decides on the intervention. You can send me your echocardiogram, chest X-ray, and other reports, and I will be happy to assist you further.

Thank you.