How to manage BP spikes during anxiety?

Question

Hi doctor,

I have been suffering from high blood pressure for the past three years. During periods of discomfort, my readings range between 140-148/90-98 mmHg, while under normal conditions, they are around 120/80 mmHg. Currently, I am taking Cilnidipine 10 mg in the morning after breakfast, along with Atorvastatin and Aspirin at night, as prescribed by my doctor. I have been on Cilnidipine for nine months and started Atorvastatin and Aspirin about five to six months ago. Previously, I was taking Telmisartan 40 mg, but my high blood pressure has not been fully controlled. Occasionally, particularly in the evening, I experience discomfort and uneasiness in my left chest due to anxiety, although I do not have any pain.

I struggle to fall asleep, often taking one to two hours to do so, but once I achieve deep sleep, I feel relieved. My blood sugar levels, lipid profile, and my most recent ECG (electrocardiogram) were all normal. My doctor did not recommend an echocardiogram or any additional tests. I have attached my latest blood report. I do not smoke or drink alcohol, but I lead an inactive lifestyle due to sitting in front of a computer for hours. Could you suggest any alternative or additional medications to help manage my hypertension and anxiety?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

You have hypertension (high blood pressure) that occasionally becomes uncontrolled during episodes of anxiety, though your baseline BP is well-managed. I would suggest adding a new medication, Bisoprolol 2.5 mg, to be taken once daily at 8 AM. Please consult your specialist doctor, discuss this option with them, and take the medication with their consent. Bisoprolol will help control spikes in blood pressure during emotional stress and physical exertion. You may continue taking Cilnidipine and Aspirin, as both are effective medications.

Your lipid levels are within an acceptable range. Moving forward, I would like you to understand the importance of optimally managing your blood pressure. This is to prevent silent organ damage. Some of the medications you are taking, including Cilnidipine and Bisoprolol, are excellent at preventing kidney disease and stroke. I encourage you to adopt a healthier lifestyle. A practical suggestion would be to join a gym and work with a personal trainer. Starting with exercises like using an elliptical trainer and treadmill can help. Reducing your sedentary lifestyle will, in turn, decrease your reliance on medication. A personal trainer can also help you maintain a sustainable fitness routine.

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, you can take Bisoprolol before food. It does not have significant interactions with food, so you may take it with or without meals. Try to take it at the same time every day, as its effects last for only 24 hours. It may take a few weeks for the full effect of the medication to become noticeable.

Cilnidipine can also be taken either before or after food. It is perfectly fine to take both Cilnidipine and Bisoprolol in the morning, but aim to take them at the same time each day if possible. You also have the option of home monitoring your blood pressure using a reliable electronic BP apparatus. Just ensure you use one with an arm cuff rather than a wrist cuff for more accurate readings.

I hope this helps.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

It is likely that you experienced low blood pressure, which your body is not accustomed to. The best approach would be to reduce the Cilnidipine dose to 5 mg and take it in the evening around 9 PM. Bisoprolol 2.5 mg is already a very low dose. If your blood pressure remains low, we may consider discontinuing Cilnidipine altogether. Please consult your specialist doctor, discuss this with them, and adjust the dosage accordingly.

Continue monitoring your blood pressure to check for any further episodes of hypotension or low BP. The best way to monitor your BP is at home when you are relaxed. Home BP levels below 135 mmHg systolic and 85 mmHg diastolic are generally considered normal. Although many medications can cause significant first-dose hypotension, Bisoprolol typically does not have such an effect.

Thanks and regards.

Answer 4

Hi,

Welcome back to icliniq.com.

We will try adjusting the timing of your medications. Take Cilnidipine 5 mg in the morning and Bisoprolol 2.5 mg at 9 PM. This way, you may avoid feeling tired during the day. Since your BP levels are optimal, I do not believe the fatigue is caused by the medications. Have you started any physical activity yet? Walking for at least a short time each day can help reduce fatigue.

I hope this helps.

Thank you.