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How to manage low blood pressure caused by medications?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

My wife underwent surgery for CABG a year ago and is taking Carvedilol 3.125 mg and Ramipril 2.5 mg twice a day, among other medications. Currently, her blood pressure sometimes drops to 100/60 mmHg. Could this be due to the medications mentioned above? Should the dose be halved for relief?

Please advise.

Hello,

Welcome to icliniq.com.

I have reviewed the reports (attachment removed to protect patient identity). Firstly, given her heart function is low (25 to 30 percent), she is prone to low blood pressure. Therefore, her BP will likely remain low. In addition, both Carvedilol and Ramipril lower blood pressure. However, in her case, these medications are necessary to prevent further decline in heart function. If she is not experiencing symptoms such as dizziness or excessive fatigue, the current dosage should be continued. Generally, a systolic pressure greater than 95 to 100 is acceptable, as long as she is not symptomatic.

Regards.

Patient's Query

Hello doctor,

Thank you for the reply.

However, she experiences perspiration and weakness. What should be done if her blood pressure is 90/60 or lower?

Hello,

Welcome back to icliniq.com.

In that case, Ramipril should be skipped at that particular time. If the blood pressure remains too low, both medications should be adjusted. It is better to have a gap of one to two hours between these two medicines. If her blood pressure frequently stays this low, you should discuss the possibility of reducing the Ramipril dose to once a day. Another cause for these symptoms could be a low pulse rate, which can occur with Carvedilol, so the pulse rate should also be monitored. A pulse rate above 55 per minute is acceptable for her. If it is lower, a reduction in Carvedilol, rather than Ramipril, should be considered.

Regards.

Medically reviewed byDr. Divya Banu M

Published At April 16, 2019
Reviewed AtNovember 15, 2024

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