Question: Hi there -

40 year old male, 6 feet (183cm), 192lbs (87kg), former competitive athlete. I'd like to quit a beta blocker I'm on, but I'm concerned about the consequences, and would like to inquire about your best plan / steps / list for lowering BP without pharmaceutical drugs. Here's the full story.

Blood pressure has been inching up the past couple of years, and recently (last 2 months) have been diagnosed with severe anxiety (primary issue). The BP was 150s/100s consistently throughout the day, and higher during panic attacks. There is apparently nothing else wrong w/ me as per 2 x blood tests, 2 x urine tests, 2 x EKGs, chest x-rays, abdominal ultrasound, manual exams and more. It's all coming out normal, electrolytes, thyroid, liver, kidneys, adrenal glands, even cholesterol. The only things found are a deficiency of vitamin D and magnesium in the blood, which are now supplemented. It's hard to believe, but apparently all the fatigue, heart palpitations, hyperawareness of the heart orthostatically and in different positions, lingering upper respirotary infections and overall feeling of un-wellness is caused by the stress, anxiety and BP.

I'm getting the anxiety under control by using CBT therapy, some lifestyle changes and some supplements (theanine, gaba, inositol and taurine) without the use of anxiolytics or SSRIs. I took ativan, klonopin and lexapro, each for a couple of days only, and I seem to be super-sensitive to meditation b/c I already had withdrawal symptoms and worsening of anxiety when getting off. So no pharma for me for anxiety. The theanine/gaba/inositol/taurine seem to be working ok, though it's not a benzo, at least I won't get addicted. Side note: what do you think about niacin as visodilator, picamilon (combo gaba/niacin that crosses the blood/brain barrier) and valerian for supplemental treatment of anxiety?

But I am currently taking medication for the high BP -- metoprolol (toprol XL), 25 mg, once a day, extended release. The beta blocker was prescribed strictly for the BP, not for anxiety or any heart condition. Although this is a very low dose, it's already taken my BP from a consistent 150s/100s reading to a consistent 120s/80s reading in the morning, and 110s/70s all the rest of the day, in the only 30 days I've taken the beta blocker. My pulse is down to 50s, sitting down. The trouble is, during the same 30 days, I've done several other things which also lower BP, so there's no way to tell how much of it is due to the beta blocker alone.

I started walking fast (120bpm) 7-8 miles at a time multiple times a week, which reduces blood pressure. At the same time, I saw a naturopathic doctor. He theorized that my BP has been up due to a combination of chronic stress turning into a severe GAD w/ panic and insulin resistance (IR). I've been skipping meals for years, and eating 1-2 heavier meals/day. And though I've turned vegan 6 months ago, the vegan meals w/ plant-based carbs in them still cause a spike in blood sugar after long periods of not eating. The ND argues that I'm hypoglycemic throughout much of the day but have trained my body to not complain, and have developed IR. The magnesium deficiency in the blood shows insulin is not storing magnesium, and hence higher BP. Also, IR causes sodium retention, excessive uric acid, etc. -- all lead to higher BP. So as a natural treatment, I started megadosing (10-15grams/day) Omega 3 supplements, magnesium glycinate (1000-1600mg/day), vitamin C as dissolved ascorbic acid crystals (up to 10 grams/day), cut all processed sugar from diet, limited fructose to 15grams/day, and reduced grain intake, all of which should increase insulin sensitivity and lower BP, so I have no way of knowing how much the BP went down due to the beta blocker and how much due to the supplements, exercise and diet changes. I'd like to quit the beta blocker, but I'm concerned about a rebound.

I strongly dislike pharmaceutical drugs and see them as last resort. Beta blockers are no longer prescribed in the UK and in multiple European countries for BP alone, and have been replaced w/ ACE inhibitors, calcium channel blockers and diuretics. Not sure what the situation is in India. But here in the US, they give you a knee-jerk beta blocker prescription the moment you have higher BP. Long-term use has been linked to CHF, and even short term, it feels really unnatural to have something slow down and inhibit your heart. It's supposed to make one feel palpitations less, but ironically, b/c the heart wants to beat faster but it can't, it's causing harder contractions and hence greater sensation/feeling of the heart, and that is true while I'm exercising or having an anxiety attack or eating fast or just bending over sometimes. The drug is also giving me every side effect in the book -- very cold hands and feet (sometimes), extreme fatigue when it peaks lasting several hours, difficult to exercise (due to fatigue / weakness and sensation of the heart), and I'm gaining weight for the first time since I turned vegan, after steadily losing weight slowly without even trying due to vegan diet. I think I may be overmedicated even at 25mg/day, and in any event, would like to quit. My PCP is supportive of the idea of quitting, especially b/c I've only been on for a month and he doesn't think my "real" BP is that high without anxiety and white coat effect, but here are my concerns:
- I don't want to have stroke during an anxiety attack (I've measured 180s/110s during panic) until I get the anxiety under control. I know panic attacks are harmless medically, but I'm not sure that BP going to 180s/110s is harmless. I know that power lifters can see 300s/180s momentarily while lifting weights and they don't have strokes or aneurysms, but that's a highly trained athlete. Last thing I need while I'm handling/healing the anxiety is the fear of a real/non-imagined serious medical event during a panic attack. How likely is this scientifically? They say no one ever died, had a heart attack or stroke during a panic attack, unless they already were a heart patient, etc. I'm not a heart patient and I'm apparently pretty healthy otherwise, except for this BP.
- I'm concerned about a strong rebound where the BP gets worse than before taking beta blockers, which apparently happens to some people.

So, questions:
1. How safe is it to quit beta blockers and what's the best way to do it? (Cut pill in half, skip days, wean off over a period of time, etc.)

2. Given the above case history, would you recommend coming off the beta blocker right now? If not, when?

3. If/when I'm off the beta blocker, I'd like to lower and maintain healthy BP without medication, b/c othewise, I'd be simply ignoring it -- doing nothing. Assuming I'm working on the anxiety as outlined, what is your best prescription for lowering BP "naturally", i.e. without drugs? I'm open to nutritional changes, any type of exercise, meditation (re-started my Vipassana practice), supplements and anything else. Additionally, there is an ayurvedic supplement called Carditone, which has herbs (Convolvulus, Arjuna, Tribulis) plus Rauwolfia Serpentina in it, which is the primary substance in Reserpine, a now defunct hypertension drug that used to be the default prescription in the US. A lot of people say Carditone lowered their BP where even beta blockers couldn't. Do you have any experience w/ this ayurvedic supplement and is it safe / effective?

Finally, what can I realistically expect from a drug-free way of lowering BP? Should I give it 1, 3 or 6 months before expecting results and which parts of your plan are most important / would yield the best returns? Many thanks in advance.

Hi -

Thank you for your answer. I will not stop the beta blocker on my own. The MD is supportive of me stopping it, since I've only been taking it for one month, and have had many side effects. In addition, the beta blocker is slowing down motility, which is making the gas worse. This brings me to my follow-up question:

I have an extreme amount of gas in bowels and trapped air in stomach so I think I either have a medical condition such as GERD, hiatus hernia or celiac disease, or just a distended abdomen and excessive gas caused by bacteria due to recent diatery changes or magnesium deficiency (proven by blood test), causing slow motility. In any event, the palpitations are often physically triggered and not due to anxiety. I'd like your opinion/possible diagnosis on this please.

- I can mechanically reproduce palpitations (heart not tachy, 80s XXXXXXX nor skipping beats nor extra beats, only beating "harder") regardless of state of mind when laying on stomach or sides, putting pressure on abdomen or thorax in certain other ways, vasoconstriction of any kind (from belt tightening to alcohol consumption), eating after many hours on empty stomach, eating too fast or a heavy meal, even slouching/bad posture and bending over, etc.

- I can actually measure a jump of up to 30-35 in systolic pressure only (diastolic remains the same) when the palpitation is happening. Clearly, the heart is contracting much harder, but not beating faster -- I'm not imagining it. Example: Ate a heavier meal a bit too fast last night, not enough chewing. It also contained grains/gluten. My BP is now routinely 120s/80s, even 110s/70s during the day w/ the beta blocker. After the meal, I got the palpitations, and measured systolic BP of 140s-160s while it was happening, while the diastolic remained in the 70s and 80s. Pulse is 60s to 70s while it's happening (in contrast to resting heart rate of about 58), so my heart is not racing, just contracting harder.

This was measured repeatedly while sitting slouched on the bed, where the full abdomen after dinner obviously applies some pressure on the thorax and heart. When I sit up straight in a chair and thus relieve the pressure, and especially when I follow the urge to burp repeatedly (many times, sometimes for minutes) during which nothing but trapped air seems to come out, the systolic pressure goes down as much as 20-30 points. In this case, it went from 160 to 140, then to 130, within a minute. Thus, I'm convinced that part is not anxiety.

My theory: I turned vegan overnight 6 months ago and have had tremendous amount of gas since. Obviously the intestinal flora is suffering from the sudden change from a standard American diet and I don't have the enzymes + bacteria to digest all the new food. Also, the blood tests found a magnesium deficiency, which may be causing slow motility leading to more gas. I lost a fair amount of weight during the same time period without even trying due to the vegan diet, but appear to still have a distended abdomen. I don't think that's all remaining belly fat. I think a lot it is bowel gas as well as trapped air in stomach. I feel constantly bloated. And burping seems to both alleviate the bloating and regulate the heart rhythm when I have palpitations. Sometimes I can burp for many minutes straight. So my potential self diagnoses are:

(a) The gas is swelling my stomach to the point it is pressing against my diaphragm. This is making it difficult to breathe as the expanding chest allows the swelling to push into the thorax rather than creating a larger place for the lungs. This is also the cause of the palpitations.
OR: (b) Trapped gas/air is backing into esophagus, irritating the vagus nerve.
OR: (c) I may have GERD b/c the palpitations are happening after meals, and I've also had chronic cough and sinus infections as per GERD. However, this still appears unlikely b/c I almost never have heartburn/acid reflux.
OR (d) Hiatus hernia. Again, no reflux or regurgitation, so unlikely, but the esophagus would trap gas when the hernia slides into the chest cavity. The trapped gas presses on the vagus nerve and causes heart palpitations. (c) and (d) are consistent b/c repeated burping and orthostatic repositioning seems to regulate the heart rhythm and make the palpitations go away. Orthostatic vitals were done but were not clinically significant. However, they weren't done while I was having the palpitations and I was thus not able to demonstrate that I'm able to relieve the palpitations orthostatically and by burping.
AND/OR: (e) I have celiac disease and developed gluten sensitivity since turning vegan.

Does this make sense? What do you think is going on, what's more vs. less likely, and what should I do about it? The palpitations are very disruptive. Sometimes they go on for a long time and when they happen at night, I end up losing much sleep. Many thanks in advance.