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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I am having blood pressure problems..most of the time my

Answered by
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Dr. Aaron Branch

General & Family Physician

Practicing since :2011

Answered : 875 Questions

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Posted on Sat, 23 Feb 2019 in Medicines and Side Effects
Question: I am having blood pressure problems..most of the time my pressure is good but I keep having spikes of high blood pressure so I will take a small dose of beta blocker..my blood pressure spikes to 145/95..when I take my small dose of blood pressure meds 2.5-5 mg of propranolol my pressure goes down but then after about 5 hours it jumps up higher than what it was to begin with.. like a rebound effect.. last reading was 170/108..so I take more beta blocker about 5’more mg.. it is normal now 120/80..the problem is if I take more mg of the blood pressure it drops too low like 99/50... how do I resolve this problem?? I would live with the slightly elevated bp but the last echo showed that I have dystolic dysfunction of one.. like I said most of the time my blood pressure is fine.. it has stayed more elevated after I started using the blood pressure meds!!! I know with dystolic dysfunction it is important that I keep my blood pressure down right?? Please help me..
doctor
Answered by Dr. Aaron Branch 2 hours later
Brief Answer:
phenomenon that you are describing is known to occur with short-acting beta blockers

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using Ask a Doctor.

The phenomenon that you are describing is known to occur with short-acting beta blockers such as Propranolol, so I would suspect that this is the cause of your spikes in high blood pressure. Also, typically I would not give for Propranolol for hypertension, it is perhaps not the best choice, since it does not target the heart as well as other blood pressure medications, and it is short-acting as I mentioned before. You are right that it would be important to keep your blood pressure controlled with diastolic dysfunction in order to prevent any further dysfunction and possibly to improve the function of your heart. For this, I would recommend using either a long-acting beta blocker such as Atenolol or Carvedilol, or perhaps better, an ACE inhibitor such as Lisinopril or Enalapril. Either of these medications can help protect the heart and control your blood pressure better than Propranolol.

Hopefully this gives you some things to talk to your doctor about as far as possible options to replace your Propanolol with. Please let me know if you have any questions about that and I'll be glad to discuss it with you further.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Aaron Branch 2 hours later
Do you usually see dystolic dysfunction in a 60 year old? Is it a dangerous diagnosis ? Once I get my blood pressure under control will the dysfunction go away? When I had the echo I was real nervous and my blood pressure and pulse was high.. could that change the outcome of the test? Thank you so much!! You have given me such a detailed answer!!!
doctor
Answered by Dr. Aaron Branch 15 minutes later
Brief Answer:
See below

Detailed Answer:
You're very welcome, I'm glad I could help. Diastolic dysfunction is a common finding, and the older the patient the more common it becomes. If you are not having any symptoms of heart failure (shortness of breath, leg edema), many patients continue to not have symptoms for many years without having any problems. Heart complications are increased in patients with diastolic dysfunction, but still rare and less than in patients with systolic heart failure.

I don't believe the blood pressure or pulse would effect the results of the echocardiogram to mistakenly diagnose diastolic dysfunction.

Another medication I should mention is spironolactone, which is actually perhaps the preferred medication for your condition. This medication has also been shown to help prevent complications from diastolic dysfunction, and I would suggest discussing it with your doctor the next time you see them.

I hope that helps, again, please let me know if you have any other questions and I would be glad to answer them the best I can.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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