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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for hypertension and weightloss

Answered by
Dr.
Dr. Bhanu Partap

Cardiologist

Practicing since :2010

Answered : 2776 Questions

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Posted on Thu, 13 Apr 2017 in Hypertension and Heart Disease
Question: Hi there,

I'm a 36 year old male, 5'11", ~245 lbs. I am obese but exercise regularly several times a week (usually at least 5), try to eat healthy (and do much more often than not), don't smoke, and drink moderately (except for rare occasions). I also take several heart healthy supplements (fish oil, garlic, grape seed extract, Vitamin D, Vitamin K2, etc.).

For the last several years I've struggled with weight loss (I'm doing most of the right things, but having a hard time losing) as well as pre-hypertension. I'm starting a more intensive exercise program (intervals and circuit training, which I haven't done before) and showing some early results as far as losing weight, so I'm hopeful. At any rate, 3 years ago, I had an echo done of my heart (since my dad died early at 53 of a heart attack), and it came back as good/normal. At that time, left ventricle was 1.1cm, which is considered the upper limit.

We just repeated the echo, and similarly, my heart looked fairly good with the exception of mild concentric left ventricular hypertrophy, as the size this time was 1.2 cm. My doctor assured me that this was nothing to worry about at this stage and didn't put me at additional risk for heart attack/stroke, but she did feel it might be time to go onto meds to bring the borderline BP down (and hopefully allow my left ventricle remodel smaller).

The medicine I'm on is 5mg Bystolic (once daily). I understand it's a beta blocker and one of the new ones, so it has very few side effects (hopefully). I started it today, and so far so good.

I do have a few questions - I plan to run them by her, but she's going on vacation soon, so I'm not sure if I'll be able to catch her, so I thought I'd get some feedback here (and try her tomorrow as well).

1.) How long does Bystolic take to notice a blood pressure difference? Right away, or is there an acclamation period?

2.) As I mentioned, I'm doing cardio interval training with some cross-training mixed in, and I'm basing it on rough heart rate estimates. 220-36=184 (my max), so I'm trying to keep it at 85% of that, or <156. However, I'm aware beta blockers can slow heart rate. What I'm trying to figure out is, as long as I feel fine (talk test, etc.), is it still okay to aim for the 156 on this medication? She seemed to think I can exercise just as intensely, but I forgot to ask if Bystolic would lower my exercising target heart rate or the maximum safe heart rate. So can I just do as I've been - keep it under 156 if possible and go by how I feel?

3.) Will Bystolic make it harder for me to lose weight? I know earlier beta blockers could lead to weight gain, and this one seems better with that, but a few have still reported it. Does it slow down metabolism?

4.) Looking at the report, I see the only other value I don't understand is:
166 MV E-F Slope (80-150 mm/sec)
Is that abnormal as well, or related to left ventrical?

The fact that my left ventricle is even slightly over the size it should be does scare me, but I'm trying to trust that if the doctor says I shouldn't worry, I shouldn't - I hope you agree with that assessment.

Thank you very much for your help!

Warmly,
XXXX
doctor
Answered by Dr. Bhanu Partap 48 minutes later
Brief Answer:
Nothing serious to worry for

Detailed Answer:
Hi There

I have gone through the details provided by you and First of all i want to thank you for such a nicely framed question. Now ill try to explain according to your points.

1. The onset of action of nebivolol is within 4 hrs of intake.

2. Thats the formula to calculate target heart rate during the exercise testing not to be used routinely to keep any goal of any target heart rate. A healthy heart is one which has a resting heart rate between 60-80 bpm. And yes Beta blockers do keep heart rate low even on exercise.

3. No Bystolic contains NEBIVOLOL which is a highly selective beta blocker and it do not have any effect of body Fat metabolism.

4. EF slope is basically a echocardiographic measure of Diastolic function which is the filling of the heart with blood during diastole. Patients with high blood pressure usually have slightly high reading of this measurement. Dont worry ots fine.

Yes your treating doctor is absolutely right that there is nothing significant as of now to worry about.

My suggestion is to maintain your healthy lifestyle habits and follow your doctor advise. You will be alright.

I hope this information will answer all your queries and guide you properly.
If you have any more doubt you can ask me or else you can close the discussion and kindly rate the answer.

I wish you Good Health
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhanu Partap 22 minutes later
Dr. Partap,

Thanks very much for your detailed responses! A few followups:

1.) So when you say 4 hours for Bystolic action, are you saying I should see the full effect on my blood pressure starting the first day? Or does it take time (days/weeks) to see the full effect on BP? Does it last all day?

2.) Understood re the target heart rate formula, but I still need to figure out how to exercise safely going forward. To clarify my question, I exercise in intervals and just use 85% of XXXXXXX as a guideline to try not to go over for long periods. In my case, that's currently 156 bpm. Can I still use that same target as a "not to exceed in most cases" benchmark, or would that target now be significantly lower because of the medication.

To rephrase (and I'm aware without a stress test, it's somewhat arbitrary), some people feel that regularly exceeding 85% of maximum heart rate is risky, so to be on the safe side, I shoot for below that to stay in a "safe zone". Can I still consider myself safe if I'm below that threshold, or do I have to stay even lower now on medication since my heart rate is now slowed? (And of course, I'll listen to my body - if something feels too difficult, even if my heart rate is below that, I'll ease up.)

3.) Dementia seems to run in my family, and I know recently it came out that long-term use of anticholinergic drugs may be linked to this. Is Bystolic/Nebivolol anticholinergic and something to be concerned about?

Thanks much!
XXXX
doctor
Answered by Dr. Bhanu Partap 19 minutes later
Brief Answer:
Welcome Again

Detailed Answer:
1. Yes the effect of the medicine will start after day 1. Yes the effect last a day.

2. Ideally when a person is on beta blockers its advisable to exert upto what extent the patient can tolerate if feel dizzy or light headed exercise should be stopped. One formula is also proposed for patients who want to exercise while on the medicine is [162-(0.7 x age)].

3. No its does not have any such properties its acts by decreasing the renin secretion by kidney and by blocking the beta receptors in heart there by controlling the rate and pressure.

Regards
Dr Bhanu Partap
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhanu Partap 34 minutes later
Thank you! Last followup, if you don't mind. =)

1.) Thank you for that formula. I haven't done cardio today (I was able to do some stretches and light weights with no issue though), but I'll see how I do with the formula tomorrow. The answer I get is ~137, which seems awfully low compared to where I'm usually at, but I won't know until I try it and see how this medicine affects my heart rate. If I feel okay, is it *safe* to go past that, as long as I pay attention to the feelings you mention?

2.) One other question - I do take small amounts of supplemental magnesium and potassium. Are there concerns about buildup as with some other blood pressure drugs (and if so, how would I know/be able to avoid it)?

Thanks again for all your help - you've been excellent!
doctor
Answered by Dr. Bhanu Partap 7 minutes later
Brief Answer:
LOL, Never Mind

Detailed Answer:
1. Yes you can go ahead till you are comfortable, but its possible that your heart rate wont go till that far with ongoing medicine so dont over push the limits.

2. Yes some cardiac medicine do affect these electrolyte levels, so its advisable if you want to continue these supplements then you need to check your serum electrolytes via blood test every 3 months to check for any significant alterations.

Wish you good luck and health
Above answer was peer-reviewed by : Dr. Kampana
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