Question: I am a 41 year old female who developed postpartum preeclampsia, with a bp of 180/100 and protein in my urine. My blood work was normal. The protein reduced and I was medicated for the bp and discharged.

I am now 7 weeks postpartum and still medicated. My urine no longer has protein. My doctor thinks I have essential hypertension but the medication keeps my bp too low
100/70. However, in the late evening it spikes to around 170/105. I can usually bring it down to 130/80 through breathing and relaxing. I do have anxiety but I am on atenolol that brings my hr down to about 55 and I don't feel stressed when I take it. What could be causing these spikes? They are nearly every night. I take the atenolol at 8am and the spikes happen around 10pm. However, I always wake up with normal numbers. Last night I went as high as 170/105 at 11pm and this morning (25 hours after my 50mg dose of atenolol and 13 hours after my 10mg dose of enalapril) my bo was 120/80. I'm so confused.

Until a couple of days ago I was on labetalol 200 mg 3 times daily. I took a dose at 8pm as well as 10mg of enalapril. I would still get the spikes at around 10/11pm. Also, if my pressure on the atenolol 50mg is 100/70 with a pulse of
50-55, wouldn't an increased dose send me too low? Especially sleeping

I am on 50mg of atenalol at 8 in the morning. I take 10mg of enalapril at 8 at night.

When my BP goes high my heartrate doesn't change - its still below 55.

I have been tracking my BP every hour for the last couple of days to review the medication change. Tonight it didn't go as high: the highest was 140/105 and 158/95. However, these were first readings and I had a heartrate of around 70 when I took them so I must have been stressed. I settled at around 120/85 with a heartrate of 53.

I am very keen to come off beta blockers. I have a normal heart and I am disappointed that my doctor went to them first (Labetalol was prescribed postpartum at the hospital and so was enalapril as my BP didnt respond to labetalol at first). I am only 41 and I have two infant children - I feel like a zombie. How would you suggest that I wean off them? My doctor is a good one but clearly not skilled in this sort of thing.

I have been thinking that enalapril at 10mg twice a day (so 20mg) and another drug that is not a beta blocker may be the way to go for me. Can you tell me about the drug that you suggest and why you have selected that?

One last question: do you have any idea why this has happened to me? I am in excellent health and I have no family history of high BP. No one ever commented about my BP before pregnancy or at the beginning of this pregnancy either. My doctor thinks that underneath all these meds my BP is running at 150-160/95-100, which is significant hypertension. I wasn't even prehypertensive before.