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What causes fluctuations in heart rate and mild hypertension?

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Posted on Fri, 15 May 2015
Question: Hi, I recently was prescribed 2.5mg of Bisopropolol for mild hypertension. However, my BP at home was in the normal range at 121/74 with pulse of 61. When I go into the Dr. office it shoots up and my pulse would race up to 100 bpm. I'm 39 and in relatively good shape. I try to exercise several days/week and my after being on the beta blocker my average pulse seems to be in the low to mid 50's and occasionally in the upper 40's. Is this acceptable? My Dr. said not to be too concerned about it but I wanted a second opinion.
doctor
Answered by Dr. Saumya Mittal (12 minutes later)
Brief Answer:
Changes can be made

Detailed Answer:
Hi
I am Dr Mittal
I have read your query.
I understand your concerns.

But I agree with your doctor.
It sounds exactly like classical "white coat hypertension".
The BP and HR always go up in a doctors office.

But since your average and usual BP is normal, I think I would suggest continuing the same treatment.
However, I personally prefer to avoid beta blockers.
I prefer to give medicines called ARBs eg olmesartan and telmisartan.
For the same reason that you have quoted- low heart rate.
That can cause symptoms like fainting.

I would suggest keeping a automatic BP machine at home.
Monitor BP on your own with heart rate at different times of the day.
And give this record to your doctor.
He may be able to suggest better with that.
Best of luck.
Dr Mittal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal (3 minutes later)
Thank you for the response. I've only been on the bisopropolol for a few days and just now cut the dose in half. Is my resting heart rate in the low 50's or upper 40's cause for concern or will my body adjust to this over time?
doctor
Answered by Dr. Saumya Mittal (2 minutes later)
Brief Answer:
meet the dr in a week

Detailed Answer:
The body cannot adjust to a phamacological induced dose.
It will become better during the day as the effects become less.
I will also suggest not cutting the dose to half on your own.
High blood pressures are dangerous business.
I suggest you maintain the record for a week.
and then meet the dr again.
Best of luck.
Dr Mittal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal (2 minutes later)
I did fail to mention that I contacted him yesterday and per his direction I cut the dose in half and he did say that should help. He also said that it should be an issue to have a resting pulse in the low 50's/upper 40's. I just wanted to get a second opinion on this. I haven't felt faint or dizzy but maybe a little tired. What is your thought?
doctor
Answered by Dr. Saumya Mittal (5 minutes later)
Brief Answer:
specific answres

Detailed Answer:
Considering that the dose reduction is on medical grounds, I would suggest you follow the advice.
As for the heart rate, I prefer to keep my patients between 60-70.
As I have already said, I prefer other drugs, not beta blockers due to the possible side effects I have mentioned.
I mean imagine getting dizzy while you are on a road driving a car?
Besides ARBs are known to be cardioprotective.
They avoid cardiac remodelling- changes in heart that come about due to high blood pressures. Something that beta blockers cannot do.
I hope that helps you.
Please feel free to contact us for more information.
Dr Mittal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2893 Questions

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What causes fluctuations in heart rate and mild hypertension?

Brief Answer: Changes can be made Detailed Answer: Hi I am Dr Mittal I have read your query. I understand your concerns. But I agree with your doctor. It sounds exactly like classical "white coat hypertension". The BP and HR always go up in a doctors office. But since your average and usual BP is normal, I think I would suggest continuing the same treatment. However, I personally prefer to avoid beta blockers. I prefer to give medicines called ARBs eg olmesartan and telmisartan. For the same reason that you have quoted- low heart rate. That can cause symptoms like fainting. I would suggest keeping a automatic BP machine at home. Monitor BP on your own with heart rate at different times of the day. And give this record to your doctor. He may be able to suggest better with that. Best of luck. Dr Mittal