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What Causes Orthostatic Hypotension And Supine Hypertension?
Question: I was recently on Propranolol (for headaches) and HCTZ (12.5mg 1x per day) for hypertension. The propranolol did nothing for my blood pressure, went up, but heart rate went down seriously 60 and below. My BP drops when standing by at least 20 points in short time, goes up when walking, sitting and can go very high in supine or lying down flat. I have to raise my back with electric bed. Started getting heart palpitations with the slow heart rate so talked to doctor and started weaning off propranolol about 2 weeks ago. Started at 60 mg extended release one time per day. Than went to 20mg 2 times per day, reduced that to 20 and 10 for about 5 days, now on 10 mg 2x/day (I split the 20 mg tab). I've been doing that for about 3 to 4 days. The BP is going up but heart rate is still low, heart palpitations aren't that bad. Can I stop it totally now? What other BP drug can I take just to lower the BP? I've tried Lisinopril 20mg 2 x per day, also took HCTZ 12.5mg, worked very well for the BP but developed a very bad cough and had to stop taking it.
I still have the orthosatic hypotension but the sitting and supine bp is getting higher. I was thinking of an ARB but concerned about a possible increase in potassium since I haven't entirely been off the Propranolol.
Don't want anything that has withdrawal problems or possible heart issues, I've had atrial fib about 15 years ago, one or two times. Would like low risk drug, fearful of going to calcium channel blocker or another beta blocker which seems to cause many problems for me. Also some side effects with HCTZ that feel like electrolyte issues since they go away when I drink Gatorade with the electrolytes.
Thanks for any input
I still have the orthosatic hypotension but the sitting and supine bp is getting higher. I was thinking of an ARB but concerned about a possible increase in potassium since I haven't entirely been off the Propranolol.
Don't want anything that has withdrawal problems or possible heart issues, I've had atrial fib about 15 years ago, one or two times. Would like low risk drug, fearful of going to calcium channel blocker or another beta blocker which seems to cause many problems for me. Also some side effects with HCTZ that feel like electrolyte issues since they go away when I drink Gatorade with the electrolytes.
Thanks for any input
Brief Answer:
please see below.
Detailed Answer:
Respected Madam
From your description it appears that you have a combination of orthostatic hypotension and supine hypertension. This scenario has two possibilities; if this orthostatic hypotension has developed only after starting propranolol or was there before starting it. I would like you to clarify this.
If the orthostatic hypotension got superimposed on high blood pressure after starting propranolol, then the gradual withdrawal of propranolol, under your physician's supervision would be appropriate. We also do not give HCTZ or other diuretics to our patients with orthostatic hypotension. We would prefer trying a long acting ARB like telmesartan, at low doses in such patients. This has all good effects of lisinopril minus cough as side effect. A watch on potassium will be required with telmisartan. This does not effect sodium markedly as HCTZ. This is not a CCB or beta blocker. This is not related with marked withdrawal hypertension. This has been shown to have beneficial effect on atrial fibrillation and has been known as cardio-protective and reno-protective drug. You need to discuss it out with your physician and get a prescription from him.
If you have baseline orthostatic hypotension and supine hypertension before starting propranolol, then it is more difficult a situation. This would require consultation with a neurophysician first to evaluate your orthostatic hypotension. Only after deciphering its cause and good management, supine hypertension can be properly treated.
Hope this provides some insight. Feel free to discuss further.
Sincerely
Sukhvinder
please see below.
Detailed Answer:
Respected Madam
From your description it appears that you have a combination of orthostatic hypotension and supine hypertension. This scenario has two possibilities; if this orthostatic hypotension has developed only after starting propranolol or was there before starting it. I would like you to clarify this.
If the orthostatic hypotension got superimposed on high blood pressure after starting propranolol, then the gradual withdrawal of propranolol, under your physician's supervision would be appropriate. We also do not give HCTZ or other diuretics to our patients with orthostatic hypotension. We would prefer trying a long acting ARB like telmesartan, at low doses in such patients. This has all good effects of lisinopril minus cough as side effect. A watch on potassium will be required with telmisartan. This does not effect sodium markedly as HCTZ. This is not a CCB or beta blocker. This is not related with marked withdrawal hypertension. This has been shown to have beneficial effect on atrial fibrillation and has been known as cardio-protective and reno-protective drug. You need to discuss it out with your physician and get a prescription from him.
If you have baseline orthostatic hypotension and supine hypertension before starting propranolol, then it is more difficult a situation. This would require consultation with a neurophysician first to evaluate your orthostatic hypotension. Only after deciphering its cause and good management, supine hypertension can be properly treated.
Hope this provides some insight. Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply. The orthostatic hypotension was there befoe the stroke and propranolol, but to a much lesser degree. It only effected me in hot weather, when exercising, sitting than rising. Occassionally I felt it when squatting and rapidly rising to a full standing position, I would temporarily see black. Now I go faint, but if I simply stand the BP systolic can drop 20 points but if I walk or exercise it goes up.When you suggest followup with a neurophysician do you mean a neurologist? Or is there a neuro cardiologist?
Brief Answer:
please see details.
Detailed Answer:
Respected madam
Indeed your history is suggestive of postural hypotension. The general measures for the condition include avoiding dehydration, maintaining adequate levels of electrolytes, moving your legs well before getting up from sitting or recumbent position, avoiding drugs like diuretics. Specific measures include use of compression stockings and medicines. Do consult a neurologist and a cardiologist. A neurophysician is also called neurologist.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Respected madam
Indeed your history is suggestive of postural hypotension. The general measures for the condition include avoiding dehydration, maintaining adequate levels of electrolytes, moving your legs well before getting up from sitting or recumbent position, avoiding drugs like diuretics. Specific measures include use of compression stockings and medicines. Do consult a neurologist and a cardiologist. A neurophysician is also called neurologist.
Sincerely
Sukhvinder
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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