A hypertension Facebook member share that her blood pressure was 85/69 mm Hg, and her heart rate was 65. She was concerned about heart rate and wanted to know if her blood pressure was too low. She said she did not have any symptoms. Her question was, would her heart rate be lower while asleep.
Her Story
Her blood pressure has been 140-150/100, sometimes higher, usually lower, but she would get spikes. Her doctor told her to try a low salt diet, exercise, and continue to monitoring. It helped, but she was still a Stage 1-2. Her blood pressure would spike, sometimes as high as 165/115 mm Hg. So, she called her doctor for medication.
She was started on hydrochlorothiazide (HCTZ) 25 mg. After the 2nd day of od 25 mg, she was feeling dizzy, so she decreased her medication to 12.5 mg. She thinks the 12.5 mg is now going to stabilize her blood pressure, and if not, she plans to self-adjust her medication…meaning skip a day. She says she did not want to bother her doctor.
She was started on HCTZ 25 mg once a day six days ago and the reading throughout the day has ranged from 93/70 mm Hg to 141/94 mm Hg overall:
Day 1 on 135/94 mm Hg (HR 85)
Day 2 122-141/93-104 mm Hg (HR 72-90)
Day 3 96-131/78-90 mm Hg (HR 66-108)
Day 4 113-126/81-87 mm Hg (HR 72-85)
Day 5 93-120/70-87 mm Hg (HR
Day 6 85/69 mm Hg (HR65); 96/72 mm Hg (HR66), 103/76 mm Hg (HR64)
Lifestyle Modifications
This member was told by her doctor to make some lifestyle changes that would reduce her blood pressure. I can only assume that her doctor’s request was vague. In other words, he asked that she take action without any specific steps. He may have said, cut back on salt and exercise for 20 minutes on most days, but she probably did not get any specific instructions.
Nevertheless, the best case is that she received specific lifestyle modifications instructions, including a flyer with all written information. Despite the fact that lifestyle modifications are simple, they are hard to do routinely without coaching and accountability. The video below explains lifestyle modifications.
The video below explains proven lifestyle modifications including exercise, smoking cessation, and alcohol moderation.
Recommendation
My advice to her was to call her doctor before taking her medication today because at 85/69 mm Hg, she might need her blood pressure medication adjusted or changed.
I don’t know her medical history details, but from what she was telling me, her blood pressure looked too well controlled.
Low Blood Pressure
There are some exceptions, but for the average adult, a blood pressure of less than 90/50 mm Hg is usually too low, especially that she is having symptoms of dizziness. Other symptoms of low blood pressure are lightheadedness, weakness, blurred vision, fatigue, feeling faint, cold, and wet skin (clammy). Sudden onset of symptoms might be worst than the gradual onset of symptoms due to the risk of falling. It would be important that she let her family know how she feels so that they would monitor her symptoms.
Risks versus Benifits
Her doctor called in the medication for her high blood pressure to reduce her risk of having a stroke, heart attack, heart failure, kidney disease, and blindness. High blood pressure over time can also cause damages to her arteries, causing vascular problems and nerve damage.
If her blood pressure is too low, this could be dangerous. I’m assuming that her low blood pressure is coming from the new blood pressure medication. Still, there may be some underlying causes for her low blood pressure that are not likely because perhaps she would’ve had them before taking the medication.
Causes of Low Blood Pressure
Severe dehydration could be the cause of her low blood pressure. There are other causes of low blood pressure, like blood loss, shock, infections, or spinal cord injury.
Do you Have Questions or Comments?
Other problems like hyper or hypothyroid, Addison disease or other endocrine diseases, low or high blood sugar, heatstroke, severe pain, nutritional deficiency, or heart problems could cause low blood pressure.
Suppose there is no underlying cause for her low blood pressure, perhaps she may need a different medication. Of course, only her your doctor can figure this out using her medical history, physical exam, and possibly labs.
What Can Be Done About Low Blood Pressure?
She is on HCTZ (12.5 mg or 25 mg), and her blood pressure is dipping lower than 90/50 mm Hg, losartan, or some other angiotensin receptor blocker might give her less variation.
I will say the more information she can collect regarding her blood pressures, time of day, medications, and other lifestyle activities, the more likely the solution will be identified by her doctor.
It would be interesting to know if she has orthostatic hypotension with this, which would likely be associated with dehydration. It’s been very hot in the south where she lives.
She believes after five days of medicine that her body is working on stabilizing the medication. She said she was trying to manage it herself, but since it was still on the higher side, she decided to take the medication.
Even assuming that she is otherwise healthy and have no underlying problems, I still say she needs to call her doctor before taking her next dose to discuss what to do about the low blood pressures.
Perhaps the wide variation in her blood pressure and pulse may indicate that she might be dehydrated. She needs to check with her doctor about this because she might need to get checked for underlying conditions, and her medications may need to be reevaluated for a dose or medication adjustment.
I also recommended that she download a blood pressure log app and log blood pressures in the app, which might be useful for her doctor to coordinate her blood pressure times and dates to get to identify probable causes for her low blood pressures.
Detecting Orthostatic Hypotension
The easiest way to get an orthostatic blood pressure is by taking her blood pressure while lying down, then stand up slowly and repeat her blood pressure after 3 minutes of standing. She would need someone at her side to do this for safety. I would not want her to fall. If her top number drops 20 points or more or her bottom number drops 10 points or more, then she is likely dehydrated. In the clinic, we get blood pressure lying, sitting, and standing, but this would be enough to give her doctor enough information.
If she is dehydrated, that’s an easy fix, and perhaps her medication regimen is okay. It is a good idea to get medical advice and not wait it out. Many times there is a Nurse Practioner in the doctor’s office who usually have a lot of experience with controlling blood pressure. So, I encouraged her to talk with the Nurse Pracotisnor or whoever is on call when you call the doctor’s office.
Summary
This was a middle-aged white woman who was newly diagnosed with hypertension. She was having some hypotension with dizziness on day two after being started on HCTZ 25 mg for level 1-2 hypertension. Her blood pressure was as low as 85/69 mm Hg by day 6.
She was concerned about her pulse, but her blood pressure was probably the main issue. She was doing a good job monitoring and tracking her blood pressure, and a blood pressure tracking app would make it easier to track and useful for her doctor to see the measurements at a glance.
Diuretics like HCTZ are effective medications but may not be good for everybody. She might only need a small dose such as 6.25 mg a day instead of 25 mg, and if that is not enough, perhaps another medication that is not as powerful as losartan may keep her blood pressure at goal without bringing it down too low.
Her main goal should be communicating with her doctor for medical advice since her blood pressure is very low, and she is symptomatic.
Get your free “The Salt Fix” at audiobook here.
This Website was created with Bluehost. Click here to create your website.
[podcast_subscribe id=”4188″]
