Blood Pressure Problems

[Mobi]

Hi, I know there is already a similar thread going on blood pressure, but my case is a little different, so thought it better to start again.

I am 60 years old, have been diabetic and a chronic alcoholic for over 30 years, inject insulin 4 times a day, and have had angina and high blood pressure problems for many years, for which I take a whole team of medication.

I am now on day 67 of total abstinence from alcohol, and am committed to quitting for the rest of my life. I also stopped smoking some 25 years ago.

My blood pressure has not been good for many years, and was as high as 170-180 over maybe 80-90, reducing with substantial medication to maybe 135-145 over 80-90 in recent years.

Yesterday, I checked my blood pressure, for the first time since I stopped drinking, as I wasn't feeling well. I was shocked as it was 105/43. and even went as low as 99/47. My pulse was around 38 - 40.

Yesterday evening it went up to about 123/57, and late evening it was 145/55, pulse 45.

I take all my medication in the morning when I wake up (Tritace - 10 mg, Amlodipine 10 mg, Natrilix 1.5 mg, Atenolol 100 mg), so can only assume that the pressure increases during the day as the medication wears off.

Today, on waking, my pressure was 134/67, pulse 52, and by 9.30 it had dropped to 99/60, pulse 41, presumably as thre drugs kicked in.

At 11.30 a.m. it was 104/54, pulse 40.

So if there are any experts out there, my questions are:

Is pressure of 100/50 too low? If so, what is the lowest I should be having and still be OK?

Should I reduce my medication? (I decided to take only 5 mg of Tritace this morning instead of the normal 10 mg)

Should I split my medication - some in the morning and some at night? Maybe I should take the other 5 mg of Tritace tonight?

Clearly the absence of alcohol has had a dramatic effect on my condition, and I'm not sure how to proceed. I really don't trust the doctors, they just say what I want to hear most of the time, and say: try this, or reduce that and come back in 2 weeks.

Any farang expertise out there will be gratefully appreciated.

[wanali]

With a history like yours (DM, ehtylism, angina, HT), being >60 and on polypharmacy and a BP and PR (as low as 38?!?!) as described, you must be really insane to start self-medicating, speculating about the pharmacodynamics of your medicines and/or taking advice from a forum as this one, especially in a country where there's plenty of really good cardiologists (Bangkok Hospital, Bumrungrad, Bangkok Pattaya, ...) that you can consult for less then 1000THB.

Of course you should go to see a (real) doctor. And once your there, it might be a good idea to see someone with knowledge about 'paranoia in early Korsakow patients' at the same time. It seems the abstence (and most likely the previous use) of alcohol is taking it's toll in the upper body regions.

And of course the doctor will say "Try this and come back in 2 weeks" (although in your case he should say "Try this and come back in 1 week" or even "Admit for observation"), what else should he do? Send you home without any follow-up to evaluate the results?

Don't let your paranoia threaten your health, go to one of the mentioned hospitals (this is Thailand, you don't even need an appointment) and follow the doctor's advice.

[Mobi]

Hi wanali,

Thank you for your input, which is appreciated.

It may interest you to know that I can add Samitvej, and BNH to your list of hospitals I have tried over the past few years.

I was previously under the care of excellent cardiologist and diabetic specialists in London, and also monitored with TLC by my GP and had every confidence in their treatment, and in fact, despite my high alcohol consumption, I did pretty well, all things considered.

If you know anything about Diabetes, you will know that most patients tend to (and are encouraged to) monitor and medicate themselves, as only they are aware of the particular idiosyncrasies of their own bodies.

Since being in Thailand, I have completely lost confidence that any cardiologist really gives two hoots about a farang who comes in with hypertension, and at best, he will put him on standard drugs to reduce the pressure and tell him to come back in 3 months, or at worse, admit him and perform unnecessary operations, and /or procedures.

There have been countless threads about the Bangkok Pattaya hospital, which has the biggest bunch of money grabbing, unethical charlatans it has ever been my misfortune to meet, and I would have to be really desperate to go anywhere near their front door, and even then, dragging and screaming.

I once consulted a specialist at Samitivej in Bangkok about my medication, and showing him an article I had just read on ace inhibitors. he said, 'well, you can change if you want to - it's all the same'.

I have been admitted several times to hospitals in BKK, and not once did any doctor take any account of my diabetes, and treat me accordingly, usually putting me on glucose drips which sent my blood sugars through the roof. The they take all you medication away from you, and forget to give you any. This has happened several times (despite the fact that all my medical conditions were on their records), and even at Bumrungrad - supposedly the best.

I met a pretty good Diabetic specialist at Bumrungrad, who at least seemed to care, but even she took no account of my 'non- diabetic' medication, and made no suggestions on consulting a cardiologist before suggesting changes to medication - as they would always do in the UK.

Is it any wonder I am insane, and probably paranoid?

Money isn't an issue - except I ain't going back to England. I spend the best part of 10K per month on medication as it is.

I could go on and on. I know what they should be doing, after being cared for by the best in England for a number of years, but here, they just treat patients like customers at a 7/11.

I'll take my chances with any expert advice I might get on this forum.

Anyway, that's the way it is - and thanks for your post - and your instant diagnosis of me suffering from Korsakow syndrome - pretty good from a half page post on the internet - which I honestly think has had the effect of raising my BP, for which I thank you kindly.

.

[Sheryl]

Mobi,

You don't sound in any way paranoid to me. Speaking as a health professional, I found your questions and concerns totally reasonable.

First of all, congragulations on your sobriety, which is by far the best thing you can do for your health.

It is to be expected that once no longer drinking your BP would improve, and that therefore your medications may need to be adjusted. You may find that this also occurs with respect to your insulin.

It is of course ideal to do the adjusting under the guidance of a competent and concerned doctor familiar with all of your medical problems and medications. I hear you re the frustrations you've encountered in that respect. I will go ahead and advice you on self-adjusting your meds but also encourage you to keep trying to find a competeent and caring cardiologist, they do exist in Thailand. Try googling this thread as I seem to remember someone recently asking for and getting recommendations. Alternatively, find a specialist in diabetes who is willing and able to manage your hypertension. A high percentgae of diabetics are hypertensive and the two diseases closely interact, so this should be possible. There have been threads on various pdiabetes specialists and clinics, google that for recommendations. In either case it'll probably requitre a trip to Bangkok.

Anyhow, on to advice. First of all, the issue is not just whether your BP is too low but also whether all the medications currently taken at current dose are still necessary. It is always best to take the least amount necessary to get your BP within normal range, which generally means under 130/70 and at a level where you feel well. The pressures you report may indeed be too low for someone used to a much higher level.

You are on four different types of antihypertensive: a beta blocker (atenolol), a calcium channel blocker (amlodipine) a diuretic (natrilix), and an ACE inhibitor (Tritace). ACE inhibitors are particularly helpful fo diabeteics as they have a protective effect on kidney function. The amliodipine also has a beneficial effect on angina.

For today, go ahead and leave the tritace at half dose. Starting tomorrow, my personal suggestion would be to taper off the beta blocker, since (1) recent literature suggests it is not optimum therapy for persons with heart disease; (2) your heart rate is pretty slow (an effect of the beta blocker. 50-60/min is no problem but when you get below 50 it's too slow and you may become symptomatic) and (3) the dose you are on is fairly high.

Note I say taper off it: don;t go at once from 100mg to nothing. Starting tomorrow, take 75mg, then a few days later 50mg, then 3-4 days later later 25mg, then stop. At any point in this if your BP shoots up or you otherwise feel unwell you can slow down the tapering process.

I would do this first keeping the other drugs the same and see what happens/ If once you are off the atenolol your BP is still dropping below say 110/70 then yes, go ahead and try reducing the tritace, since you are currently on the maximum dosage, but do it gradually and don't go below 5mg without the advice of a doctor.

I do not recommend altering the dose of the amliodipine except on the advice of a cardiologist, as in addition to reducing BP it also has an effect on angina. Likewise the diuretic since it may be needed to avoid congestive heart failure (you are on a low dosage anyhow).

Hope this is helpful. Obviously, monitor your BP closely as you adjust meds. Also, pay close attention to your blood sugar as insulin requirements often drop remarkably once someone stops drinking. Some people are even able to go off insulin in favor of an oral drug. And do keep looking for the right doctor.

And above all...keep up the good work on your recovery from alcoholism!!!!

Edited April 25, 2007 by Sheryl

[Mobi]

Hi sheryl,

Many thanks for your kind and thoughtful response.

I really am very grateful.

I will certainly follow your advice - and yes, I will still seek a doctor - definitely in Bangkok - who I can have some confidence in.

I've actually been trying to quit the booze since early last year and previously went 4 months without, before succumbing. Since then I have been a binge, rather than a regular imbiber, but over Christmas , it started to get bad again, so hence the irrevocable decision to quit for good. After several 'dress rehearsals' I know the pitfalls and am confident I will succeed.

All this has obviously effected my health, and BP, one way or another, but my recent feeling of lethargy, 'out of sorts' and occasional dizziness, got me worried, hence the need for quick advice rather than the drawn out stuff I would get at a hospital.

Yes, my blood sugars are a bit better than when I used to drink, but perversely, more difficult to control. I think the alcohol used to suppress the blood sugars to some extent, but now it's often all over the place. Sometimes way too high, and at other times I'm getting frequent hypos. So I do test frequently, and try to keep it under control.

Anyway, thanks so much, once again, for the time you have taken to advise me.

Mobi

[desi]

I am 60 years old, have been diabetic and a chronic alcoholic for over 30 years, inject insulin 4 times a day, and have had angina and high blood pressure problems for many years, for which I take a whole team of medication.

I know this is going to sound strange, but trying it won't harm you either ...

Google 'cayenne' and 'high blood pressure'

My mother inlaw can't stand the pills they put her on. She refuses to take them, so I checked around and was surprised at what I found.

Btw - I am not an expert of anything medical.

Good luck.

[wanali]

1. Of course the Korsakow comment was only ironically spoken. Just to enforce my opinion that seeking the advice from would-be-doctors (or even from real doctors who can not see you in person, examine you, take your complete history, ...) on a forum rather then going to a highly qualified cardiologist is, unless when it is about a common cold or an ingroing toe nail, totally crazy.

2. "your heart rate is pretty slow" is with 38bpm the least you could say

3. "tend to (and are encouraged to) monitor and medicate themselves": ok for insuline etc. but this is surely not my opinion when it comes to heart medication and the vital signs as you described.

4. The "horror stories" that some people (but you must surely be the top producing author of them) write about Thai hospitals: It's very easy to find the same amount and many more succes stories eventhough people usually tend to go and write comments about negative experiences rather than about positive ones. And to prefer UK healthcare above Thai (or Zimbabwe or Belarus if you like) healthcare ... we all need a good laugh now and then don't we? ;-)

Anyway, I hope you'll get better soon and don't end up in one if the hospitals that you despite so much. Better advice "from distance" (without any examination or investigation) as the advice from Sheryl you will probably not get. And also keep her comment "And do keep looking for the right doctor" in mind because I really think you're playing a dangerous game.

[Mobi]

1. Of course the Korsakow comment was only ironically spoken. Just to enforce my opinion that seeking the advice from would-be-doctors (or even from real doctors who can not see you in person, examine you, take your complete history, ...) on a forum rather then going to a highly qualified cardiologist is, unless when it is about a common cold or an ingroing toe nail, totally crazy.

2. "your heart rate is pretty slow" is with 38bpm the least you could say

3. "tend to (and are encouraged to) monitor and medicate themselves": ok for insuline etc. but this is surely not my opinion when it comes to heart medication and the vital signs as you described.

4. The "horror stories" that some people (but you must surely be the top producing author of them) write But Bangkok Pattaya is another case altogther.But Bangkok Pattaya is another case altogther.about Thai hospitals: It's very easy to find the same amount and many more succes stories eventhough people usually tend to go and write comments about negative experiences rather than about positive ones. And to prefer UK healthcare above Thai (or Zimbabwe or Belarus if you like) healthcare ... we all need a good laugh now and then don't we? ;-)

Anyway, I hope you'll get better soon and don't end up in one if the hospitals that you despite so much. Better advice "from distance" (without any examination or investigation) as the advice from Sheryl you will probably not get. And also keep her comment "And do keep looking for the right doctor" in mind because I really think you're playing a dangerous game.

If you do a Thai Visa search, you will find that there are a great many posts, many more vociferous than my own, on the vexed subject subject of Bangkok Pattaya Hospital, including the dear, late Noel Thomas, who had endless run-ins there before he died on the operating table at Bumrungrad. And even though I personally have not had particularly good experiences at BKK hospitals. I have never criticised them, and in fact have recommended them to many.

I resent your inference that I am the ' top producing author of them' - which is patently untrue.

Maybe you work there?

So, the specialists in Harley Street are on a par with medical care in Belarus and Zimbabwe are they?

Now we can all have a good laugh .

[Mossfinn]

Hi Mobi,

I cannot give you any advice.

You are one of the good guys, look after yourself, I wish you well.

Good Luck

Moss

[Gary A]

I had a stroke when I was in the US right before I retired. When I came over here I was on four different drugs I felt really bad every day and my blood pressure WASN'T under control. A Thai doctor told me to throw all those drugs away and take a 20mg ace inhibitor and a baby aspirin every day. I felt better within two days. Since I have moved up country I have really cut back on my drinking and lost about another 10 pounds. I drink beer a couple of times a week with a friend of mine and very seldom drink at home. With no stress, cutting back on my drinking and the lost weight my blood pressure was maybe 110 over 60. I am now taking half an Anapril every day (10mg). I think I could probably quit taking the Anapril but since I am comfortable and feel fine, I'll continue taking it. It appears that alcohol does have some affect on blood pressure. I agree that gradually cutting back on your meds is the right answer.Which ones to cut back on is the big question.

[Luckydog]

I had a stroke when I was in the US right before I retired. When I came over here I was on four different drugs I felt really bad every day and my blood pressure WASN'T under control. A Thai doctor told me to throw all those drugs away and take a 20mg ace inhibitor and a baby aspirin every day. I felt better within two days. Since I have moved up country I have really cut back on my drinking and lost about another 10 pounds. I drink beer a couple of times a week with a friend of mine and very seldom drink at home. With no stress, cutting back on my drinking and the lost weight my blood pressure was maybe 110 over 60. I am now taking half an Anapril every day (10mg). I think I could probably quit taking the Anapril but since I am comfortable and feel fine, I'll continue taking it. It appears that alcohol does have some affect on blood pressure. I agree that gradually cutting back on your meds is the right answer.Which ones to cut back on is the big question.

Had HT for years....Thanks Dad!

Low BP is fine as long as you dont fall down in a feint. Mine is highest in the Morning usually about 135/75. I take 5mg Amlodipine (makes your ankles swell a bit) and I take 20mg Fluvastatin at night and 75mg Aspirin. ASPIRIN IS VITAL!!!

Statins keep your Cholesterol down but they make you feel a bit odd when you first start to take them. I am used to them now, but when I get up my Calf Muscles are a bit tight for about ten minutes.

Incidentally, a couple of capsules of Cinnamon is said to have a good effect on your sugar levels and even prevent Diabetes.....I take it as a preventative measure.

Take care all you good 'ol boys, and don't drink too much.

[Phil Conners]

Mobi, I fully agree with your view on Thai doctors in general and BP in particular. I have been considering visiting Bumrungrad for a while but it seems they're not much better? Maybe you really should consider a trip back to Europe in the summer and see some proper doctors.

Your BP is surely too low and your pulse certainly! In my experience beta blockers lower your pulse so I think Shery's advice make good sense.

[helicoptor]

Mobi

Following on from Moss's post I too can not offer any advice, but I would just like to say this;

I look out for your posts, they are always informative, descriptive and unbiased, I think I am a fan

I have never met you but I wish you all the very best of health and luck and take my hat off to you regarding your abstinence from the gargle, keep it up.

Chok dee Krap

Heli

[Mobi]

Thanks for all the encouragement, advice and good wishes folk.

Sheryl, my BP is high-sh in the evening, and early morning ( midnight: 134/55; 7.a.m: 154/55) and then it drops dramatically to 113/58 1 hour after medication, and gradually increases as the day goes on. (unless I get posts telling me I'm brain damaged, in which case it goes up a bit quicker )

Do you think I should split my medication, and take some at night?

My pulse is still below 40, so I will start to reduce the atenolol from tomorrow.

Phil, the beta blocker was prescribed to lower my heart rate, and was the main factor that got rid of my angina. But now it seems to be too low.

I think I'll give Bumrungrad one more go to see if I can find a doctor I have some confidence in.

Anyone know of a good cardiologist there?

[Sheryl]

Thanks for all the encouragement, advice and good wishes folk.

Sheryl, my BP is high-sh in the evening, and early morning ( midnight: 134/55; 7.a.m: 154/55) and then it drops dramatically to 113/58 1 hour after medication, and gradually increases as the day goes on. (unless I get posts telling me I'm brain damaged, in which case it goes up a bit quicker )

Do you think I should split my medication, and take some at night?

These drugs are usually taken as a single daily dose. Before messing about with this, I would alter the schedule so that between the 4 drugs you are currently on for BP (all of which are single daily doses), you take some in the AM and some in the night about 12 hours later. Keep the diuretic in the morning so that you aren't up at night peeing. For the other 3, it doesn't matter which are in the morning and which in the evening, but since you need to bring the amount of beta blocker on board down (to get your pulse back up) I'd make the atenolol one of the night meds -- i.e. tomorrow just wait to nighttime to take it, and still with the gradually tapering dose.

It is always best to go slow in altering medication dosage and timing and to change just one thing at a time, otherwise it is hard to know what's affecting what. So try this first.

If after about a week things seem to have stabilized and you are still having much higher BP first thing in the AM (before you take meds) then go ahead and divide the 10mg tritace into 2 5mg doses 12 hours apart....while continuing to taper down the atenolol.

Is your pulse regular? If it is slow and irregular you should see a cardiologist immediately as you may have a dangerous arrythmia (heart block), beta blockers can cause these and it is a medical emergency.

You probably already know this but in case not -- for pulse rate do not rely on what you feel at the wrist nor what a BP machine tells you. Count for yourself for a full minute by feeling the carotid pulse at the neck (or listen to your heart if you have a stethoscope). This is for 2 reasons: (1) if you are having any abnormal beats they may fail to produce a pulse at the wrist and (2) BP machines may estimate the pulse from just a fraction of a minute's worth of beats, this is fine for normal pulse rates but with very slow pulses can make quite a difference. The general cut off for sinus bradycardia -- a slow pulse which is normally conducted in the heart -- from an abnormal slow heart rhtyhm is 40 beats per minute, so it is important to know for sure if you have a heart rate of under 40.

If counted for a full minute at the neck your heart rate is at least 40 and regular, given the high doses of beta blocker you have been on, that is the most likely culprit and reducing the beta blocker will probably resolve it.

If in the course of slowly trapering the atenolol you get to a point where your heart rate is 90 or more at rest, or you start to have angina, do not taper any further until you've seen a cardiologist.

[Trevor]

Just search www.mercola.com : all you need to know.

And get yee on a raw food diet! And off the toxic meds asap.

[click2delete]

I am 60 years old, have been diabetic and a chronic alcoholic for over 30 years,

Should I split my medication - some in the morning and some at night? Maybe I should take the other 5 mg of Tritace tonight?

You're taking a lot of medication. By all means, if the medication can be split, take half in the morning and half at night.

Most people die in the early morning - they wake up and then drop dead so make sure you are covered for your nights sleep into morning.

How did you come to this concoction of pills.

I too have high BP, have had it since I was 38 and I am now in my mid forties. My BP was under control until I moved to Thailand.

SALT

I realized that I had been eating way too much salt this past 10 months. The Thais seem to be immune to a degree to the ravages of salt.

Cook your own food or try to catch the street vendors before they put MSG and SALT in your portion. Good luck.

Allow me to change the subject somewhat: How did you manage to function, make money and retire as an alcoholic?

[Mobi]

I am 60 years old, have been diabetic and a chronic alcoholic for over 30 years,

Should I split my medication - some in the morning and some at night? Maybe I should take the other 5 mg of Tritace tonight?

You're taking a lot of medication. By all means, if the medication can be split, take half in the morning and half at night.

Most people die in the early morning - they wake up and then drop dead so make sure you are covered for your nights sleep into morning.

How did you come to this concoction of pills.

I too have high BP, have had it since I was 38 and I am now in my mid forties. My BP was under control until I moved to Thailand.

SALT

I realized that I had been eating way too much salt this past 10 months. The Thais seem to be immune to a degree to the ravages of salt.

Cook your own food or try to catch the street vendors before they put MSG and SALT in your portion. Good luck.

Allow me to change the subject somewhat: How did you manage to function, make money and retire as an alcoholic?

You're asking a lot of questions.

The concoction of medication was prescribed by two of the most eminent specialist in Harley street some years ago. one a cardiologist, one a a diabetic specialist, who concurred together on my 'concoction'.

So far, no doctor in Thailand has had the temerity to challenge or change it. Just for the record, in addition to my four heart related drugs, I also take soluble aspirin, Bestatin 40 mg to lower my cholesterol, Cardura to keep my enlarged prostate under control, and last but not least Betoptic 0.5 % eye drops for my glaucoma, which BTW, I have just been advised, is no longer available in Thailand!! All this in addition to two different types of insulin. God help me if I ever do become brain damaged - I won't know what to inject and and what to swallow, and what to put intr my eyes.

Nearly all my meals are home cooked, and my salt and msg intake is very low - bad for the heart and diabetes.

I won't have to worry about a good night's sleep, because my dodgy prostate gets me up 3 - 4 times a night anyway.

I managed to function, make a lot of money and retire as an alcoholic because I am very clever, and can achieve more drunk than most people can sober.

Who knows what I might have achieved if I hadn't been a a slave to the evil liquid. Anyway, those days are behind me.

I guess I now have to suffer and live with the consequences.

[Mobi]

These drugs are usually taken as a single daily dose. Before messing about with this, I would alter the schedule so that between the 4 drugs you are currently on for BP (all of which are single daily doses), you take some in the AM and some in the night about 12 hours later. Keep the diuretic in the morning so that you aren't up at night peeing. For the other 3, it doesn't matter which are in the morning and which in the evening, but since you need to bring the amount of beta blocker on board down (to get your pulse back up) I'd make the atenolol one of the night meds -- i.e. tomorrow just wait to nighttime to take it, and still with the gradually tapering dose.

It is always best to go slow in altering medication dosage and timing and to change just one thing at a time, otherwise it is hard to know what's affecting what. So try this first.

If after about a week things seem to have stabilized and you are still having much higher BP first thing in the AM (before you take meds) then go ahead and divide the 10mg tritace into 2 5mg doses 12 hours apart....while continuing to taper down the atenolol.

Is your pulse regular? If it is slow and irregular you should see a cardiologist immediately as you may have a dangerous arrythmia (heart block), beta blockers can cause these and it is a medical emergency.

You probably already know this but in case not -- for pulse rate do not rely on what you feel at the wrist nor what a BP machine tells you. Count for yourself for a full minute by feeling the carotid pulse at the neck (or listen to your heart if you have a stethoscope). This is for 2 reasons: (1) if you are having any abnormal beats they may fail to produce a pulse at the wrist and (2) BP machines may estimate the pulse from just a fraction of a minute's worth of beats, this is fine for normal pulse rates but with very slow pulses can make quite a difference. The general cut off for sinus bradycardia -- a slow pulse which is normally conducted in the heart -- from an abnormal slow heart rhtyhm is 40 beats per minute, so it is important to know for sure if you have a heart rate of under 40.

If counted for a full minute at the neck your heart rate is at least 40 and regular, given the high doses of beta blocker you have been on, that is the most likely culprit and reducing the beta blocker will probably resolve it.

If in the course of slowly trapering the atenolol you get to a point where your heart rate is 90 or more at rest, or you start to have angina, do not taper any further until you've seen a cardiologist.

Thanks once again Sheryl.

I just checked my pulse rate at my neck for a full minute and it was 41, and then on the PB m/c and it was also 41, so the m/c seems to be OK but I'll bear it in mind.

I've just been out to get some 25 mg and 50 mg Atenolol, so I can start the tapering off process.

I don't suppose you happen to know anything about glucauma and medication do you? I've been taking Betoptic (0.5% Betaxolol) for years and it has kept my eye pressure under control. The pharmacy have just informed me that 0.5% is no longer manufactured and the only drops available are 0.25% Betaxolol. I asked if I should take 2 drops of the 0.25% instead, and she said she didn't think it was a good idea. So I have bought the 0.25% anyway, and will use that - one drop per eye - until I can find a decent eye specialist - and God knows when that may be.

Anyway, thanks once again.

[Mossfinn]

Blimey Mobi, It takes a lot to put copious amount of meds in the shade, but you have just done it by a mile.

Good Luck

Moss

[Pattaya_Fox]

Mobi, you mention using Betaxolol opthalmic solution which I am sure that you are aware can also in some instances cause drug interactions with oral beta-adrenic blocking agents such as propranolol or atenolol and can result in causing excessively low blood pressure or reductions in the heart rate.

I mention this purely because you are having difficulty in finding your usual strength Betaxolol solution and maybe now could be the time to look for an alternative which may not have the same side effects.

[karenbenn]

Is pressure of 100/50 too low? If so, what is the lowest I should be having and still be OK?

Of course, the pressure 100/50 is considered low, but some people feel good with similar numbers. So it is very individual. If you are fine with this pressure I think there is no need to elevate it.

And if you are not going to continue drinking, you will probably need the lower dose of blood pressure meds.

[Morgan]

Mobi had to get blood pressure checked at the doc's today,asked the nurse for some info. Gave me a leaflet from the Blood Pressure Association UK. (gidelines for measuring blood pressure at home)They have a web site with same info on that, and low blood pressure, goto

( www.bpassoc.org.uk ) on home page click on any center link, then in left menu you will find links to info.

[frikkiedeboer]

Hi, I know there is already a similar thread going on blood pressure, but my case is a little different, so thought it better to start again.

I am 60 years old, have been diabetic and a chronic alcoholic for over 30 years, inject insulin 4 times a day, and have had angina and high blood pressure problems for many years, for which I take a whole team of medication.

I am now on day 67 of total abstinence from alcohol, and am committed to quitting for the rest of my life. I also stopped smoking some 25 years ago.

My blood pressure has not been good for many years, and was as high as 170-180 over maybe 80-90, reducing with substantial medication to maybe 135-145 over 80-90 in recent years.

Yesterday, I checked my blood pressure, for the first time since I stopped drinking, as I wasn't feeling well. I was shocked as it was 105/43. and even went as low as 99/47. My pulse was around 38 - 40.

Yesterday evening it went up to about 123/57, and late evening it was 145/55, pulse 45.

I take all my medication in the morning when I wake up (Tritace - 10 mg, Amlodipine 10 mg, Natrilix 1.5 mg, Atenolol 100 mg), so can only assume that the pressure increases during the day as the medication wears off.

Today, on waking, my pressure was 134/67, pulse 52, and by 9.30 it had dropped to 99/60, pulse 41, presumably as thre drugs kicked in.

At 11.30 a.m. it was 104/54, pulse 40.

.

if there are any experts out there, my questions are:

Is pressure of 100/50 too low? If so, what is the lowest I should be having and still be OK?

Should I reduce my medication? (I decided to take only 5 mg of Tritace this morning instead of the normal 10 mg)

Should I split my medication - some in the morning and some at night? Maybe I should take the other 5 mg of Tritace tonight?

Clearly the absence of alcohol has had a dramatic effect on my condition, and I'm not sure how to proceed. I really don't trust the doctors, they just say what I want to hear most of the time, and say: try this, or reduce that and come back in 2 weeks.

i was diagnosed as suffering from hypertension about 25 years ago and was told by my doctor that i would be on the medication for ther rest of my life. cant remember the exact numbers,but let me just say that if mine had dropped to the highest figure you quoted as being worrysome,my doctor would have been happy that the medication was working!

when i got to thailand i gave up trying to find my medication or a local generic thereof and simply stopped taking it. at the same time i stopped drinking-simply because i couldnt find anybody in my village who could have a conversation -after two quarts of beer they puked on themselves and/or passed out!

moral of the story is: after a few months i took my son for one of his innoculations and asked the nurse just to check my bp at the same time. was really surprised when she told me that at 120/80 i was doing ok for my age (approaching 50)

started monitoring it every month and it remained stable. i have since returned to south africa,where all my friends are heavy drinkers and after a short while and back into my old drinking habits, i am back in there with the hypertension!

i really love the booze, and should stop,and as a diabetic, you have even more reason not to drink than i have-you have really made the right decision and i envy you for your will-power and dedication.

i cannot offer medical advice as i am not a doctor, but it seems to me that,just as i do,-you know the cause of at least a good percentage of your hypertension problems. i have no right to lecture you,either,since i have the same habits and suffer the consequences for my actions.

obviously we should both monitor our condition carefully, and neither of us can blame our doctors for our own damaging habits.

i got really great, dirt cheap medical care from the local government hospital - even in the remote isaan village i stayed in, and if we remove the cause of our medical condition, obvioiusly we would need to alter our use of the medication to suit. regular monitoring and following doctors recommendations should help=and if you are not happy with a diagnosis or medication,-get a second opinion.

good luck

frikkie

Edited April 26, 2007 by frikkiedeboer

[Mobi]

Mobi, you mention using Betaxolol opthalmic solution which I am sure that you are aware can also in some instances cause drug interactions with oral beta-adrenic blocking agents such as propranolol or atenolol and can result in causing excessively low blood pressure or reductions in the heart rate.

I mention this purely because you are having difficulty in finding your usual strength Betaxolol solution and maybe now could be the time to look for an alternative which may not have the same side effects.

Hi Fox,

This is the very first time I have heard of a link between Betaxolol and beta blockers. I have been taking both for yonks and no doctor has ever raised any concerns.

Is this a recent finding? Maybe that's why they don't make the high strength one any more - I wasn't sure whether the pharmacy was just making an excuse because they had run out, but they usually order stuff for me that isn't in stock, so I was inclined to believe them.

[mikethevigoman]

Hi sheryl,

Many thanks for your kind and thoughtful response.

I really am very grateful.

I will certainly follow your advice - and yes, I will still seek a doctor - definitely in Bangkok - who I can have some confidence in.

I've actually been trying to quit the booze since early last year and previously went 4 months without, before succumbing. Since then I have been a binge, rather than a regular imbiber, but over Christmas , it started to get bad again, so hence the irrevocable decision to quit for good. After several 'dress rehearsals' I know the pitfalls and am confident I will succeed.

All this has obviously effected my health, and BP, one way or another, but my recent feeling of lethargy, 'out of sorts' and occasional dizziness, got me worried, hence the need for quick advice rather than the drawn out stuff I would get at a hospital.

Yes, my blood sugars are a bit better than when I used to drink, but perversely, more difficult to control. I think the alcohol used to suppress the blood sugars to some extent, but now it's often all over the place. Sometimes way too high, and at other times I'm getting frequent hypos. So I do test frequently, and try to keep it under control.

Anyway, thanks so much, once again, for the time you have taken to advise me.

Mobi

TOP ADVISE, GO SEE A SPECIALIST ,I GUESS YOUR BODY/BLOOD BP IS CHANGING DUE TO A CHANGE IN HABITS

[Mobi]

I probably jumped the gun in worrying about my low blood pressure, because now that I have monitored it properly for a couple of days there is a pattern emerging.

High first thing in the morning (155/66)

Low after the drugs kick in:100-115/55

rising by mid afternoon: 137/63

high in the late evening: 148/50

So all those drugs - no booze for more than 2 months and still not very satisfactory, especially for a diabetic when we are told to keep it below 130 at all times.

The bigger problem seems to be my heart beat is too low, so I will taper off on the atenolol and see if I can get it up a bit.

Thanks for all the input folks, it is appreciated.

[Sheryl]

Mobi,

Re the betoptic:

If the 0.25% preparation is Betoptic S, then it is equivalent to regular Betoptic 0.5%. Betoptic S has largely replaced betoptic 0.5% as it is more comfortable/causes less side effects.

If what you have been given is some other form of betaxolol then better send me the full details (exact brand name etc) and I'll try to figure out how it relates to betoptic 0.5%

It is true that betaxolol is a beta blocker in itself, in fact given orallty it is used for hypertension with action quite similiar to atenolol. Used topically in the eye, there is only a little systemic absorption and this usually does not have a noticeable effect, however in your case combined with the high dose of atenolol you have been on, it could be a factor, especially if one of the doses of the betoptic is taken at about the same time. Suggest you make sure to take the atenolol as far apart from the betoptic as you can. I assume you take the betoptic every 12 hours so in 6 hours afterwards (i.e. exactly between the 2 doses of betoptic) would be best. And do try a gradual tapering of the atenolol, cautiously while keeping close tabs on both your heart rate and BP. A resting heart rate between 50 - 60 would be best.

Given what you have said about the time flunctuations (with low BP only after AM meds and BP still too high systolic in the early AM) I would reinforce my earlier suggestion that you move some of the antihypertensive meds to bedtime...maybe the tritace since you don't want the atenolol too close to the betoptic.

[Mobi]

Hi Sheryl, Yes it is Betoptic S, so it should be OK.

I will follow you advice and let you know how things go.

I am going away for a week and will not have access to doctors - which is part of the reason I sought help here, so don't worry if I am silent for a while.

Thanks once again for all your valued advice

Mobi

[Cuban]

Hi Mobi,

After reading through this thread, others have already mentioned a few things that sprung to my mind about the BP and Diabeties interaction and medication.

However please accept these thoughts for what they are worth depending on your application.

You mention the Harley Street treatment that you had in the past, I assume that this was the basis of your current medication program. You would be wise to consider that good medical treatment has a foundation in taking a full history from the patient to understand how they got from healthy to ill. At the time you were under the care of Harley Street where you living/working in the UK as a heavy drinker/ eater with little excerise? If that was the history that guided doctors to your current medication menu have you moved the goal posts sufficiently to warrant a complete re-assessment of your current situation based on the changes you have made. Are you taking tablets that are no longer suitable for your changed body?

Although aspirin is great for basic blood thining for people in cold Northern lattitudes, people living in warmer countries have thinner blood naturally, if you have been in Thailand for a few years your's too will thin. Taking a medication to thin already thinned blood may not be "helpful" to the body. When you take a pin prick of blood does it bleed too long?

BP: Has you have seen will vary during the day, the comment above about most deaths occur after waking up is true, going from sleep mode to active mode does put a strain on the body, the heart acts to support this period of high demand by getting that heart pumping to supply muscles with blood - ready for action. I'm not suggesting bed rest but you might be wise to consider taking your morning BP measurements after an hour or so. I know it is the norm for self-treating diabetics to get up measure blood sugar and then take actions as required. You might want to see what your BP does if left to it's own devices before knocking it down with medication.

During the day BP varies in everyone. You are wise to keep a record, the habit of monitoring your blood sugar to calculate insulin dose is a good one to apply to BP. Cutting out alcohol will do your body the world of good, your liver will be recovering and thanking you from not starting again. The occasional glass of red wine might help your heart - however if the taste tiggers a desire to hit the bottle it is a risk best avoided. I was wondering what has replaced drinking beer/whiskey in your diet, the caffeine in tea/coffee etc. will have the effect of pumping up that BP, you will already be avoiding sugar laden soda. Green Tea is generally agreed to be a healthly drink.

I think you are already keeping clear of salt both as the white stuff and in hidden foods, however ensure you are getting some salt in your diet, your body needs about 6 grammes a day to work correctly. These days with total control and good food labelling it is possible to cut something like salt out of a diet completely, you need about a teaspoon of salt a day to remain healthy. If you are frequently sweating you might need to increase this amount.

Hospitals: I was in two minds whether to include this line, but it appears I'm writting it. Noel's run-ins at the hospitals were more on the admin side than clinical, and it was the cancer that killed him not the hospital. In the situation he was in he had little choice but to take the risk of that operation.

With your own experiance and responsibility of self-mediaction and the open mind to both seek other's experiances and guidance I think the following approach might offer a new path.

Over on the motoring forum you see from time to time nightmare stories of Thai "mechanics" having a go at fixing a new/expensive car that they are not really sure how to work on. I get the feeling this is how you see some Thai hospitals? But you do not want to return to Harley Street for a consultation.

What you might be able to do is talk to your previous doctor there, explain that a return to the UK is not possible but you are seeking a second opinion on the Thai doctors you have already seen. Getting tests done in Thailand is easy and a dman sight cheaper that Harley Street. If they are willing to take you on for a remote consultation see what tests they would run on you Chem 7 and CBC/FBC to start with maybe a ECG too, and get these done locally, you are paying for the tests so the results are your own.

It would be wise not to make a knee jerk reaction to a single test result, which is what some other doctors appear to have done from your comments, but as the process of gathering data forming the medical history that has brought you from the past to now it would be a positive step in the right direction rather than a random leap. Test results need to be seen in context and alongside lifestyle choices as they say now days.

Doing your own research and data gathering is wise, then discuss with a Thai doctor rather than presenting them with just the problem might be a path that you both benifit from, the doctor is more inclined to take a deeper interest in you as a patient.

Best of luck.