My Blood Pressure To Low

[Prajak]

8 Years ago I came here with high blood pressure and had medication. Daily 15 mg amlodipine and 20 mg enalapril, zestril. Lost 20 kg weight (93 kilo now, 204 pounds) , no stress anymore, and slowly reduced the amlodipine. Now only 5 mg/day. Feel fine. But the pressure is still going down. When I wake up it is 100/60 and when active 120/70. In the evening, nicely on the sofa watching TV, lower. Dizzy.

The cardiologist says that I can not reduce the enalapril. This is for life, she says. And without her permission I do not have the courage to lower this doses. You never know....

By the way, Nongkhai hospitals....nice people, do their utmost for you, but sometimes I doubt.......

Anyone ? May be a better cardiologist in Udon or Bangkok ?

Well, smoking is an option or lots of alcohol but......

[Prajak]

I forgot my age. 63.

[Penkoprod]

Do you have/have you had, any heart problems?

Does cardiologist seem concerned about this low BP at all?

You might like to ask her if raising your fluid intake might help (water,juice and such)

Also, is this dizzyness only when you are sitting and relaxing, and have you checked BP during , or just after a dizzy spell?

Penkoprod

[Prajak]

Thanks.

Question 1 No, question 2 No, I take 3 L fluid per day (1/2 L mullberry tea in the morning, moderate coffee, 500 gram fruits, 1,5 L mullberry tea in the evening, moderate beer, glass of wine). BP only low when resting or at TV. Late in the evening the computer and writing and Sudoku and than dizzyness gone. Low BP is not so bad but you better wake up in the morning.......

What is this enalapril actually doing ? Something with the vains....

No heart problems at all. Had a TIA long time ago (1998) and take medication since than.

Smoke a sigar and a pipe, one per day each....... no inhaling of course.

[Phil Conners]

I took Enalapril for HBP some years ago but stopped again due to side effects. Never heard that it should be "for life". Suggest you get a 2nd and if necessary 3rd opinion on that.

Edit: just checked Enalapril on the internet and it seems it's used also for some cardio problems, not just HBP, maybe that's the reason... still, would get a 2nd opinion if I was you.

Edited January 4, 2010 by Phil Conners

[Penkoprod]

Well, both tablets you mention do the same thing, in that they both relax the veins. Zestril is an ACE inhibitor, and Enalapril is of the beta blocker family.

BOTH pills are used for heart failure, too. Your Transient Ischaemic Attack was a warning about your general bloodflow as well, as what it means is a clot formed in the blood.

I would probably get some blood tests for cholesterol done, as well as an electrocardiogram and an Echocardiogram. JUst to eliminate the heart from the equation. There may well some preventative treatment going on here, tbh, but its not worth taking that chance.

Was this cigar and pipe a day, but not inhaling, a new development you have started, or is this something you always did?.........no inhaling, EVER?

Like Phil Conners said, get second, and, if need be third opinion. Probably nothing to worry unduely about. More a "put the mind at rest" thing.

Penkoprod

[Phil Conners]

^ Not to be pedantic but Enalapril is in a group of drugs called ACE inhibitors. (not a Beta Blocker).

Edited January 4, 2010 by Phil Conners

[Penkoprod]

^ Not to be pedantic but Enalapril is in a group of drugs called ACE inhibitors. (not a Beta Blocker).

Quite right. I stand corrected.... i got my "prils" mixed up with my "lols"

So..............both are ACE inhibitors. Side effects of both are ............hypotension

I wonder why the 2 are being perscribed

Penkoprod

[moe666]

If you can figure out what the medicine you are taking is doing cutting it out for a day or two should not hurt you and see were the blood pressure goes.

Drs. are not gods and most should be suspect.

[dumball]

Dr Wiwat at BNH put me on the path to no heart medication after my second heart attack in a year , he was my attending doctor , I have been off all medication for over 5 years now with no distress . On my visit to my Canadian doctor early last year , the staff were amazed and said "excellent " my bp is and has been for a long time , 120/60 , all blood tests were fine .

Incidentaly , I am 77 years of age , walk most places we go and climb stairs to the 3rd floor

BNH has eqipment to give you a coloured print out of your blood system with correlated readings at major points and a 'Life age' of your body as apposed to years , never seen one of those in Canada .

[Penkoprod]

What was the plan he gave you............just diet and exercise?

I have heard nothing but good about this Dr, around the various forums, i must admit

Penkoprod

[phetaroi]

Although not the drug you are talking about, I am on one that does two things...lowers BP and slows the heart. Appropriate at this time, but as I have lost a little weight and begun getting a little more walking exercise, I too notice both my BP improving and my heart rate become more satisfactory. But in my situation as well, the doctor has said DO NOT reduce one med to its benefits for your heart, although I am allowed to adjust the other BP med I take. However, I too see the possibility of eventually getting to the same point you are.

[Prajak]

Thanks.

I will go for a second opinion. By the way, I woke up this morning so it is no SO bad......

Inhaling ? Never. Clean lungs.....

[Penkoprod]

Ok, what you have are narrowing of the arteries, which leads to Hypertension. Squeeze the end of a hosepipe and 2 things happen. One is that the rate of flow of the water increases (Hypertension) The other is that there is extra strain on the pump that pumps the water. Eventualy, the pump will fail through overwork, if left unattended. (You ARE being attended to, so ........no real worries )

Let's call those 2 things "blood" as the water, and "heart" as the pump. Both the calcium blocker (amlodipine) and the ACE inhibitor (enalapril) work to relax the walls of the arteries, therefore lessening the strain on the heart. The level of restriction your arteries are under, will determine the risk level of possible future heart failure. BTW, in your OP are you saying you are on both Enalapril AND Zestril? If so, that could well be your problem...too MUCH relaxing. If not, then you should discuss halving the dose of the one ACE inhibitor with the cardiologist. Its a mysery as to why she hasnt put you on a blood thinning medication...Aspirin, or warferin or suchlike as well. The thinning of the blood also relieves the strain on the heart. Look at it this way: Narrowing of the arteries causes Hypertension (high blood pressure). Hypertension causes heart failure

Again....a second opinion cant hurt, and, also regular heart checkups, if only with a stethoscope..which she probably does now, anyway, and doesnt think the risk of failure is that great, but its worth mentioning just in case.

Penkoprod

[Prajak]

Penkoprod, thanks a lot. Understand thing better now. I will ask a second opnion. Maybe the stuff plus 80 mg/d aspirine is too much since I lost weight and have no stressy workload anymore...

[Penkoprod]

Good luck

And i would get those heart checks done, too...................just to be sure

Penkoprod

[moe666]

High blood pressure can also be caused by kidney overload and there inability to properly clear toxins from the blood.

[PMNL]

Hi Prajak,

I would like to share some advise.

Please stop one of the ACEI(Enarapril or Zestril), I can assure you it will do you good.

You now have orthostatic hypotension/ Hypotension. You have to stop one of them.

In normal curcumstance, If people with Hypertension can control their blood pressure by Lifestyle Modification by JNC7

in which you did one of the suggestions,weight loss,then the number and dose of medication can be reduced to maintain blood pressure ~120/70 mmHg

However which one to be cut off is crucial.

For your situation, you had TIA and are active smoker, according to statistic the chance of recurrent stroke is high.

Drug of choice for you would be ACEI ( To lower you blood pressure by dilate the arterirs)AND Aspirin( Secondary prevention of stroke by prevention of platelet clumps). There is no need for two ACEI which you are taking ( Enarapril and Zestril) though. You can stop one of them.

Another one tablet that lots of physician add for they patients with TIA or previous stroke is Statin.

You should ,as said above, get you lipid profile tested. Cholesterol, Triglyceride, LDL, HDL should be ontained.

If LDL is > 130 mg% ( recently prefer less than 100) you might need to take statin as well.

ECG and Chest xray should be done annually. Exercise stress test is good to check if blood flow to your heart is compromised.

In long term using ACEI, Creatinine and Potassium should be tested occasionally.

Hope you seek medical attention quick if you do not want to discontinue one of the ACEI, you blood pressure is too low.

Good Luck.

[FBN]

Reduce or stop BP medication under guidance from a good physician after a full assessment at a reputable clinic.

There is no reason, if there is such significant lifestyle changes as in your case that your BP drops to a normal level, why medications could not be stopped completely if there are no other risk factors.

Don't try to get the BP up by increasing fluid and/or salt intake.

TIA can be brought on by a significant drop in BP as well as high BP.

Get the assessment done and stop medication if possible.

[Prajak]

I will have a second opinion. Thanks all of you.

But one mistake, I do not take both enalapril and zestril, they are the same stuff. I use 5 mg amlodipine and 20 mg enalapril, in Europe known as Zestril, also known as Zestoretic which includes a diuretic.

My lipids are low. But I will have a full checkup in Udon including ecg and stress test.

There is one more reason to slow down the enalapril. I am due for a hip replacement and the nsaid pain pills (celebrex e.o.) do not go together with enalapril. But I hear that morphine is a good alternative. Or not ?

[ericg1953]

I will have a second opinion. Thanks all of you.

But one mistake, I do not take both enalapril and zestril, they are the same stuff. I use 5 mg amlodipine and 20 mg enalapril, in Europe known as Zestril, also known as Zestoretic which includes a diuretic.

My lipids are low. But I will have a full checkup in Udon including ecg and stress test.

There is one more reason to slow down the enalapril. I am due for a hip replacement and the nsaid pain pills (celebrex e.o.) do not go together with enalapril. But I hear that morphine is a good alternative. Or not ?

I agree with the fact that you need a 2nd opinion. I can recommend a Dr. Visuit at Bumrungrad in BKK...he is Director of the Cardiology Department there and is a good knowledgeable Dr. He has been mentioned many times on these forums and has a good reputation as well as Bumrungrad having all the necessary facilities to get you the proper testing.

[PMNL]

I will have a second opinion. Thanks all of you.

But one mistake, I do not take both enalapril and zestril, they are the same stuff. I use 5 mg amlodipine and 20 mg enalapril, in Europe known as Zestril, also known as Zestoretic which includes a diuretic.

My lipids are low. But I will have a full checkup in Udon including ecg and stress test.

There is one more reason to slow down the enalapril. I am due for a hip replacement and the nsaid pain pills (celebrex e.o.) do not go together with enalapril. But I hear that morphine is a good alternative. Or not ?

Long term use of celebrex is not good. You may try tramadol for your hip pain.

You can take enarapril as low as 5 mg a day but should never stop it.

At least two of three pill you should keep up with it once you had TIA/Ischemic stroke.

ACEI/ASPIRIN/Statin

Since you only take enarapril and Amlodipine (no zestril) , then you should stop amlodipine.

hope to hear your update with the second opinion.

[geriatrickid]

Some may find this completely out in left field, but how is your red blood cell count? Do you have a vitamin B12 deficiency? I'm not talking about a folic acid deficiency, but has your B12 ever been measured? Its standard in most blood tests. As well, when the blood test has been taken, was thyroid functioning checked? Yes, in all likelihood, the BP situation is probably related to the meds, but sometimes, blood pressure while on these drugs is impacted by another issue. None of the tests I have referenced is anything special and is part of the standard blood tests, but sometimes they are overlooked. If it's been done, coolio, if not give it a look.

[dumball]

Penkoprod' date='2010-01-05 02:40:07' post='3244651']

What was the plan he gave you............just diet and exercise?

I have heard nothing but good about this Dr, around the various forums, i must admit

Penkoprod

Diet more about what not to eat , exercise was not specific to a programme , aditional advise was to get a good woman , prefferably young , have done that and she only feeds me the 'Good stuff" after training , plus gives me all of the heart extra exercise .

I do take a daily vitamin 'B ' complex and still smoke .

It is possible to go medication free dependant on the severity of your problem , but what you eat is of the utmost importance and you have to keep an eye or two wide open if you eat outside , I rarely do , my wife and I are the only two I trust , it is my life on the line and I do not care who I insult or upset in the line of food I ingest .

[phetaroi]

I have to admit that I'm rather disturbed by this thread.

There's nothing wrong about seeking or giving advice. But we have so many of these lay people telling this OP what he MUST do. That's a lot different than saying to someone, "Well, here's my experience."

We're not talking about heat rash here. We're talking about drugs that control/regulate blood pressure, heart rhythm, and so forth. A bunch amateurs telling people what they must do in dropping or adding such a drug can lead a person to heart attack and/or stroke...conditions that could kill or lead to a life of disability.

Seeking a little advice online about such things...fine...but for god's sake spend a few baht and go to a qualified doctor. Your life may depend on it.

[dumball]

Phetaroi , excellent advice , no one , no how should change/add/delete medication unless they are in care of a proffesional , in this case , a heart specialist not a clinition .

However , it is your life not mine to do with as you will/must .

[fiercesnake]

If you can figure out what the medicine you are taking is doing cutting it out for a day or two should not hurt you and see were the blood pressure goes.

Drs. are not gods and most should be suspect.

Agree. I understand they may be nice people and very helpful but maybe not that competent in this area. You need to change your specialist very soon. I think more emphasis on regular cardiovascular exercise and good diet is advisable. Don't let your age deter you from improved exercise. It doesn't have to be a super-fitness regime that you may see on the internet but definitely I believe this would help. I'm also concerned at the drugs taken as these may not be appropriate for your exact situation. Over the internet here is inadequate to be sure as each patient is an individual and a GOOD doctor should be able to change the drugs to ones that cause less hypotension and hopefully with the view to remove them all together in lieu of good exercise and controlled diet, reduced stress, adequate rest regimes.

Definitely agree with above. Don't assume your doctor knows everything, especially here. I've even seen many locally trained health professionals here consider a few headache pills and multi-vitamins (gosh do they love handing out those here for solutions) will solve just about every problem under the Sun. Honestly reconsider to go back there. There are a lot of good doctors here and exercise-diet is also bound to assist.

[PMNL]

I have to admit that I'm rather disturbed by this thread.

There's nothing wrong about seeking or giving advice. But we have so many of these lay people telling this OP what he MUST do. That's a lot different than saying to someone, "Well, here's my experience."

We're not talking about heat rash here. We're talking about drugs that control/regulate blood pressure, heart rhythm, and so forth. A bunch amateurs telling people what they must do in dropping or adding such a drug can lead a person to heart attack and/or stroke...conditions that could kill or lead to a life of disability.

Seeking a little advice online about such things...fine...but for god's sake spend a few baht and go to a qualified doctor. Your life may depend on it.

Just felt that I need to explain : It is a professional advise here.

There is no need to take any advise from me but incase the OP have to wait long to seek the second opinion.

Then He has to do something.

Sorry if the so confident statement bother you.

But I know what I am taking about.

Cheers,

[phetaroi]

Just felt that I need to explain : It is a professional advise here.

There is no need to take any advise from me but incase the OP have to wait long to seek the second opinion.

Then He has to do something.

Sorry if the so confident statement bother you.

But I know what I am taking about.

If you're a doctor, then most of what I said didn't apply to you, not to mention which -- my comments were general, not in regard to any particular poster -- but rather on comment on amateurs giving medical advice that could bring on a fatal reaction. However, if you are a doctor, have you examined this patient's EKG or cardiovascular stress test? Have you studied his blood panels?

Now, if you are not a doctor or something closely related, then you definitely don't know what you're talking about in regard to the OP. You haven't looked at that EKG or any stress test that he did. You haven't studied his blood panels. You haven't reviewed a single medical test taken. What you know is something that happened to you, which may or may not be the same or similar. And you're willing to stake his life on it.

Edited January 11, 2010 by phetaroi

[FBN]

We have stated before and perhaps it needs to be said again. The value in this forum is feedback from people that have suffered the same problems/treatment etc etc and is not intended to give or be authoritive advice on any subject or issue, although some posters seem fairly adamant in their approach when posting perhaps due to the "anonymity" that cyberspace offers...

Many medical and health professionals do post here but none, as they will all be aware of the implications and risks should anybody here only follow advice as suggested on this forum, will use a professional reference or title and this reduces the subjective "authority" of the post and makes it more relevant to the environment that we are posting in; an internet forum, nothing more and nothing less.