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Suggest BP Medication That Can Be Taken Along With Tenormin
Question: I am 65 y.o female. 5ft. 6 in. 112 lbs. Exercise daily and eat a good diet. No alcohol, coffee or smoking. Have been treated for PIC'S and PAC'S and occasional SVT for years. Take Tenormin 50mg/am and 75mg/ pm. Also Have Lifelong Anxiety Disorder AND Take Xanax XR..1 mg am and pm. Synthroid 62.5 mg in am for Hypo.Echo last week was all good except for mild diastolic dysfunction consistant with relaxation abnormality. I have noticed that my BP resting has been higher lately sometimes 169/90. Going back to cardiologist on Fri. To discuss options as I feel I now need BP meds. Want to reverse the diastolic dysfunction I'd I can.would like you opinion on best BP meds to use in conjunction with the Tenirmin. I am VERY sensitive to new meds. Tried to switch to Toprol XL instead of Tenormin and my heart went crazy. What BP meds come with the least "laundry list" of adverse reactions? In you opinion? Sorry for long post. P.S. rest of my Echo was all good. White Coat syndrome BP before Echo was 200/100 yikes.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your medical history and would like to explain that, before deciding to start a certain anti-hypertensive therapy, it is necessary to properly address any possible secondary cause of hypertension.
In this regard, I would recommend to first discuss with your doctor on the opportunity of a new review of your thyroid gland status. Here, I mean a new revision of your actual Synthroid daily dose regimen, as not rarely excessive doses of exogenous thyroid hormones may be responsible for similar symptomatology (hypertension, palpitations, persistent anxiety, premature heart beats, etc.). So, a careful thyroid imagine study coupled with blood thyroid hormones level evaluation would be necessary.
Also, some additional potential secondary causes could be ruled in/out by the following medical tests:
- complete blood count (confirm or exclude anemia),
- BUN & creatinine (reveal potential renal dysfunction),
- blood electrolytes, arterial blood gas analysis, eventual blood aldosterone level (to evaluate a potential adrenal gland cortex abnormality),
- if enough suspicions are raised, urine metanephrine would properly screen an adrenal gland medulla abnormality.
If all the above tests result normal and actual thyroid therapy is OK, then an initial anti-hypertensive therapy would be advisable (as you have persistently high blood pressure values).
Coming to this point, I would explain that, there is not any specific anti-hypertensive drugs class that is more preferred over the other regarding potential adverse effects. In general all the existing anti-hypertensives may yield adverse effects in specific individuals.
The main drug classes are:
- ACEIs (ramipril, lisinopril, perindopril, etc.)
- ARBs (valsartan, losartan, telmisartan, irbesartan, etc.)
- calcium channel blockers (amlodipine, lercanidipine, felodipine, etc.)
- beta-blockers (bisoprolol, atenolol, metopriolol, nebivolol, carvedilol); inj fact you are using Tenormin (atenolol),
- thiazide diuretics Hydrochlorothiazide, etc.)
- centrally acting antihypertensives (used mainlty in specific cases when the above classes exert contraindications).
- Alfa blockers doxasosine, etc.)
So, when a decision to start high BP therapy is done, it may be started with any of the above drugs, for example an ACEI or ARB; or even a calcium channel blockers.
No predefined schemes has been shown superior to the other possible schemes.
Sometimes, a mono-therapy is not sufficient to control BP values; and a second drug is added. For example, ACEIs or ARBs may be combined with hydrochlorothiazide or a calcium channel blocker.
In your case, as you have a history of a thyroid gland disorder and premature heart beats, a beta-blocker (such as Tenormine, etc.) should be always present.
What, I would suggest is to be careful of any contraindications that make impossible beneficial effects of certain anti-hypertensive drugs (they can not be used in such circumstances).
For example, in the presence of a renal function dysfunction, ACEIs and ARBs generally are not suitable; in liver dysfunction this is true for calcium channel blockers, etc.
I recommend discussing with your attending physician on the above mentioned issues.
In case of any further uncertainties, feel free to ask me again at any time.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your medical history and would like to explain that, before deciding to start a certain anti-hypertensive therapy, it is necessary to properly address any possible secondary cause of hypertension.
In this regard, I would recommend to first discuss with your doctor on the opportunity of a new review of your thyroid gland status. Here, I mean a new revision of your actual Synthroid daily dose regimen, as not rarely excessive doses of exogenous thyroid hormones may be responsible for similar symptomatology (hypertension, palpitations, persistent anxiety, premature heart beats, etc.). So, a careful thyroid imagine study coupled with blood thyroid hormones level evaluation would be necessary.
Also, some additional potential secondary causes could be ruled in/out by the following medical tests:
- complete blood count (confirm or exclude anemia),
- BUN & creatinine (reveal potential renal dysfunction),
- blood electrolytes, arterial blood gas analysis, eventual blood aldosterone level (to evaluate a potential adrenal gland cortex abnormality),
- if enough suspicions are raised, urine metanephrine would properly screen an adrenal gland medulla abnormality.
If all the above tests result normal and actual thyroid therapy is OK, then an initial anti-hypertensive therapy would be advisable (as you have persistently high blood pressure values).
Coming to this point, I would explain that, there is not any specific anti-hypertensive drugs class that is more preferred over the other regarding potential adverse effects. In general all the existing anti-hypertensives may yield adverse effects in specific individuals.
The main drug classes are:
- ACEIs (ramipril, lisinopril, perindopril, etc.)
- ARBs (valsartan, losartan, telmisartan, irbesartan, etc.)
- calcium channel blockers (amlodipine, lercanidipine, felodipine, etc.)
- beta-blockers (bisoprolol, atenolol, metopriolol, nebivolol, carvedilol); inj fact you are using Tenormin (atenolol),
- thiazide diuretics Hydrochlorothiazide, etc.)
- centrally acting antihypertensives (used mainlty in specific cases when the above classes exert contraindications).
- Alfa blockers doxasosine, etc.)
So, when a decision to start high BP therapy is done, it may be started with any of the above drugs, for example an ACEI or ARB; or even a calcium channel blockers.
No predefined schemes has been shown superior to the other possible schemes.
Sometimes, a mono-therapy is not sufficient to control BP values; and a second drug is added. For example, ACEIs or ARBs may be combined with hydrochlorothiazide or a calcium channel blocker.
In your case, as you have a history of a thyroid gland disorder and premature heart beats, a beta-blocker (such as Tenormine, etc.) should be always present.
What, I would suggest is to be careful of any contraindications that make impossible beneficial effects of certain anti-hypertensive drugs (they can not be used in such circumstances).
For example, in the presence of a renal function dysfunction, ACEIs and ARBs generally are not suitable; in liver dysfunction this is true for calcium channel blockers, etc.
I recommend discussing with your attending physician on the above mentioned issues.
In case of any further uncertainties, feel free to ask me again at any time.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer. I have had recent ( less than 6 months) blood work for knee surgery. No anemia, or abnormal levels, BUN and creatinine normal. Urinalysis, normal. Also have had thyroid function bloodwork done less than 4 months ago. All were normal and have had previous thyroid ultrasound. ( Hashimotos). My Synthroid levels are where they should be. I continue to be able to work out daily( at a reasonably high level) without difficulty or shortness of breath. As far as the anxiety, that is not a new symptom, I have had severe anxiety disorder for most of my life.I also have dealt with the PVC's and PAC's most of my life and my cardiologist has stated that I have an "irritable conduction system".I have worn an event monitor a number of times and a telemetry /event monitor and have been told that the palpitations are not serious. I even asked my cardiologist if I should see an electrophysiologist and her reply was " They wouldn't even think it necessary if they saw your telemetry reports. I am concerned about my negative reactions to many new medicines and that is why I have concerns about BP lowering meds, but I would like to reverse the process of mild diastolic dysfunction before it has a chance to progress. To be honest, I am loathe to go looking for zebra's when pretty much all of my symptoms have existing for a very long time. I also have familial trait for high BP. My mother had it all of her adult life and two of my son's also take BP meds. I have always had incidental readings of high BP in past few years it is just that now the readings have become more consistant and with Echo findings my feeling is that the one comment about mild diastolic dysfunction has caused me to examine my BP readings more closely. P.S. I get an Echocardiogram every 2-3 years. My Cardiologist knows me very well, as I said, I was just looking for information concerning the meds. I am scheduled to see her this Friday. Saw her a month ago for regular checkup and Echo was last week.
Just to add one more thing. She has seen my BP go sky high at every check-up, as I said I have " white coat Syndrome" . So she knows my BP is very reactive to external stresses. Additionally, I have taken the Synthroid for about 5 years only because my TSH level was .5 above the normal and also had Ultrasound done two times. I had to SLOWLY go on the Synthroid because my heart was VERY reactive to it. I just add this to let you know that this is my "makeup" normally. ( if you can call it normal by any stretch). I will even have palpitations to antibiotics ( though I have rarely taken them). Palpitations have definitely affected my quality of life even though I have been told they are not dangerous. (Anxiety Disorder.)
Just to add one more thing. She has seen my BP go sky high at every check-up, as I said I have " white coat Syndrome" . So she knows my BP is very reactive to external stresses. Additionally, I have taken the Synthroid for about 5 years only because my TSH level was .5 above the normal and also had Ultrasound done two times. I had to SLOWLY go on the Synthroid because my heart was VERY reactive to it. I just add this to let you know that this is my "makeup" normally. ( if you can call it normal by any stretch). I will even have palpitations to antibiotics ( though I have rarely taken them). Palpitations have definitely affected my quality of life even though I have been told they are not dangerous. (Anxiety Disorder.)
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
Coming to this point, as all your tests have resulted normal, I would recommend starting an ARB (valsartan, losartan, etc.)or a calcium channel blocker (amlodipine, felodipine, etc.).
As you are so sensitive to all the drugs, starting in low doses and increasing slowly would help prevent possible adverse effects related to the drugs.
Regarding diastolic dysfunction, I would explain that it is not a concerning echo finding. It is usually common in elderly patients.
A better control of your blood pressure would help stop the progression of this disorder.
Another point to consider is a better management of your anxiety. Xanax XR is not the best drug for this purpose. It is a benzodiazepine which can cause addiction and tolerance (which means that after a chronic intake it does not control anxiety any more and stopping it could lead to exacerbation of your symptoms). I would recommend to gradually reduce its doses and switch to an antidepressant (sertraline, paroxetine, etc.) in order to have a better control of your anxiety.
White coat syndrome is related to the anxiety before or during the consult with your doctor. It usually does not cause progressive changes in the heart structure and it is quite a benign syndrome. Basically there is no need for any treatment for this disorder.
You should discuss with your doctor on the above issues.
Wishing all the best,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
Coming to this point, as all your tests have resulted normal, I would recommend starting an ARB (valsartan, losartan, etc.)or a calcium channel blocker (amlodipine, felodipine, etc.).
As you are so sensitive to all the drugs, starting in low doses and increasing slowly would help prevent possible adverse effects related to the drugs.
Regarding diastolic dysfunction, I would explain that it is not a concerning echo finding. It is usually common in elderly patients.
A better control of your blood pressure would help stop the progression of this disorder.
Another point to consider is a better management of your anxiety. Xanax XR is not the best drug for this purpose. It is a benzodiazepine which can cause addiction and tolerance (which means that after a chronic intake it does not control anxiety any more and stopping it could lead to exacerbation of your symptoms). I would recommend to gradually reduce its doses and switch to an antidepressant (sertraline, paroxetine, etc.) in order to have a better control of your anxiety.
White coat syndrome is related to the anxiety before or during the consult with your doctor. It usually does not cause progressive changes in the heart structure and it is quite a benign syndrome. Basically there is no need for any treatment for this disorder.
You should discuss with your doctor on the above issues.
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your response. I didn't mean to imply that the high BP due to Whitecoat Syndrome was responsible for the elevated numbers ongoing. Just that she is aware that there is a correlation with stressers and their affect on my BP. I agree about the Xanax XR and have talked with my Therapist to try to titrate down my dosage and to switch to a better drug. We are scheduled to talk about this soon. I don't want to confuse the situation though, with reducing one medication and possibly adding a BP med. I will discuss it with both of my Doctors. Thanks again for your good advice. I hope things can be sorted out so that I can start to feel better. I have a feeling that, knowing how I react to new drugs) if she wants to start me on an additional drug, she will take it slow. We shall see. Thanks again.
Brief Answer:
You are welcome!
Detailed Answer:
Hello again,
I am glad to have been helpful to you!
If you have any other questions you can ask me directly at any time on the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Wishing all the best,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again,
I am glad to have been helpful to you!
If you have any other questions you can ask me directly at any time on the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Sharka. I will be sure to do so. I appreciate your time and information very much.
Brief Answer:
You are welcome!
Detailed Answer:
You are welcome!
Regards,
Dr. Iliri
You are welcome!
Detailed Answer:
You are welcome!
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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