Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I carefully reviewed your recent medical history and would like to explain that as you are a young and hence a physically active person, beta blockers (including Bisoprolol) are not much preferred like a chronic therapy for hypertension, as they may reduce the overall physical performance.

Nevertheless, as you has started already Bisoprolol, it is not advisable to stop it cold turkey as it may risk such way to trigger a rebound phenomenon (palpitations and racing heart rate after abrupt beta blocker withdrawal).

So, coming to this point, I would advise to take your Bisoprolol daily dose and discuss with your prescribing doctor on the possibility of gradually reducing its daily dose on an escalating manner until it is completely stopped.

Meanwhile you should continue therapy with Telmisartan + Amlodipine.

In addition, it is important to investigate for any possible secondary causes of hypertension (facing your young age).

Several medical tests are advisable:

- complete blood count,
- thyroid hormones level,
- BUN & creatinine,
- blood electrolytes level,
- cardiac ultrasound,
- plasma renin activity,
- aldosterone blood levels,
- cortisol blood level,
- urine metanephrines,
- arterial blood gas analysis

You need to discuss with your doctor on the above mentioned issues.

Hope you will find this answer helpful!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
My opinion as follows:

Detailed Answer:
Hi again,

As all your performed medical tests have resulted normal, then palpitations do not seem to be related to a pathological issue.

I don't know if you have checked also thyroid hormones level (you didn't mention that!).

Now returning to palpitations, it seem that exacerbation because of Bisoprolol dose reduction may be explained most probably by a faster reduction which has brought to some kind of rebound phenomenon I mentioned earlier in our thread.

Coming to this point, I would recommend performing a Holter monitoring (ambulatory ECG monitoring) for a better understanding of heart rate trends during the day-night period and excluding any possible arrhythmic events.

At the end, I would conclude that Bisoprolol isn't a wise choice at your age (as I explained you before), so it needs to be stopped; but WITH CAUTION (should be done very gradually in an escalating dose manner).

Best regards,

Dr. Iliri

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