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1 day ago · Resistant Hypertension in Heart & Blood Health

Good morning, Sue @ashby1947. I'd like to respond hastily, but helpfully, to your present quandary — writing as a victim of hypertension that I also characterize as "resistant." Quickly, my first observation is that your daily BP is not all that bad for a person of your age. Your systolic 151 is a little high for my taste, but your 80 diastolic is great! Your reliance on 5 different BP meds is worth detailed discussion with a nephrologist as well as your cardiologist (and given your worrying, perhaps an endocrinologist and a psychologist as well). I am taking 3 BP meds daily after having been prescribed a dozen others over the past 20 years — a medical ambivalence attributable to a rare cause of my hypertension, an inherited kidney defect that imposed a Liddle Syndrome (inability of the kidneys to reclaim potassium that is excreted along with sodium). The solution to that is a special diuretic that protects potassium levels. In addition to those factors, I have a 4th med on hand for use "as needed" after experiencing a hypertensive emergency that sent me to the ER about a year ago. I have used this med only twice when my BP spiked above 170/100. Worrisome as all that may be, my medical team is confident that my situation is not especially threatening, given daily readings of about 140/86 most times and lifestyle choices promoting BP stability at levels of lower threat. Martin

Tue, Jun 30 10:43am · Taking Eliquis and Metoprolol for A-fib: Concerned about side effects in Heart Rhythm Conditions

Hi @elwood. I get your question frequently — why do I stick with Warfarin as my anticoagulant? My answer is simple and to the point. There is a readily available antidote for Warfarin, but not for most other anticoagulants. Almost all hospitals (but with a few stupid exceptions) have the Warfarin antidote (a Vitamin K solution) on hand for use when it's needed. I have two personal experiences that drive my choice of Warfarin.

Three years ago, a neighbor on Warfarin fell off a ladder in his garage. I called 911 and the EMTs came and hauled him off to a hospital emergency room a mile away. An hour later, a medical helicopter picked him up and flew him to another hospital 20 miles away. Within another hour, he was pronounced dead from a hemorhaggic stroke — an uncontrolled brain bleed. The first hospital had no Warfarin antidote on hand. It's sister hospital 10 miles away could not rush it over either. So they called for the helicopter. The second hospital administered the proper antidote, but by that time, it was too late. I sang at his funeral a week later.

Another episode just last week involved a friend with A-fib who also takes an anticoagulant, but not Warfarin. I reminded him about my neighbor's fate. He called the doctor, asked about his medication, and was told it is a lot less trouble than Warfarin — lab tests, some diet restrictions, etc. In our pandemic environment, that's a bigger problem than before, risking the coronavirus to go to a medical laboratory for a periodic blood test required to remain safe under Warfarin. Even so, he is now looking for a doctor who will include Warfarin in his range of therapies for A-fib.

I remain upset about the death of my neighbor as a result of his treatment in a hospital that had no antidote for Warfarin on hand. As a result, my first question of doctors when I was rushed to the emergency room last Fall was "Do you have an antidote for Warfarin on hand?" They did. I resolved that I'll always ask that question when under treatment at any clinic or hospital, regardless of which anticoagulant I am taking at that time. I hope this gives you some options to consider and discuss with your doctors, hospital, and EMT services. Martin

Sat, Jun 20 8:58pm · What is the correct range for blood pressure? in Heart & Blood Health

@diannecochran, you were fortunate to hear from Colleen Young at the outset of your quandary. She knows a lot, and she has given you the Internet address of a good Healthline article. Another Healthline report that may interest you is at https://www.healthline.com/health/high-blood-pressure-hypertension#overview and several following pages citing "everything" about hypertension. Be aware that your kidney may also be crucial to your blood pressure status. My medical care practice refers hypertensive people like me to kidney doctors (nephrologists) as soon as Stage 2 hypertension is found. From the two Healthline articles, you'll be alerted to crucial considerations that could drive your blood pressure up. Age is a factor that gradually raises the allowable maximum from the mid-60s up. The most important guidelines from cardiology and nephrology now aim at Stage 1 hypertension (139/89), Stage 2 (140+/90+), and "hypertensive crisis" (180+/120+). A single blood pressure reading at home, however high it is, needs confirmation with another reading — normally after 10-15 minutes (or sooner if it is in hypertensive crisis and a call to 911 might be wise). Treatment will depend on which of a dozen symptoms is caused by high blood pressure readings. If you would like to know more about my experience than the two Healthline articles provide, I'll gladly respond to questions and recruit some other Connect members to weigh in as well. Martin

Mon, May 25 2:08pm · I'm starting carvedilol. What are your experiences? in Heart Rhythm Conditions

jfperrone @jfperrone, in my earlier message to you, I neglected to provide a link to a report on Carvedilol, its use, its side effects, and its avoidable problems. I hope you will find the time to check that out at https://www.drugs.com/carvedilol.html. The report reminded me that Carvedilol is used to treat heart failure among other things, particularly in people who have suffered a heart attack, but that's not a requirement for its use (just a possibility). Martin

Mon, May 25 9:33am · Taking Eliquis and Metoprolol for A-fib: Concerned about side effects in Heart Rhythm Conditions

Hi @damari. Glad to see you back with us, especially since the two of us are A-fib victims. Your reliance on Metoprolol and Eliquis is not uncommon. The first of these and its side-effects are discussed on Mayoclinic.org. Check out https://mayocl.in/2LTLhoP as well as https://mayocl.in/3d0JLx7 for starters. Search separately there for Eliquis or its generic name apixaban with a focus on the "oral route" (as opposed to the intravenous route). On your question about lesser amounts, be advised that changing the dosages on both drugs is possible, but only in direct coordination with your specialist or primary care physician. A lot of patients cut their dosages without consultation, causing side effects that are hard to tolerate. In my case, my similar drugs are Carvedilol (25mg morning and evening) and Coumadin (5.0 and 7.5 mg on alternating days).

The side effects you mentioned are on public lists for your drugs. Can you raise your questions about them with your doctor(s) or your pharmacist before any changes are made in dosage? Martin

Sun, May 24 5:58pm · I'm starting carvedilol. What are your experiences? in Heart Rhythm Conditions

Hi @jfperrone, I hope my experience might be helpful to you. Carvedilol (Coreg) is a beta blocker, similar to Metoprolol. I have been taking Carvedilol for a few years as part of my therapy for hypertension and atrial fibrillation. My dosage is 25mg in the morning and the same in the evening, so your dosage is a smart introductory amount. It might turn out to be increased if your doctor gets concerned about arrhythmia, tachycardia, or high blood pressure. Some people encounter side effects that are uncomfortable for them; it seems to me that happens more often when the patient drops the dosage sharply in hope of escaping side effects or simply misses doses that are much larger than yours. The rule should be: Don't drop the medication, only phase it down at a rate approved by your doctor. I'll be interested to hear more about your concerns and your aspirations for getting things back to normal. Martin

Sun, Apr 26 9:10pm · HCM-ers: Introduce yourself or just say hi in Hypertrophic Cardiomyopathy (HCM)

Hi, @estefania03, glad you dropped in with us at Mayo Connect, making you and me a party of two facing similar problems. I tend to suspect that hypertension is the cause of your family's cardiomyopathy, because your dad's situation and mine are similar, and I'm a 45-year practitioner of antihypertension therapy.

I had some difficulty qualifying for a new life insurance policy back in 1974 because of high blood pressure, then began round-the-year medical therapy for it 10 years later (age 50). After 20 years of fairly ordinary medication, my new HMO took a good look at my heart and found asymptomatic hypertrophy (their diagnosis was LVH as well). Other symptoms emerged over a few years, and the HMO referred me to a nephrologist, because my hypertension seemed not to be mainly a heart problem that would be relieved with the old medical protocols. My nephrologist diagnosed that part of my problem is Liddle Syndrome, a genetic mutation of the kidneys causing them to slough off potassium, and she solved that with a potassium-sparing diuretic. Then the cardiology team started looking at my heart again. We ran through all of the popular tests, except cardiac catheterization, confirming my cardiomyopathy but deferring therapy for want of significant symptoms.

Along came atrial fibrillation about seven years ago. It felt asymptomatic, showing itself only on my EKGs and blood pressure readings. But standard therapy with A-fib calls for an anticoagulant to prevent blood clots. I chose Coumadin for two reasons: 1) it involves regular lab tests monthly and 2) there is a ready antidote for it in emergency situations. By good fortune, my A-fib has never rattled my chest or caused any discomfort there. But it hit me the other way — a small blood clot, apparently formed in my heart, blocked a capillary deep in my brain, causing a "small stroke." Physical therapy has helped overcome the stroke symptoms, and I feel rather normal now without any sense that my heart is working extra hard to overcome the resistance of the thickened ventrical walls.

My medication is different in only one respect now: I take Carvedilol, a beta blocker, to steady my pulse and ease the power my heart needs to drive blood out in my system. Otherwise, its Coumadin to prevent blood clots, my potassium-sparing diuretic, and Lisinopril, a kidney medication for my hypertension.

I once thought I'd relentlessly pursue a cure for the problems of my circulatory system, whatever the cost or the inconvenience. I long ago gave that up and developed plans for anticipating what might pop up and threaten me, so that I'll know exactly what to ask for at the emergency room if my wife ever has to call 911 over my heart problem. Life is a lot more calm and predictable, except for the coronavirus that's taking over now. Martin

Sun, Apr 26 3:14pm · Heart rate questions: Rate increases when standing or waking up? in Heart & Blood Health

@learningstudent, I haven't heard of "white coat syndrome" in connection with heart rate. It commonly refers to elevated blood pressure, not heart rate, when a patient visits a clinic or doctor's office. I wouldn't be mistaken if I assumed you don't trust the doctor who prescribed Atenolol, a beta blocker, for you, would I? What about your neurologist? Did s/he uncover any nerve damage? Did s/he have any advice for you or prescribe any medications or activities to ease your heart rate? Do you think it's time to get a second opinion — first from an internist and then, if necessary, from a cardiologist? I understand your frustration at not finding a path to a stable pulse, and I hope you will be able to work with your doctors to find the way. But don't try to do it alone. Martin