Re: Re: Hypertension alternating with Hypotension (orthostatic)

[Guest guest]

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

[Guest guest]

Sorry sent last one before entered message. If you note in my article most meds don't work in PA.

Also if BP is lowered by spiro the LVH will take care of itself.

It is very important to have the center of the cuff in the proper position when taking the standing BP. Above the heart level and BP will be falsely low by 2 mm for every inch above and higer for evey inch below heart level. Use a music stand to support arm so cuff is at heart level when standing.

When a pt complains of dizzyness on standing or exercise just standing may not bring our the fall in BP. What I have the pt do is to stand up and down on toes 10-20 times and then repeat pressure. Or step up and downn on a step 10 x.

In a message dated 12/18/06 9:01:01 AM, shahall@... writes:

Hi Kim,

My BP is a normally about the same or just a little

lower when I stand. It's only a lot lower standing

when my BP gets down to around 100 systolic sitting.

That's when I know to back off on the spiro for a few

days.

a

--- kimsstay <cornerstone@cornersto> wrote:

> Hello a

> thanks for the reply! see my reply to Dave re/why i

> am still on other

> meds...would love to just be able to chuck them all

> in the garbage. Do

> you find that you have lower BP all the time when

> standing, or just when

> you feel faint? Mine is lower when I stand, at least

> every time I have

> tested it. Usually somewhere from 10-20 lower than

> when I am sitting.

> Kim in MN

>

> >

> > Hi Kim,

> > I also have a problem with intermittent

> orthostatic

> > hypotension. BP was 66/40 standing one day at work

> > when I thought I was going to pass out. I weaned

> off

> > all BP meds except Toprol XL 50 mg after getting a

> > firm diagnosis of PA. The cardiologist wants me

> to

> > stay on Toprol for a while since I have LVH from

> > long-standing uncontrolled HTN and some studies

> have

> > shown that BB's may help that. I take spiro

> (inspra

> > gave me a raging headache) 100 mg twice a day

> which

> > controls the BP well, sometimes too well. When I

> > notice I'm getting on the low side or start to get

> > dizzy when I stand I cut back on the spiro to 75

> mg

> > twice a day for about a week. When BP starts

> creeping

> > back up I go back to 100 mg. I'm curious as to

> why

> > are you still taking all the other BP meds? The

> > hypertension specialist who finally diagnosed me

> with

> > PA said to wean off the four that I was on because

> > "they aren't doing diddly-squat for you".

> >

> > a

> >

> >

> > --- kimsstay cornerstone@ --- kimss

> >

> > > Hello all,

> > > wondering if anyone else has had a problem with

> > > alternating

> > > hypertension and hypotension, specifically

> > > orthostatic hypotension for

> > > me. I am treating my hypertension pretty

> aggresively

> > > (100 mg Inspra,

> > > 180 mg Verapamil, 100 mg Toprol XL, 12.5 mg

> > > Maxzide). This past 2

> > > weeks my BP has been high a little over 1/2 of

> my

> > > readings, the other

> > > readings low, but really low for me, like 70-90

> over

> > > 52-70 range. When

> > > my readings are this low i feel extremely faint

> and

> > > have to sit down

> > > quickly (or fall down!). I recently switched and

> now

> > > take the

> > > verapamil in the AM and the Toprol in the Eve,

> this

> > > is what my doc

> > > suggested. then i take 50 mg inspra at night and

> the

> > > other 50 mg in am

> > > with the maxzide.

> > > thanks for your input,

> > > Kim in MN

> > >

> > >

> >

>

>

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

[Guest guest]

Hi Kim,

My BP is a normally about the same or just a little

lower when I stand. It's only a lot lower standing

when my BP gets down to around 100 systolic sitting.

That's when I know to back off on the spiro for a few

days.

a

--- kimsstay <cornerstone@...> wrote:

> Hello a

> thanks for the reply! see my reply to Dave re/why i

> am still on other

> meds...would love to just be able to chuck them all

> in the garbage. Do

> you find that you have lower BP all the time when

> standing, or just when

> you feel faint? Mine is lower when I stand, at least

> every time I have

> tested it. Usually somewhere from 10-20 lower than

> when I am sitting.

> Kim in MN

>

> >

> > > Hello all,

> > > wondering if anyone else has had a problem with

> > > alternating

> > > hypertension and hypotension, specifically

> > > orthostatic hypotension for

> > > me. I am treating my hypertension pretty

> aggresively

> > > (100 mg Inspra,

> > > 180 mg Verapamil, 100 mg Toprol XL, 12.5 mg

> > > Maxzide). This past 2

> > > weeks my BP has been high a little over 1/2 of

> my

> > > readings, the other

> > > readings low, but really low for me, like 70-90

> over

> > > 52-70 range. When

> > > my readings are this low i feel extremely faint

> and

> > > have to sit down

> > > quickly (or fall down!). I recently switched and

> now

> > > take the

> > > verapamil in the AM and the Toprol in the Eve,

> this

> > > is what my doc

> > > suggested. then i take 50 mg inspra at night and

> the

> > > other 50 mg in am

> > > with the maxzide.

> > > thanks for your input,

> > > Kim in MN

> > >

> > >

> >

>

>

[Guest guest]

In a message dated 12/17/06 7:11:19 PM, cornerstone@... writes:

(100 mg Inspra,

> > 180 mg Verapamil, 100 mg Toprol XL, 12.5 mg

> > Maxzide). This past 2

Note Verap and toprol are expected to have almost no effect on BP in PA. See my article in files.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

[Guest guest]

In a message dated 12/17/06 7:09:18 PM, cornerstone@... writes:

>Hello Dave,

yea, it is a lot. I have indicated to my doc that i want to reduce the

number of meds i am on, but she says i need them all...tried a bit of

experimenting on my own this past month -- dropped off one of my BP

meds at a time for 1 week (not my inspra, tho!) to see what would

happen. And sure enough, my BP climbed each time. Now (past 2 weeks) i

am back on everything but still having some high readings. In the 22

readings i took over 2 weeks, only 9 were at or under 120/80, and of

those 9, 5 were what i would think would be called "hypo" at under 110

systolic. maybe i need to increase my inspra (at 100 mg now) and then

try going off the toprol, verapamil and/or maxzide...

kim in mn

When does the drop occur and when do you take your meds?

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

[Guest guest]

In a message dated 1/7/07 6:30:02 PM, cornerstone@... writes:

Which i would agree with, but don't think it is working so

great.

Your Dr can tell how your BP is doing but cannot tell how you are doing unless you tell them.

I know the goal is to be below 140/90 and that the ideal if 120/80 is

probably a pie in the sky for me, but i am still getting alot of

readings over the 140/90 -- my diastolic is the one that is

persistently high, the systolic only occasionally and then usually

10-20 over. I have calibrated my at home unit with the one at the

clinic, so i know my readings are correct.

Oscillometric devices are notoriously inaccurate for diastolic as the calculate it not measure it.

I take one in the am at

the same time each day (sitting for at least 5 min prior to 1st

reading, than taking 3 total and averaging the last 2) -- right? I am

taking 100 mg of Inspr, split in two doses, one at night (along with

the Toprol) and one in am (along with verap and maxzide). do you think

I should pursue increasing the inspra, or adding another drug to the

"cocktail" -- hopefully in place of either the toprol or verapamil

since i figure they aren't doing much for me. what do you think?

sorry to ramble on and on...

I would focus on DASHing first.

kim in mn

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.