Managing Heart Health: Questions on Blood Pressure, Sugar, and Symptoms

Examination issues

Hello, doctor.
I am 165 cm tall and weigh 127 kg (I originally weighed 150 kg and have lost weight over the past two and a half months).
I am taking antihypertensive medication and diabetes medication: Shumai Kang enteric-coated tablets 5/20 mg (1 tablet), Tenormin 100 mg (half a tablet), sodium nitroprusside 1.5 mg (half a tablet), and half a tablet of Puda and half a tablet of the diabetes medication Kuruwa tablets (1 tablet in the morning and evening), and Forxiga 10 mg/tab (1 tablet in the morning).
My blood sugar is measured every three months; on October 21, my fasting blood sugar was 103, and my hemoglobin A1c was 6.2.
On November 19, my fasting blood sugar was 101.
I measure my blood pressure every morning and evening, and it is usually in the 110s before taking medication, and in the 100s at night (sometimes in the 90s).
My heart rate is generally between 60 and the 70s, but my diastolic pressure is usually in the 50s to 60s.
Cardiac ultrasound, carotid ultrasound, EEG, and chest and neck X-rays all came back normal.
My primary physician said that my blood pressure and blood sugar are well controlled and advised me to continue losing weight.
However, recently I have been experiencing a feeling of pressure in my temples in the afternoon, and I often feel fatigued and weak during the day.
Sometimes I feel pain near my chest close to the armpit, and my hands feel numb.
I would like to ask the doctor: 1.
What additional tests should I schedule? 2.
Could this be related to my medications? Thank you.

Azu, 30~39 year old female. Ask Date: 2016/12/12

Dr. He Dongjin reply Cardiology

Hello, it is recommended to reduce the medication dosage as your blood pressure is too low.
You can decrease Tenormin 100 mg to half a tablet (0.25 mg) and then discontinue it.
If you continue to lose weight, you can reduce the dosage of Kuroha tablets from one tablet in the morning and one in the evening to one tablet in the morning.
Changhua Hospital cares about your well-being.

Reply Date: 2016/12/12

More Info

Managing heart health is a multifaceted endeavor, especially for individuals with a history of hypertension and diabetes. Based on the information you've provided, it appears that you are actively managing your health through medication and lifestyle changes, which is commendable. However, the symptoms you are experiencing, such as headaches, fatigue, and localized chest pain, warrant further investigation.

Understanding Your Current Health Status
1. Blood Pressure and Blood Sugar Control: Your blood pressure readings indicate that you are maintaining relatively normal levels, especially considering your history. The systolic readings in the 110s and diastolic readings in the 50s to 60s suggest that your blood pressure is well-controlled, but the lower diastolic numbers could indicate a potential issue with blood flow or perfusion, especially if you are experiencing symptoms like fatigue and headaches.

2. Weight Management: Losing weight is one of the most effective ways to improve cardiovascular health and manage blood pressure and blood sugar levels. Your commitment to weight loss is crucial, and continuing this trend will likely yield further health benefits.

3. Medication: You are on a regimen that includes antihypertensives and medications for blood sugar control. While these medications are essential for managing your conditions, they can also have side effects. For instance, some blood pressure medications can lead to fatigue or dizziness, especially if they lower your blood pressure too much.

Addressing Your Symptoms
1. Headaches and Fatigue: The "pulsing" sensation in your temples could be related to several factors, including medication side effects, dehydration, or even tension headaches. Fatigue can also stem from various causes, including inadequate sleep, stress, or the side effects of your medications.
2. Chest Pain and Arm Weakness: The localized chest pain near your armpit and hand numbness could be concerning. While it may be musculoskeletal in nature, especially if it occurs with certain movements, it is essential to rule out any cardiac causes.

Recommendations for Further Evaluation
1. Consult Your Physician: Given your symptoms, it is crucial to discuss them with your healthcare provider. They may recommend additional tests, such as:
- Electrocardiogram (ECG): To assess your heart's electrical activity.

- Stress Test: To evaluate how your heart performs under physical stress.

- Holter Monitor: To track your heart rhythm over 24-48 hours.

- Echocardiogram: If not already done, to visualize heart function and structure.

2. Review Medications: Discuss with your doctor whether your current medications might be contributing to your symptoms. Adjustments may be necessary to optimize your treatment plan.

3. Lifestyle Modifications: Continue with your weight loss efforts, and consider incorporating regular physical activity that is appropriate for your current health status. Activities like walking, swimming, or cycling can improve cardiovascular health without putting excessive strain on your body.

4. Dietary Considerations: Focus on a heart-healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Reducing sodium intake can help manage blood pressure, and maintaining stable blood sugar levels is crucial for overall health.

Conclusion
Your proactive approach to managing your health is commendable, and it is essential to continue this journey with the guidance of your healthcare provider. Monitoring your symptoms closely and maintaining open communication with your doctor will help ensure that you receive the appropriate care and adjustments to your treatment plan as needed. Remember, managing heart health is a continuous process that involves regular check-ups, lifestyle modifications, and adherence to prescribed medications.

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It is recommended that you discuss the above situation with your attending physician to determine if further examinations are necessary. Thank you, and wishing you good health!