Managing Blood Pressure Medications: A Guide for Postmenopausal Women

Blood pressure medication issues?

Hello Doctor: Since the onset of menopause, my blood pressure has been unstable, fluctuating between high and low.
At the hospital and clinic, my blood pressure readings have been around 150-160/80-90.
Four months ago, I started medication: Bisoprolol fumarate 5 mg, taking half a tablet.
Recently, I have changed my diet to reduce salt and sugar intake, and I have lost 3-4 kg, with a BMI of only 18.7.
Lately, my blood pressure has been getting lower, averaging about 96/66 in the morning, 104/72 in the afternoon, and 96/64 before bed, with a heart rate of 55-60.
This morning, I measured my blood pressure at home and it was only 92/62 (measured with a mercury sphygmomanometer).
I discussed with my doctor whether to reduce my medication, but at the clinic, my blood pressure was 110/68, which the doctor considered normal.
He mentioned that my home readings are not too low, and that the medication helps maintain stable blood pressure, especially since the dosage is already quite low.
During this period of taking the medication, I have felt somewhat drowsy and fatigued.
Additionally, after one month on the new medication, my fasting blood sugar was 95, but after three months, it increased to 103.
Despite maintaining a light diet and brisk walking for 30 minutes daily, my blood sugar has actually risen.
I would like to inquire about a second opinion: Is my current medication and dosage appropriate? Thank you!

Ms. Zhang, 50~59 year old female. Ask Date: 2017/12/27

Dr. He Dongjin reply Cardiology

Hello, you don't need to take medication.
Changhua Hospital cares about you.

Reply Date: 2017/12/27

More Info

Managing blood pressure medications, especially for postmenopausal women, requires a careful balance between controlling hypertension and avoiding hypotension, particularly as hormonal changes can significantly impact cardiovascular health. Your situation, characterized by fluctuating blood pressure readings and side effects from medication, is not uncommon among women in this life stage.

Understanding Blood Pressure Variability
Blood pressure can fluctuate due to various factors, including stress, diet, physical activity, and hormonal changes associated with menopause. The readings you provided indicate that your blood pressure is on the lower side, especially in the morning and evening, which raises concerns about potential hypotension. A systolic blood pressure below 90 mmHg and a diastolic below 60 mmHg are generally considered hypotensive and can lead to symptoms like dizziness, fatigue, and fainting.

Medication Review
You mentioned taking Bisoprolol fumarate (5 mg) and adjusting your dosage to half a tablet. Bisoprolol is a beta-blocker commonly used to manage hypertension and can help reduce heart rate. However, it can also lead to bradycardia (low heart rate) and hypotension, especially if the dosage is too high or if the patient is particularly sensitive to the medication. Your heart rate of 55-60 beats per minute is on the lower side, which could be a side effect of the medication.

Blood Pressure Monitoring
The discrepancy between your home blood pressure readings and those taken at the clinic is noteworthy. Home measurements can sometimes be lower due to a more relaxed environment, while clinic readings may be influenced by "white coat syndrome," where anxiety during medical visits temporarily elevates blood pressure. It’s crucial to monitor your blood pressure consistently at home, ideally at the same times each day, to establish a more accurate trend.

Lifestyle Modifications
You mentioned dietary changes and weight loss, which are excellent steps toward managing blood pressure. However, it’s essential to ensure that your diet is balanced and includes adequate nutrients. A very low-calorie diet or excessive restriction of certain food groups can lead to nutrient deficiencies and may affect blood pressure regulation.

Blood Sugar Levels
The increase in your fasting blood sugar levels from 95 to 103 mg/dL is concerning, especially since you are making dietary changes. It’s important to monitor your blood sugar regularly, as beta-blockers can sometimes mask symptoms of hypoglycemia, making it harder to recognize low blood sugar levels.

Recommendations
1. Consult Your Doctor: Given your symptoms of dizziness and fatigue, it’s advisable to have a thorough discussion with your healthcare provider about your current medication regimen. They may consider adjusting the dosage of Bisoprolol or switching to a different antihypertensive that may be better tolerated.

2. Regular Monitoring: Continue to monitor your blood pressure at home, and keep a log of your readings. Share this information with your doctor to help guide treatment decisions.

3. Lifestyle Adjustments: Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Ensure you are not overly restricting calories, which can lead to fatigue and low blood pressure.

4. Physical Activity: Regular exercise is beneficial, but ensure that it is appropriate for your current health status. If you experience dizziness during or after exercise, consult your doctor.

5. Blood Sugar Management: Discuss your blood sugar levels with your healthcare provider, as they may want to monitor this more closely or adjust your dietary recommendations.

6. Second Opinion: If you feel uncertain about your treatment plan, seeking a second opinion from another healthcare provider can provide additional insights and reassurance.

In conclusion, managing blood pressure in postmenopausal women requires a comprehensive approach that includes medication management, lifestyle modifications, and regular monitoring. Your symptoms and blood pressure readings warrant a careful review of your current treatment plan to ensure it aligns with your health needs.

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