Fluctuating Blood Pressure and Irregular Heartbeat Risks

Blood pressure fluctuates between high and low, and when blood pressure is low, the heartbeat becomes irregular?

My father is 54 years old, 180 cm tall, and weighs 64 kg.
He has been consistently exercising but has habits of smoking and drinking alcohol.
He has a very bad temper and gets angry easily.
About a year ago, he experienced irregular heartbeats and sought medical attention.
An echocardiogram revealed left ventricular hypertrophy.
He has been on medication, including Dronedarone (for arrhythmia) and Amlodipine (for hypertension).
Recently, he mentioned that his blood pressure has dropped to 70, so he stopped taking his antihypertensive medication.
However, he has recently been experiencing frequent fluctuations in blood pressure, with episodes of discomfort and irregular heartbeats.
In the morning, his blood pressure is typically around 180/110, while at night, it drops to about 140/70.
However, when his blood pressure decreases, he experiences discomfort from arrhythmia (though his heart rate is slow).
He has trouble sleeping at night, tossing and turning.
Is this fluctuation in blood pressure dangerous?

Zhang Wei, 20~29 year old female. Ask Date: 2019/02/23

Dr. He Dongjin reply Cardiology

Hello, I am more concerned about my arrhythmia situation.
1.
I have quit smoking and drinking; stimulants easily cause irregular heartbeats.
2.
I adjusted my dosage of Dronedarone to 0.5, taking half a tablet at a time.
My heart rate is very slow, below 60 beats per minute, so I should not take it when my heart is racing and uncomfortable; I will take an additional half tablet if needed.
3.
I adjusted my dosage of Amlodipine to 0.5, taking half a tablet at a time.
If my blood pressure at night is below 120, I will pause taking it.
I have trouble sleeping at night, tossing and turning, which causes my blood pressure to fluctuate.
I should first improve my sleep.
Changhua Hospital cares about you.

Reply Date: 2019/02/23

More Info

Fluctuating blood pressure and irregular heartbeat can pose significant health risks, especially in individuals with a history of heart conditions such as left ventricular hypertrophy (LVH), which your father has. Given his age, lifestyle factors, and medical history, it is crucial to understand the implications of these symptoms and the potential risks involved.

Firstly, let's break down the components of your father's condition. Left ventricular hypertrophy is often a response to chronic high blood pressure (hypertension) and can lead to various complications, including heart failure, arrhythmias, and an increased risk of heart attack. The fact that he has been prescribed medications for arrhythmia and hypertension indicates that his healthcare provider is concerned about these risks.

Your father's reported blood pressure readings are concerning. A morning reading of 180/110 mmHg indicates severe hypertension, which can lead to acute complications such as stroke or heart attack. Conversely, a nighttime reading of 140/70 mmHg suggests a significant drop in blood pressure, which can be problematic as well. This fluctuation can lead to symptoms such as dizziness, fainting, and, as he has experienced, irregular heartbeats.

The irregular heartbeat, or arrhythmia, can be exacerbated by several factors, including stress, alcohol consumption, smoking, and even the medications he is taking. The fact that he experiences discomfort when his blood pressure drops suggests that he may be experiencing symptoms of orthostatic hypotension, where blood pressure falls significantly upon standing or changing positions, leading to dizziness and palpitations.

Moreover, lifestyle factors such as smoking and alcohol consumption can further complicate his cardiovascular health. Both habits are known to contribute to hypertension and can exacerbate heart rhythm issues. Additionally, his temperament and tendency to get angry can lead to spikes in blood pressure due to stress, which can further strain his heart.

Given these factors, it is essential for your father to closely monitor his blood pressure and heart rate. He should not stop taking his antihypertensive medication without consulting his healthcare provider, as this could lead to dangerous spikes in blood pressure. It is also advisable for him to avoid alcohol and smoking, as these can worsen his condition.

In terms of immediate action, I recommend that your father consults with his cardiologist or primary care physician as soon as possible. They may want to perform additional tests, such as a Holter monitor to assess his heart rhythm over a 24-hour period, or an echocardiogram to evaluate the function of his heart and the degree of hypertrophy. Adjustments to his medication regimen may be necessary to stabilize his blood pressure and manage his arrhythmia effectively.

In summary, fluctuating blood pressure and irregular heartbeat can indeed pose serious health risks, particularly for someone with a history of heart issues like your father. It is crucial for him to seek medical advice promptly to address these symptoms and ensure that he is managing his condition effectively. Regular follow-ups and lifestyle modifications will be key in reducing his risk of serious cardiovascular events.

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