Managing Palpitations and Blood Pressure: Should I Resume My Medications?

Q: Managing Palpitations and Blood Pressure: Should I Resume My Medications?

Hello： Whether to take antihypertensive medication depends on whether your blood pressure readings are consistently high. <br>It is important to rest adequately and measure your blood pressure in a quiet and comfortable environment. <br>It is normal for blood pressure to be eleva

Palpitations and high blood pressure?

I have had arrhythmia (premature ventricular or atrial contractions) since childhood, and I am currently taking medication for hypertension and arrhythmia.
My blood pressure tends to be normal in the summer, but in the winter, it is around 140.
Recently, in August, my blood pressure has been between 120-80, sometimes dropping to 90-60.
Therefore, I have not taken my antihypertensive medication for the past half month.
While sitting or lying down, I feel fine, but my resting heart rate is usually around 55-60 beats per minute.
However, when I stand up to walk or do a little activity, I experience palpitations, and my blood pressure can spike to 160-90.
I also notice a sensation of my heart racing in my ears, but when I sit down and rest, my blood pressure returns to 110-70.
Should I resume taking my antihypertensive and arrhythmia medications? Could this be a sign of heart failure?

Xu Xing, 60~69 year old female. Ask Date: 2021/08/04

Dr. Huang Yinghe reply Cardiology

Hello: Whether to take antihypertensive medication depends on whether your blood pressure readings are consistently high.
It is important to rest adequately and measure your blood pressure in a quiet and comfortable environment.
It is normal for blood pressure to be elevated after physical activity or during times of emotional stress, but this should not be used as a basis for medication decisions.
Blood pressure tends to be lower in warmer weather compared to colder conditions.
If your blood pressure does not drop too low (systolic pressure less than 100 mmHg), it is advisable to continue with the current dosage; otherwise, a slight reduction in medication may be considered.
The decision to medicate for early systolic hypertension generally depends on symptoms; if there are no symptoms, long-term medication may not be necessary.
Based on your symptoms, you are not at the level of heart failure, so it is recommended to continue monitoring your blood pressure and follow up for an evaluation regarding medication adjustments.

Reply Date: 2021/08/04

More Info

Managing palpitations and blood pressure can be a complex issue, especially for someone with a history of arrhythmias and hypertension. Given your symptoms and the fluctuations in your blood pressure, it is crucial to approach this situation with caution and seek professional medical advice.

Firstly, it is important to understand the relationship between blood pressure, heart rate, and the medications you are taking. You mentioned that you have a history of arrhythmias, specifically premature ventricular contractions (PVCs) or premature atrial contractions (PACs), and that you are currently on antihypertensive and antiarrhythmic medications. The fact that your blood pressure tends to be lower in the summer and higher in the winter could indicate a seasonal variation in your blood pressure regulation, which is not uncommon. However, the recent drop in your blood pressure to 90/60 mmHg, combined with your symptoms of palpitations and dizziness upon standing, raises some concerns.

When you experience palpitations, especially with a heart rate that increases significantly upon exertion, it may indicate that your heart is responding to stress or a change in blood flow dynamics. The fact that your heart rate is around 55-60 beats per minute while at rest is relatively low, and if it spikes to 160 beats per minute with minimal exertion, this could be a sign of an underlying issue that needs to be addressed. It is also worth noting that a sudden increase in blood pressure to 160/90 mmHg, followed by a return to normal levels when at rest, could suggest that your body is reacting to physical activity or stress.

Regarding your question about whether to resume your medications, it is essential to consult with your healthcare provider. They can evaluate your current symptoms, review your medication regimen, and determine if adjustments are necessary. Resuming your antihypertensive and antiarrhythmic medications without medical guidance may not be advisable, especially if you have experienced significant changes in your blood pressure and heart rate.

It is also important to consider the possibility of heart failure, particularly if you have a history of heart disease or if you are experiencing symptoms such as shortness of breath, fatigue, or swelling in the legs. Heart failure can manifest with palpitations and changes in blood pressure, and it requires a thorough evaluation by a healthcare professional. Diagnostic tests such as an echocardiogram, electrocardiogram (ECG), and blood tests may be necessary to assess your heart's function and rule out any serious conditions.

In the meantime, you can take some steps to manage your symptoms. Ensure you stay hydrated, avoid excessive caffeine or stimulants, and monitor your blood pressure regularly. If you experience severe symptoms such as chest pain, severe dizziness, or fainting, seek immediate medical attention.

In summary, it is crucial to consult with your healthcare provider regarding your symptoms and medication management. They can provide personalized advice based on your medical history and current condition. Do not hesitate to reach out for help, as managing heart health is vital for your overall well-being.

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