Managing High Blood Pressure: Medication and Heart Health Concerns

Hypertension medication issues?

Due to issues with benign prostatic hyperplasia, I visited a urologist and discovered my blood pressure was over 180/112.
This led me to consult a cardiologist for hypertension.
I have been smoking for over 30 years and started feeling anxious at the age of 27 due to family circumstances.
Sometimes, I feel my heart suddenly racing.
When I visited the clinic, the doctor mentioned a valve issue and arrhythmia.
I only took medication when I felt unwell.
Now at 55, since May, I have been experiencing chest tightness.
I went to the clinic for medication and started measuring my blood pressure, which averaged between 145-158/87-102, with a heart rate averaging 59-78 beats per minute.
Later, I went to the hospital for an ultrasound, which indicated left ventricular hypertrophy and mild to moderate premature ventricular contractions, but my contractions were normal.
The exercise electrocardiogram showed normal results as well; I only managed to run for about 90 seconds.
I experienced shortness of breath while running with the doctor, and sometimes I have chest tightness at home, but not always.
I wonder if this is due to my anxiety.
I also question whether it is related to a purple psychiatric medication I was prescribed, which I stopped taking.
That medication was given to me by the doctor when I went to check my blood pressure.
Later, at the hospital, the doctor prescribed medication for three days, and my average blood pressure was 126-149/86-101, with an average heart rate of 65-78 beats per minute.
The doctor prescribed Nifedipine 30 mg and Bokey 100 mg, both taken once in the morning.
Initially, I was prescribed Carlatrend 6.25 mg once daily, but after reviewing my blood test results, the doctor asked if my heart rate was often fast.
I mentioned that I tend to get anxious, so that medication was discontinued.
My blood test results showed Glucose 104, CREA 1.01, eGFR 81.51, Cholesterol 108, LDL-C 59, HDL-C 37, TG 117, Uric Acid 6.2, GPT 39, and HbA1c 5.4.

I would like to ask the doctor why, despite my exercise electrocardiogram being normal and no further tests being conducted, I was prescribed Nifedipine, a medication for angina? Can't I just take medication for hypertension alone? Could taking that medication have adverse effects? If I don't take it, will there be side effects? Additionally, what about Bokey? Am I experiencing any blockages? However, the doctors have all said that everything seems fine and have not recommended further testing, only medication.
They suggested I see a pulmonologist or consider advanced testing if I do not want to take medication.

A-Cheng, 50~59 year old female. Ask Date: 2021/09/08

Dr. Cai Guiqin reply Cardiology

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!

Reply Date: 2021/09/08

More Info

Managing high blood pressure (hypertension) is crucial for maintaining overall heart health, especially when there are additional concerns such as left ventricular hypertrophy (LVH) and potential arrhythmias. Based on your description, it seems you have a complex medical history that includes long-term smoking, anxiety, and recent symptoms like chest tightness and palpitations. Let's break down your situation and address your concerns regarding medication and heart health.

Understanding Your Blood Pressure and Heart Health
1. Blood Pressure Readings: Your blood pressure readings have been quite variable, with some readings exceeding 180/112 mmHg. This level of hypertension is concerning and can lead to serious cardiovascular complications if not managed properly. The average readings you provided (145-158/87-102 mmHg) indicate that you are still in the hypertensive range, which requires ongoing management.

2. Left Ventricular Hypertrophy (LVH): The ultrasound indicating LVH suggests that your heart is working harder than normal, often due to high blood pressure. This condition can lead to more serious issues, such as heart failure or arrhythmias, if not addressed. The fact that your left ventricle is hypertrophied means that your heart is adapting to increased workload, which is often a result of chronic hypertension.

3. Palpitations and Anxiety: The sensation of your heart "suddenly jumping" could be related to anxiety, especially given your history of stress and nervousness. Anxiety can exacerbate heart rate and blood pressure, leading to a cycle of discomfort. It’s important to manage stress through relaxation techniques, therapy, or medication if necessary.

Medications: Nifedipine and Bokey
1. Nifedipine: This medication is a calcium channel blocker that helps lower blood pressure by relaxing the blood vessels. It is often prescribed for hypertension and can also help with angina (chest pain). While it is true that Nifedipine can be used for angina, it is not exclusively for that purpose. It is effective in managing high blood pressure, especially in patients with LVH.
- Side Effects: Common side effects may include swelling in the legs, flushing, and dizziness. If you experience significant side effects, it’s essential to discuss these with your doctor. Stopping the medication suddenly can lead to rebound hypertension, so any changes should be made under medical supervision.

2. Bokey (Aspirin): This medication is often prescribed for its antiplatelet effects, which can help prevent blood clots. It is particularly important if there are concerns about cardiovascular events, especially given your history of hypertension and LVH.

Next Steps
1. Follow-Up with Your Doctor: It’s crucial to maintain regular follow-ups with your healthcare provider to monitor your blood pressure and heart health. If you feel that your current treatment plan isn’t addressing your symptoms adequately, don’t hesitate to seek a second opinion or ask for further testing, such as a stress test or echocardiogram.

2. Lifestyle Modifications: In addition to medication, lifestyle changes can significantly impact your blood pressure and heart health. Consider the following:
- Diet: Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins. Limit sodium intake and avoid processed foods.

- Exercise: Regular physical activity can help lower blood pressure and improve heart health. Aim for at least 150 minutes of moderate aerobic exercise each week, but consult your doctor before starting any new exercise regimen.

- Smoking Cessation: Quitting smoking is one of the most significant changes you can make to improve your cardiovascular health. Seek support through programs or medications designed to help with smoking cessation.

3. Managing Anxiety: Since anxiety can exacerbate your symptoms, consider speaking with a mental health professional. Therapy, mindfulness, and relaxation techniques can help manage stress and anxiety levels.

Conclusion
Your situation involves multiple factors that can affect your heart health and blood pressure. It’s essential to work closely with your healthcare team to find the right balance of medications and lifestyle changes. If you have concerns about the medications prescribed, discuss them openly with your doctor to ensure you feel comfortable and informed about your treatment plan. Remember, managing hypertension is a long-term commitment, and with the right approach, you can significantly improve your quality of life and heart health.

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