Managing Hypertension and Heart Rate Issues During Menopause: A Patient's Journey

Issues with Hypertension Medications

It seems that your autonomic nervous system is disrupted due to menopause, which has led to issues such as tachycardia and elevated blood pressure.
You have also been experiencing anxiety.
At home, your blood pressure typically ranges from 120 to 140, while your heart rate is between 90 and 110.
Recently, you visited a cardiologist because your blood pressure tends to spike during hospital visits, possibly due to white coat hypertension; on that occasion, your blood pressure was recorded at 180 with a heart rate of around 120.
An electrocardiogram showed sinus tachycardia at 115, and an echocardiogram was normal.
The doctor recommended that you need medication to control your blood pressure and prescribed Diltiazem 160 mg and Bisoprolol 1.25 mg.
After taking the medication for a month and a half, you noticed that your daily blood pressure readings sometimes drop to around 95-110.
However, during follow-up visits at the hospital, your blood pressure readings were elevated again, so the doctor did not adjust the dosage.

Given your situation, you are inquiring whether you might be experiencing medication overdosage that requires a reduction in dosage, or if you could stop taking Diltiazem and only continue with Bisoprolol, as it helps lower your heart rate.
Thank you for your response.

Cai Xiaojie, 40~49 year old female. Ask Date: 2021/10/30

Dr. Wu Xueming reply Cardiology

If blood pressure is not very stable, it is advisable to start with half a dose and monitor the response.

Reply Date: 2021/10/30

More Info

Managing hypertension and heart rate issues during menopause can be a complex journey, especially when combined with anxiety and autonomic nervous system dysregulation. Your experience of fluctuating blood pressure and heart rate, particularly during medical visits, is not uncommon and can be influenced by several factors, including stress and anxiety, which may lead to what is often referred to as "white coat syndrome."
From your description, it appears that you have been experiencing elevated blood pressure readings, particularly in clinical settings, alongside a consistently high heart rate. The medications prescribed to you, including Diltiazem (known as "得安穩") and Bisoprolol (康肯), are commonly used to manage hypertension and control heart rate. Diltiazem is a calcium channel blocker that helps to relax blood vessels and reduce heart rate, while Bisoprolol is a beta-blocker that primarily lowers heart rate and blood pressure.

Your concern about the possibility of medication overdosage is valid, especially given your reported blood pressure readings at home (95-110 mmHg) compared to those taken in the clinic (180 mmHg). It is essential to understand that blood pressure can vary significantly based on various factors, including time of day, activity level, and emotional state. The readings you take at home may reflect a more accurate picture of your baseline blood pressure, particularly if you are in a relaxed environment.

Here are some considerations regarding your situation:
1. Medication Review: It is crucial to have an open discussion with your healthcare provider about your current medication regimen. If you are experiencing low blood pressure readings at home, it may indicate that your current dosage of Diltiazem or the combination of medications is too high. Your doctor may consider adjusting the dosage or switching medications based on your home monitoring results.

2. Monitoring and Documentation: Keep a detailed log of your blood pressure readings, noting the time of day, your activities, and how you feel during each measurement. This information can help your healthcare provider make informed decisions about your treatment plan.

3. Anxiety Management: Since anxiety can exacerbate both hypertension and heart rate issues, consider discussing anxiety management strategies with your healthcare provider. This may include therapy, lifestyle modifications, or relaxation techniques such as mindfulness or yoga, which can help mitigate stress and improve overall well-being.

4. Lifestyle Modifications: Incorporating healthy lifestyle changes can significantly impact blood pressure and heart rate. Regular physical activity, a balanced diet low in sodium, maintaining a healthy weight, and avoiding excessive caffeine and alcohol can all contribute to better cardiovascular health.

5. Follow-Up: Regular follow-up appointments are essential to monitor your condition and adjust treatment as necessary. If your blood pressure remains high during visits, your doctor may recommend additional tests or a referral to a specialist, such as a cardiologist or an endocrinologist, to rule out other underlying conditions.

In conclusion, while your current medications may be effective in managing your hypertension and heart rate, it is essential to communicate openly with your healthcare provider about your experiences and concerns. Adjustments to your treatment plan may be necessary to ensure optimal management of your symptoms, especially as you navigate the changes associated with menopause. Always consult your doctor before making any changes to your medication regimen.

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