Managing Low Blood Pressure and Heart Rate in Hypertension Patients

Issues with Hypertension Medications

My mother is in her 70s and has been taking antihypertensive medication for nearly a year.
Recently, she often feels dizzy, and her heart rate, which has always been slow, has recently dropped below 45.
Last week during a follow-up visit, her systolic blood pressure was 105, and the doctor mentioned that her blood pressure is low, so the medication dosage was reduced.
Currently, she is taking Valsartan (Diovan 160 mg) and Bisoprolol (Concor 1.25 mg).
However, a few days ago, before taking her medication in the morning, her systolic blood pressure readings were 98 and 101.
Since it seems unwise to abruptly stop her medication, I would like to know how we can further reduce her medication dosage.
Is it possible to take only one of the medications? Or can she take half a dose of Diovan instead? Additionally, it seems that Concor's side effects may cause her heart rate to slow down.
Over the past month, her Concor dosage has been adjusted from 5 mg to 2.5 mg, and then to 1.25 mg.
However, after taking the medication for over a week, her heart rate still remains around 41 to 45.
I would like to know if it is appropriate for a patient like my mother, who already has a slow heart rate, to continue taking Concor.
Should we consider asking the doctor to switch her medication?

Miss Lin, 40~49 year old female. Ask Date: 2021/11/29

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: 2021/11/29

More Info

Managing low blood pressure and heart rate in patients with hypertension, especially in older adults, requires careful consideration and a tailored approach. Your mother's situation, characterized by low blood pressure readings and a notably slow heart rate, is indeed concerning and warrants a thorough evaluation.

Understanding the Medications
Your mother is currently taking Valsartan (Diovan), an angiotensin receptor blocker (ARB), and Bisoprolol (Concor), a beta-blocker. Both medications are effective for managing hypertension, but they can also contribute to lower blood pressure and heart rate.
1. Valsartan: This medication helps relax blood vessels, which lowers blood pressure. It is generally well-tolerated, but if blood pressure readings are consistently low, it may be necessary to adjust the dosage.

2. Bisoprolol: As a beta-blocker, Bisoprolol can significantly reduce heart rate. It is often prescribed for hypertension and heart-related issues, but in patients with already low heart rates, it can exacerbate bradycardia (slow heart rate).

Current Concerns
Your mother's blood pressure readings of 98 and 101 mmHg are indeed on the lower side, especially for someone on antihypertensive medication. Additionally, a heart rate consistently below 45 beats per minute is concerning and could lead to symptoms such as dizziness, fatigue, or even fainting.

Recommendations
1. Consultation with a Healthcare Provider: It is crucial to discuss these symptoms and readings with her healthcare provider. Given the complexity of her condition, any changes to her medication regimen should be made under medical supervision.

2. Medication Adjustment:
- Reducing Dosage: If her doctor agrees, reducing the dosage of Valsartan or Bisoprolol may be appropriate. For instance, taking half a dose of Valsartan could be considered if her blood pressure remains low.

- Discontinuation of One Medication: Depending on her overall health and specific circumstances, her doctor might suggest stopping one of the medications. However, this should not be done without professional guidance.

3. Monitoring: Continuous monitoring of her blood pressure and heart rate at home can provide valuable data for her healthcare provider. Keeping a log of these readings can help in making informed decisions about her treatment.

4. Lifestyle Modifications: Encourage your mother to stay hydrated, as dehydration can contribute to low blood pressure. Additionally, small, frequent meals can help prevent postprandial hypotension (a drop in blood pressure after eating).

5. Potential Side Effects: If Bisoprolol is causing significant bradycardia, her doctor may consider switching to a different class of antihypertensive medication that does not have this effect.
6. Regular Follow-ups: Regular follow-up appointments are essential to monitor her condition and adjust medications as necessary. If her symptoms persist or worsen, seeking immediate medical attention is crucial.

Conclusion
Managing low blood pressure and heart rate in a hypertensive patient, especially an elderly one, is a delicate balance. It is essential to work closely with her healthcare provider to ensure that her treatment plan is safe and effective. Adjustments to her medication should be made cautiously, with close monitoring of her symptoms and vital signs. Your proactive approach in seeking advice is commendable, and it is vital to continue advocating for her health and well-being.

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