Managing Hypertension: Medication Side Effects and Symptoms

Hypertension, medication side effects?

Hello Doctor: On June 2nd, while I was sitting and preparing to stand up from a chair, I suddenly experienced severe back pain that made it difficult to speak and caused breathing difficulties.
When I arrived at the emergency room, blood tests and a chest X-ray were performed, and they reported no significant issues.
However, my blood pressure was recorded at 19x/1xx.
I had previously experienced high blood pressure in the range of 16x-19x due to kidney stones.
I received an injection and antihypertensive medication, but the pain did not alleviate.
After reviewing the reports, the doctor informed me that the chest X-ray was normal and there were no signs of myocarditis or myocardial infarction.
The doctor mentioned that my blood pressure was somewhat elevated and recommended that I see a hypertension specialist for follow-up.
On June 16th, I visited a cardiologist.
My height and weight were recorded as 164 cm and 80 kg.
The doctor advised me to lose weight and prescribed Epanutin 160 mg once daily, Nebivolol 5 mg once daily, and Ambien to take before bed.
The following morning, I had blood tests and a urinalysis, and I was instructed to measure my blood pressure twice daily and return for a follow-up.
During the medication period, I frequently experienced spontaneous headaches in the afternoon, which could be alleviated by moving around.
I did not feel discomfort while exercising briskly in the evening.
However, sitting still or daydreaming would trigger headaches.
On June 23rd, I returned for a follow-up and reported my headache discomfort to the doctor.
The reports appeared normal, and the doctor stated that the headaches were likely a side effect of the medication.
The prescription was adjusted to include Epanutin 160 mg once daily, Labetalol 6 mg once and a half daily, and Nebivolol 5 mg once and a half daily.
I continued to measure my blood pressure twice daily, but the headache discomfort persisted.
On July 7th, I reported the ongoing headache discomfort to the doctor again.
The doctor reiterated that it was a side effect of the medication.
After reviewing my blood pressure records, which showed significant improvement, the doctor prescribed another month of Epanutin 160 mg once daily, Nebivolol 5 mg once and a half daily, and changed to Ergotamine 1 mg once daily.
However, after switching medications, I experienced dizziness two to three times when standing up from a seated position.
That morning, my blood pressure was 113/70 with a heart rate of 55.
I later consulted a pharmacist at the hospital about reducing the dosage to half a tablet, but I still experienced dizziness 1-2 times, and the headache issue remains.
Here are my blood pressure records:
- 6/17 AM: 159/100/63 -- PM: 176/107/75
- 6/24 AM: 111/69/58 -- PM: 113/73/63
- 6/18 AM: 152/99/61 -- PM: 170/104/63
- 6/25 AM: 118/78/58 -- PM: 126/75/64
- 6/19 AM: 125/88/55 -- PM: 140/88/64
- 6/26 AM: 128/79/59 -- PM: 125/71/67
- 6/20 AM: 122/88/61 -- PM: 125/74/68
- 6/27 AM: 111/78/58 -- PM: 127/76/63
- 6/21 AM: 121/82/61 -- PM: 130/80/62
- 6/28 AM: 108/72/58 -- PM: 122/78/63
- 6/22 AM: 119/78/61 -- PM: 122/73/62
- 6/29 AM: 120/82/55 -- PM: 122/71/64
- 6/23 AM: 108/65/61 -- PM: 122/73/63
- 6/30 AM: 118/81/55 -- PM: 120/74/65
- 7/1 AM: 113/77/50 -- PM: 115/73/65
- 7/8 AM: 113/70/55 -- PM: 116/68/61 -- started feeling dizzy
- 7/2 AM: 121/74/52 -- PM: 123/71/65
- 7/9 AM: 104/68/60 -- PM: 112/69/68 -- reduced Ergotamine to half
- 7/3 AM: 120/79/53 -- PM: 128/73/60
- 7/10 AM: 105/66/55 -- PM: 115/65/66
- 7/4 AM: 116/81/56 -- PM: 120/72/66
- 7/11 AM: 95/64/54
- 7/5 AM: 124/89/56 -- PM: 122/78/62
Currently, my weight has decreased to 74.5 kg, and I exercise briskly for 30-40 minutes daily.

Doctor, I would like to ask if the headache discomfort is a side effect of the medication? I am very concerned about the possibility of a brain hemorrhage or stroke.
The doctor has not yet informed me whether I have high blood pressure, but the headache issue continues to trouble me.
Additionally, during this period, I occasionally experience sudden sharp pain in my back, but it does not last long, which has caused me significant anxiety.
Whenever I sit down, I start to feel anxious and develop a headache, and I worry about dizziness when I stand up.
Since I have been prescribed a month's worth of medication, should I schedule a follow-up appointment soon to discuss these issues with the doctor, or should I wait until the next scheduled visit?

Lin, 40~49 year old female. Ask Date: 2022/07/11

Dr. He Dongjin reply Cardiology

Hello, I am not sure if you have hypertension, but you cannot assume you have high blood pressure just because of one instance of discomfort.
It is advisable to first stabilize your condition.
If your blood pressure remains stable, you may even consider stopping Nebivolol.
For the back pain issue, consult a neurologist to address it, and then re-evaluate your blood pressure changes before adjusting your medication.
Changhua Hospital cares about your well-being.

Reply Date: 2022/07/11

More Info

Managing hypertension effectively requires a comprehensive understanding of the medications involved, their potential side effects, and the symptoms that may arise during treatment. Your experience with sudden back pain, elevated blood pressure readings, and persistent headaches raises several important considerations regarding the management of your condition.

Firstly, it is essential to recognize that many antihypertensive medications can cause side effects, including headaches, dizziness, and even back pain. In your case, the medications prescribed—such as Amlodipine (often referred to as "易安穩") and Nebivolol—are known to potentially cause headaches as a side effect. These medications work by relaxing blood vessels and reducing heart rate, which can sometimes lead to fluctuations in blood pressure that may manifest as headaches or dizziness, particularly when transitioning from sitting to standing. This phenomenon is known as orthostatic hypotension, where blood pressure drops significantly upon standing, leading to symptoms like dizziness or lightheadedness.

Your recorded blood pressure readings indicate some variability, which is not uncommon in individuals with hypertension. Factors such as stress, physical activity, and even the time of day can influence blood pressure levels. It is crucial to monitor these readings consistently, as you have been doing, and to report any significant changes to your healthcare provider.

Regarding your concerns about the potential for serious complications like a stroke or hemorrhage, it is understandable to feel anxious, especially when experiencing persistent headaches. However, it is important to note that while high blood pressure is a risk factor for these conditions, the presence of controlled blood pressure readings and regular monitoring significantly reduces that risk. If your blood pressure is consistently within a normal range, it is less likely that you are at immediate risk for such severe complications.

The back pain you mentioned could be related to various factors, including muscle strain, posture, or even anxiety, rather than directly linked to your antihypertensive medications. Stress and anxiety can exacerbate physical symptoms, leading to a cycle of discomfort and worry. It may be beneficial to discuss these symptoms with your doctor, as they may suggest strategies for managing anxiety, which can, in turn, alleviate some of the physical symptoms you are experiencing.

Given your ongoing symptoms of headaches and occasional back pain, it would be prudent to schedule a follow-up appointment with your healthcare provider sooner rather than later. This will allow you to discuss your concerns in detail, review your medication regimen, and consider potential adjustments if necessary. Your doctor may also evaluate whether your current medications are the best fit for you or if alternative options could provide better symptom relief.

In summary, managing hypertension involves not only controlling blood pressure through medication but also addressing any side effects and associated symptoms. Open communication with your healthcare provider is key to finding the right balance in your treatment plan. Regular monitoring, lifestyle modifications (such as diet and exercise), and addressing mental health concerns can all contribute to better management of your condition and overall well-being.

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