Managing Blood Pressure and Heart Rate in Autonomic Nervous System Disorders

Follow-up question #196144 regarding medication inquiry?

Dear Dr.
Wu,
Thank you very much for your response and suggestions regarding the medication inquiry #196144.
My mother also expresses her gratitude to you.
I apologize for not explaining some aspects clearly in my previous question, so I would like to ask again.
My mother is a patient with "autonomic nervous system disorder," which triggers episodes of increased heart rate and elevated blood pressure (over 200/100), accompanied by symptoms such as shortness of breath, instability while standing, fatigue, cold and trembling extremities, and scalp numbness.
Initially, when these episodes occurred, our family was unaware that her increased heart rate and elevated blood pressure were due to "autonomic nervous system disorder." Therefore, we allowed her to take "Diovan (160mg)" for nearly a month.
During this period, she experienced episodes of low blood pressure (around 100/60), leading to fatigue and dizziness during the day.
More importantly, the episodes of increased heart rate and elevated blood pressure (over 200/100) due to her autonomic nervous system disorder continued to occur, and "Diovan (160mg)" clearly did not control this situation.
It was only after she was taken to the emergency room during one of her episodes that a physician prescribed "Labetalol (200mg)," which alleviated her symptoms.
When my mother is not experiencing an episode of "autonomic nervous system disorder," her blood pressure remains normal (around 120/80) even without taking antihypertensive medication.
I would like to ask Dr.
Wu the following questions:
Q1.
Based on the above description, is "Labetalol (200mg)" more suitable for my mother than "Diovan (160mg)" given her condition?
Q2.
From your previous response, I understand that "Labetalol (200mg)" has a rapid onset of action but a shorter duration of effect.
Can my mother take "Labetalol (200mg)" long-term, or is it only suitable for short-term use?
Thank you, Dr.
Wu.

Axiang, 40~49 year old female. Ask Date: 2023/05/06

Dr. Wu Xueming reply Cardiology

1.
If blood pressure is well controlled, it is certainly possible.
2.
It can be taken long-term.

Reply Date: 2023/05/06

More Info

Managing blood pressure and heart rate in patients with autonomic nervous system (ANS) disorders can be quite complex, especially when symptoms such as tachycardia, hypertension, and other autonomic symptoms manifest. Your mother's experience with autonomic dysfunction, characterized by episodes of elevated heart rate and blood pressure, is not uncommon. These episodes can be triggered by various factors, including stress, anxiety, or even physical exertion.

Understanding Autonomic Nervous System Disorders
The autonomic nervous system regulates involuntary bodily functions, including heart rate, blood pressure, and respiratory rate. In disorders of the ANS, there can be an imbalance between the sympathetic (fight or flight) and parasympathetic (rest and digest) systems. This imbalance can lead to symptoms such as increased heart rate (tachycardia), elevated blood pressure, and other systemic symptoms like cold extremities, dizziness, and fatigue.

Q1: Is Labtal (Labetalol) more suitable than Diovan (Valsartan) for your mother?
In your mother's case, it appears that Labetalol has been more effective in managing her acute episodes of elevated blood pressure and heart rate compared to Valsartan. Labetalol is a combined alpha and beta-blocker, which means it can effectively reduce heart rate and lower blood pressure by blocking the effects of adrenaline on the heart and blood vessels. This dual action can be particularly beneficial in cases of autonomic dysfunction where both heart rate and blood pressure are affected.

On the other hand, Valsartan is an angiotensin receptor blocker (ARB) that primarily works to lower blood pressure by relaxing blood vessels. While it is effective for chronic hypertension, it may not address acute episodes of autonomic instability as effectively as Labetalol. Given that your mother experiences significant fluctuations in blood pressure and heart rate, Labetalol may indeed be a more suitable option for her, especially during episodes of autonomic dysregulation.

Q2: Can Labetalol be used long-term?
Labetalol can be used long-term, but this decision should be made in consultation with your mother's healthcare provider. Long-term use of Labetalol is common in patients with chronic hypertension or those who experience recurrent episodes of elevated blood pressure due to autonomic dysfunction. However, the dosage and frequency may need to be adjusted based on her response to the medication and any side effects she may experience.

It is important to monitor her blood pressure and heart rate regularly, especially when starting or adjusting medications. If she experiences significant side effects or if her symptoms do not improve, her healthcare provider may consider alternative treatments or additional medications to better manage her condition.

Additional Considerations
1. Lifestyle Modifications: Alongside medication, lifestyle changes can play a crucial role in managing symptoms of autonomic dysfunction. Encouraging regular physical activity, stress management techniques (such as mindfulness or yoga), and a balanced diet can help stabilize blood pressure and heart rate.

2. Regular Monitoring: Keeping a log of her blood pressure and heart rate readings can provide valuable information for her healthcare provider to tailor her treatment plan effectively.

3. Follow-Up Care: Regular follow-ups with her healthcare provider are essential to assess the effectiveness of the treatment plan and make necessary adjustments.

4. Education: Educating both your mother and family members about her condition can help in recognizing early signs of autonomic dysregulation and managing episodes effectively.

In conclusion, managing blood pressure and heart rate in patients with autonomic nervous system disorders requires a comprehensive approach that includes appropriate medication, lifestyle modifications, and regular monitoring. It is essential to work closely with healthcare providers to ensure the best possible outcomes for your mother.

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