Sudden Heart Rate Increases and High Blood Pressure in Seniors

Inquiry Consultation

Dear Dr.
He,
Hello.
Below is a description of my mother's symptoms: She is approximately 69 years old and has recently experienced episodes of sudden increased heart rate accompanied by elevated blood pressure.
Her usual heart rate is around 60 beats per minute, but during these episodes, it can suddenly increase to 70-80 beats per minute.
At this time, she feels discomfort in her chest, palpitations, numbness and trembling in her hands, tightness in the back of her neck, and occasional headaches.
Simultaneously, her blood pressure can rise to around 190 mmHg systolic and over 100 mmHg diastolic.
My mother regularly takes Diovan (valsartan) and Alpraline (alprazolam), but the episodes of sudden increased heart rate and elevated blood pressure continue to occur.
I have noticed that these episodes are more frequent in the fall and winter seasons, while they occur less often in the summer.
During these episodes, she takes Labtal (labetalol), which usually alleviates her symptoms.
She has undergone a CT scan of the brain, electrocardiogram, echocardiogram, myocardial perfusion scan, and several blood tests at a local hospital, all of which have shown no significant issues.
The myocardial perfusion scan indicated some slight blockage in her coronary arteries, but the physician determined that the blockage is not severe enough to cause the sudden increased heart rate and elevated blood pressure.
I would like to ask Dr.
He the following questions:
Q1: Despite regularly taking Diovan (valsartan) and Alpraline (alprazolam), my mother still experiences episodes of sudden increased heart rate and elevated blood pressure, which only improve with Labtal (labetalol).
In your opinion, what could be the underlying issue or condition causing this? Why might this be happening?
Q2: As mentioned, my mother's episodes of sudden increased heart rate and elevated blood pressure are more common in the fall and winter seasons, while they occur less frequently in the summer.
In your opinion, what could explain this seasonal difference?
Q3: There is a warning on the Labtal (labetalol) medication label stating, "Take only as needed," which makes my mother hesitant to use it regularly.
She usually takes Diovan (valsartan) and Alpraline (alprazolam).
However, as previously stated, she still experiences episodes of sudden increased heart rate and elevated blood pressure despite taking Diovan (valsartan) and Alpraline (alprazolam), and only finds relief with Labtal (labetalol).
Can Labtal (labetalol) be taken daily? Would it be advisable for her to switch from Diovan (valsartan) to Labtal (labetalol) for regular use? Additionally, what is the maximum daily dosage for Labtal (labetalol)?
Q4: Can Labtal (labetalol) be taken on the same day as Alpraline (alprazolam)?
Thank you, Dr.
He.

Kris, 40~49 year old female. Ask Date: 2023/12/13

Dr. He Dongjin reply Cardiology

Hello,
1.
It seems that the autonomic nervous system disorder is caused by seasonal factors and unstable external environmental changes.

2.
This is not a warning; it is just that there is no need to take medication regularly.
It is not that the medication is very strong or has significant side effects.
It is also a type of antihypertensive medication, and its side effects are not greater.
Pregnant women can use this medication and take it daily.
You can switch to taking Amlodipine instead of Dantrolene or Amiodarone.
Amlodipine can be taken on the same day as Amiodarone.

Ping An Changhua Hospital cares about you.

Reply Date: 2023/12/13

More Info

Understanding sudden increases in heart rate and high blood pressure, especially in seniors, is crucial for managing cardiovascular health. Your mother’s symptoms, including episodes of rapid heart rate (tachycardia), elevated blood pressure, and associated discomfort, warrant careful consideration.

Q1: What could be causing your mother's symptoms despite her medication?
Your mother is taking Diovan (valsartan), an angiotensin receptor blocker, and Alpraline (likely a beta-blocker), which are both designed to manage blood pressure and heart rate. However, the persistence of her symptoms suggests that her condition may not be fully controlled by these medications.
Several factors could contribute to her episodes of tachycardia and hypertension:
1. Medication Efficacy: The effectiveness of antihypertensive medications can vary among individuals. It’s possible that her current regimen is insufficient for her specific needs, particularly during episodes of stress or anxiety.

2. Underlying Conditions: Conditions such as hyperthyroidism, anemia, or even anxiety disorders can lead to increased heart rate and blood pressure. Given her age, it’s also important to consider the potential for age-related changes in cardiovascular function.

3. Autonomic Nervous System: The autonomic nervous system, which regulates involuntary bodily functions, can become dysregulated, leading to episodes of increased heart rate and blood pressure.

4. Environmental Factors: Stressors, both physical and emotional, can exacerbate symptoms.

Q2: Why do symptoms occur more frequently in autumn and winter?
Seasonal changes can significantly affect cardiovascular health. In colder months, blood vessels constrict to conserve heat, which can increase blood pressure. Additionally, the body may respond to colder temperatures with increased heart rate as it works harder to maintain core temperature.
Moreover, shorter daylight hours and colder weather can lead to decreased physical activity and increased stress or anxiety, which can further exacerbate cardiovascular symptoms.

Q3: Can your mother take Labtal (labetalol) daily instead of Diovan?
Labetalol is a mixed alpha and beta-blocker that can effectively lower blood pressure and heart rate. However, it is essential to consult with her healthcare provider before making any changes to her medication regimen.
Labetalol can be taken daily, but the dosage should be tailored to her specific needs and health status. The maximum daily dose can vary, but it is typically around 2400 mg for hypertension, divided into two or three doses. Your mother’s healthcare provider can determine the appropriate dose based on her overall health and response to the medication.

Q4: Can Labtal be taken with Alpraline on the same day?
Yes, labetalol can generally be taken with other medications, including beta-blockers like Alpraline. However, combining these medications should be done under the supervision of a healthcare provider, as it may lead to additive effects on heart rate and blood pressure.

Conclusion
Given your mother’s symptoms and the complexity of her condition, it is crucial to maintain open communication with her healthcare provider. Regular monitoring of her blood pressure and heart rate, along with a comprehensive evaluation of her medications, lifestyle factors, and potential underlying conditions, will be essential in managing her health effectively.
Encourage her to report any new or worsening symptoms, and consider discussing the possibility of adjusting her medication regimen to better control her episodes of tachycardia and hypertension. Lifestyle modifications, such as stress management techniques, regular physical activity, and a balanced diet, can also play a significant role in her overall cardiovascular health.

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