Managing Heart Rate and Blood Pressure: Expert Insights on Medication Use

Medication consultation

Dear Dr.
Lee,
Hello.
My mother (69 years old) has experienced occasional episodes of sudden increased heart rate and elevated blood pressure over the past 1-2 years.
Her resting heart rate is usually 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, slight shortness of breath, numbness and trembling in her hands, and tightness in the back of her neck, along with occasional headaches.
Simultaneously, her blood pressure rises to around 190 mmHg systolic and exceeds 100 mmHg diastolic.
She regularly takes Diovan (valsartan) but still experiences these episodes.
She needs to take Labtal (labetalol) for relief of her symptoms.
I have the following questions for Dr.
Lee:
Q1.
Despite regularly taking Diovan (valsartan), my mother still experiences episodes of sudden increased heart rate and elevated blood pressure, which only improve after taking Labtal (labetalol).
Could you explain why this happens? What are the differences between these two medications?
Q2.
The medication label for Labtal (labetalol) states: "Take only as needed," so my mother is hesitant to take it regularly.
However, given that Labtal (labetalol) is more effective for her symptoms, can it be taken daily? Would daily use have any adverse effects or side effects on her health?
Q3.
My mother also takes Alpraline (alprazolam) regularly.
Can Labtal (labetalol) be taken on the same day as Alpraline (alprazolam)?
Thank you, Dr.
Lee.

Kris, 40~49 year old female. Ask Date: 2023/12/14

Dr. Li Han reply Cardiology

Hello, regarding your inquiry about your mother (69 years old) experiencing occasional episodes of sudden heart rate increase and elevated blood pressure over the past 1-2 years.
Her normal heart rate is usually 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, slight shortness of breath, numbness and trembling in her hands, tightness in the back of her neck, and occasional headaches.
Simultaneously, her blood pressure rises to approximately 190 mmHg systolic and over 100 mmHg diastolic.
It seems that her blood pressure is generally well-controlled with "Diovan," but she still experiences these episodes of sudden heart rate increase and elevated blood pressure.
Taking "Labetalol" or combining it with "Alprazolam" can help alleviate her symptoms.
Labetalol is a beta-blocker that can reduce heart rate, while Alprazolam is a sedative that can relieve anxiety and tension.
Sometimes, physical pain or psychological stress can trigger fluctuations in blood pressure.
It is essential to first rule out any dangerous clinical symptoms.
Beta-blockers can also be considered as one of the options for antihypertensive medication.
However, her doctor has prescribed Labetalol only for use as needed.
It may be worthwhile to discuss with her doctor at the next appointment whether to consider regular use of Labetalol and Alpraline on the same day, as this should not pose any issues.
Just be mindful of the warnings associated with sedative use, and when using beta-blockers, it is important to monitor for potential bradycardia or the risk of inducing asthma.
The Ministry of Health and Welfare Changhua Hospital cares about your well-being.

Reply Date: 2023/12/14

More Info

Managing heart rate and blood pressure is crucial, especially for individuals with a history of cardiovascular issues. In your mother's case, it appears that she is experiencing episodes of tachycardia (rapid heart rate) and hypertension (high blood pressure), which can be concerning. Let's address your questions one by one.

Q1: Why does my mother experience sudden increases in heart rate and blood pressure despite taking Diovan (Valsartan)? What are the differences between Diovan and Labtal (Labetalol)?
Diovan is an angiotensin receptor blocker (ARB) that primarily works by relaxing blood vessels, which helps lower blood pressure. It is effective for managing chronic hypertension and heart failure. However, it may not be sufficient for all patients, especially those with episodes of paroxysmal hypertension or tachycardia.
On the other hand, Labtal is a beta-blocker that also has alpha-blocking properties. It works by slowing the heart rate and reducing the force of contraction of the heart muscle, which can help manage acute episodes of high blood pressure and heart rate. The combination of these mechanisms allows Labtal to be more effective in situations where there is a sudden increase in heart rate and blood pressure, as it can directly counteract the sympathetic nervous system's effects that cause these spikes.

The episodes your mother experiences could be due to various factors, including stress, anxiety, or even dietary influences (like caffeine or high salt intake). It’s essential to monitor these episodes closely and discuss any patterns with her healthcare provider.

Q2: Can Labtal be taken daily, and what are the potential side effects?
While Labtal is labeled for "as needed" use, it can be prescribed for daily use in certain situations, especially if your mother finds it effective in managing her symptoms. However, it is crucial to do this under the guidance of her physician. Daily use of Labtal can lead to side effects such as fatigue, dizziness, or hypotension (low blood pressure). It may also cause respiratory issues in patients with asthma or chronic obstructive pulmonary disease (COPD). Therefore, if her doctor decides that daily use is appropriate, they will likely monitor her closely for any adverse effects.

Q3: Can Labtal and Alpraline (Alprazolam) be taken together?
Alpraline is a benzodiazepine used to manage anxiety and panic disorders. It can have sedative effects, which may be compounded when taken with Labtal. While there is no absolute contraindication for taking these medications together, caution is advised. The combination can lead to increased sedation, dizziness, and a higher risk of falls, particularly in older adults. It is essential that your mother discusses this combination with her healthcare provider to ensure it is safe based on her overall health status and other medications she may be taking.

Additional Considerations:
Given your mother's symptoms, it may be beneficial for her to keep a detailed log of her blood pressure readings, heart rate, and any symptoms she experiences. This information can help her healthcare provider make informed decisions about her treatment plan. Additionally, lifestyle modifications such as stress management techniques, regular physical activity, and a balanced diet low in sodium can also play a significant role in managing her blood pressure and heart rate.

In conclusion, managing heart rate and blood pressure requires a comprehensive approach that includes medication, lifestyle changes, and regular monitoring. It is essential for your mother to maintain open communication with her healthcare provider to adjust her treatment plan as needed and to address any concerns regarding her medications.

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