Managing Blood Pressure and Heart Rhythm Medications: A Patient's Dilemma

Issues with Blood Pressure Medications

Hello Dr.
Lee, I have hyperthyroidism and have been taking one dose of anti-thyroid medication and one dose of a heart rhythm medication daily for three months to maintain my condition.
Sometimes I feel weak, and when I measure my blood pressure at home (using an Omron blood pressure monitor), my average systolic pressure is between 90 and 100, and my diastolic pressure is between 65 and 75.
However, at the hospital, my blood pressure measured an average of 115/80.
I have also calibrated my home blood pressure monitor, and it is functioning correctly, so I am unsure if my blood pressure is genuinely low.
Does the heart rhythm medication also lower blood pressure? I am hesitant to stop taking it.
Currently, my pulse rate is maintained between 70 and 90, but I sometimes experience palpitations.
When I measure my heart rate, it ranges from 95 to 100, which is not very fast, yet I still feel palpitations.
This makes me reluctant to stop the heart rhythm medication, but I am also concerned that taking one pill daily might cause my blood pressure to drop too low.
What should I do? Thank you, Dr.
Lee.

A Yao, 30~39 year old female. Ask Date: 2024/07/22

Dr. Li Jian reply Internal Medicine

For issues related to palpitations and low blood pressure, you may consult a cardiology department.
Thank you for your inquiry.

Reply Date: 2024/07/22

More Info

Managing blood pressure and heart rhythm medications can indeed be a complex issue, especially for patients with conditions like hyperthyroidism, which can affect heart rate and blood pressure. Based on your description, it seems you are experiencing a combination of symptoms and concerns related to your medications and overall cardiovascular health.

Firstly, it is important to understand that medications used to manage heart rhythm, such as beta-blockers or calcium channel blockers, can indeed lower blood pressure. If you are taking a medication specifically for heart rhythm control, it may contribute to your lower blood pressure readings, especially if you are also experiencing symptoms of fatigue and palpitations. These medications work by slowing down the heart rate and reducing the force of the heart's contractions, which can lead to a decrease in blood pressure.

Your home blood pressure readings averaging between 90-100 systolic and 65-75 diastolic are considered on the lower side, especially if you are experiencing symptoms like fatigue and palpitations. However, the readings taken in the hospital (115/80) suggest that your blood pressure may be more stable in a clinical setting. It's not uncommon for patients to experience "white coat syndrome," where anxiety about being in a medical environment can lead to elevated blood pressure readings.

Regarding your concerns about feeling weak and experiencing palpitations, it is crucial to differentiate between what might be a side effect of your medications and what could be related to your underlying condition (hyperthyroidism). Hyperthyroidism can cause symptoms such as increased heart rate (tachycardia), anxiety, and fatigue. If your thyroid levels are not well-controlled, this could contribute to your symptoms.

Here are some steps you can take to manage your situation:
1. Regular Monitoring: Continue to monitor your blood pressure at home and keep a log of your readings. This will help you and your doctor assess whether your blood pressure is consistently low or if it fluctuates.

2. Consult Your Doctor: Schedule an appointment with your healthcare provider to discuss your symptoms and medication regimen. It may be necessary to adjust your medications based on your blood pressure readings and how you are feeling. Your doctor might consider lowering the dose of your heart rhythm medication or switching to a different medication that has a lesser impact on blood pressure.

3. Thyroid Management: Ensure that your hyperthyroidism is being effectively managed. If your thyroid hormone levels are too high, this could exacerbate your heart rhythm issues and contribute to feelings of weakness and palpitations.

4. Lifestyle Modifications: Incorporate lifestyle changes that can help manage your blood pressure and overall heart health. This includes a balanced diet, regular physical activity (as tolerated), adequate hydration, and stress management techniques.

5. Emergency Plan: If you experience severe symptoms such as fainting, severe dizziness, or chest pain, seek immediate medical attention.

6. Medication Adherence: Do not stop or adjust your medications without consulting your healthcare provider. Stopping heart rhythm medications abruptly can lead to rebound effects and worsen your symptoms.

In summary, your situation requires careful monitoring and communication with your healthcare provider. It is essential to address both your blood pressure and heart rhythm concerns while ensuring that your hyperthyroidism is well-managed. Regular follow-ups and open discussions with your doctor will help you navigate this complex situation effectively.

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