Beta blocker - low blood pressure

[jothenurse]

Does anyone have this problem? I take a very small amount of beta-blocker (12.5 mgER of metoprolol for palpitations) - but I am also taking Ativan. With the two together, I tend to get a fairly low blood pressure (low 90's systolically). I was originally on 50 mg of metoprolol, but it has been decreased a couple of times. Last night, per the pharmacist, I held the beta-blocker. They usually are tapered, but he says they do stay in your system for awhile and I am on such a small amount that I could hold it and speak with my doctor today. This morning I took my 1 mg Ativan, but I notice my pulse is in the 90's. I'm not sure if I am just focusing in on it or if it really is going back up. It's like I need a little beta-blocker, but with the benzodiazepines, they don't work well together. Now I'm afraid I'll have 's bad palpitations like I use to get in the 150's. I know - I'm doing The What if's which I shouldn't be doing. Anybody suggestions or has anyone else gone through this?

[ronski]

Hi Jo I have experience of a high resting pulse and like you I was offered beta blockers because that was the only option at the time for getting my pulse rate down below 100 beats a minute. I decided not to go on beta blockers for various reasons and I got my pulse rate down by meditation, light exercise and not going to the doctors ha ha. With your pulse rate in the nineties I would not be concerned as your sinus rate can be anywhere between 60-100 beats per minute to be within the normal range, but obviously a lowered rate would make you feel more energised. As far as blood pressure what is normal for you, if the low 90s systolic is not normal then I would get your doctors advice.

Palpitations as you are probably aware are usually not heart orientated but come from stimulation of the vagus nerve so I really would not worry about them and a slightly faster heart rate actually makes innocent palpitation occur less. I get palpitations but very rarely when I am walking, they usually occur if my resting heart rate is around 60-70 beats a minute and mostly I can identify a digestive influence that starts them off so that certainly would be a vagus nerve firing abberant signals. Try not focusing on your body for a while and you will probably find that things calm by themselves.

[jothenurse]

I ended up in the ER this morning around 4 AM - woke up and thought my heart was a little fast. I had not taken the beta-blocker the night before because my blood pressure was low. When I got to the ER, my pulse was 137. (It usually is 150-160's). So, they did hook me up to the EKG, and it was sinus tachycardia. Normal, just too fast. The ER doc was a pediatric cardiologist. He said to stop taking the beta-blocker. (I was on such a small dose that it did not need to be tapered). And also that he does not treat sinus tachycardia with beta-blockers. He said it was anxiety, and to do some deep breathing when it happens. He also said to get back into exercising and do not check the pulse while I was doing it.

[ronski]

Jo that sounds very sensible advice as sinus tachycardia is not harmful around that level but can be physically exhausting. Do some gentle walking to start with and improve your fitness levels and maybe get your doctor to prescribe some Cognitive Behavioural Therapy to lower your anxiety levels. I have mentioned it on many posts but a lot of anxiety I believe is a faulty breathing pattern when under stress. You may be breathing fast and shallow and that in itself could cause your raised resting heart rate. Is your main problem health anxiety, if so CBT or mindfulness will help you a lot.
All the best
Ron

[jothenurse]

My main problem is anxiety /panic disorder.