Pulse Pressure and BP

Heart health and blood vessels
1

21 year old, female. Diagnosed with High BP. I also run a pretty high heart rate, as high as 155.

I'm currently on metoprolol and bouncing between 50mg and 25 mg. The 25mg is not enough to bring my heart rate down and the 50 mg lowers my blood pressure to almost dangerous levels. I start getting dizzy and almost passed out a couple of times.

I was feeling very dizzy while laying down and so I took my BP. 118/43. And then I found this thing called pulse pressure.

I subtracted the two numbers and got a PP of 75! According to some studies, it should actually be 40. Oh my god.

But all the studies seem to only concern older people and men, so I'm not even sure if this applies? Nonetheless, I'm freaked out!

I stood up and took it again. Can't remember my BP, but my PP was around 55. Better.

But am I going to be okay? I've talked to a cardiologist about how low my BP goes, but she didn't seem so worried. I even told her it made me feel dizzy and she just said to take some salt water. Which is annoying to do after a while. Like, every night it's like this. It has even erupted my sleep. And well I guess she must not be worried about pulse pressure. If she even calculates that at all.

Sorry... I'm going on a vent here, but this is truly frustrating. I've been dealing with this for months now and I have no idea how both my BP and HR got so high. It all just came out of nowhere, and so far my blood tests are normal.

Had EKG, Stress Test, and Echo as well. All normal. Aside from mild MVP which my cardiologist isn't even concerned about it.

I'm trying to push to see and endocrinologist, but either my primary doctor doesn't care or my insurance is very limiting. I have to have a "reason" to see an endocrinologist. I have to have a blood test first. Maybe that's a thing, but... I mean... isn't my history is high BP and high HR enough of a reason to see a specialist?

I really do believe I have a thyroid problem or something and I know blood tests can be normal even if you have thyroid problems.

It's all frustrating, slow, and depressing. I can barely move around without feeling dizzy and I just want to give up.

I also have shortness of breath too but only god knows why. I've been to the ER more times than anyone. Tons of blood tests, been monitored, etc... and nothing.

I'm very dizzy atm, which I probably should go to the ER again, but... it might be nothing.

 

2

*interrupted

3

Also, should I consider changing medication?

4

Might seem off topic but there's a reason I'm asking and I'll explain after you reply. Have you noticed any vision changes recently?

5

Sometimes when my BP gets too low yes. But overall, my vision is fine. Sometimes, my right eye would go dim I guess, like when getting up from bed or something, but then it goes back to normal so I have no idea what that's about.

I've had several ct scans of the brain as well. All normal.

6

There is a condition that causes similar hypertension issues that you are dealing with called idiopathic increased intracranial pressure. In short it's where the spinal fluid pressure is elevated and it causes your blood pressure to rise and drop but also it causes intermediate dizzy spells. With this condition if you get up from a laying down position even a little bit too quickly you will have intermediate Deming of your vision in one or both eyes as well as dizziness and some people have been known to pass out or get a feeling that they are going to pass out. Also when you cough or sneeze you'll have these symptoms. maybe this is something you could bring up to your doctor. Good luck with everything

7

Hi can I get a better picture of your physical status, height and weight and your exercise program

8

Well the hypotension is an issue, since you don't want to be falling over.  And the tachycardia is an issue at that level.  It's sufficiently unusual that I hesitate to give even what little I know.  It could some or all be related just to electrolytes - salt water might raise your diastolic a little, if that's the problem in the first place.  I'd also worry about potassium, the simplest source of which is bananas!  I also like our sea-salt potato chips ('crisps"wink, if I feel a need for electrolytes.  And I guess make sure of your magnesium too, a little in the sea-salt, more in almonds.

​So, if your diet somehow misses all these, or you have other issues, maybe there's a quick and easy fix, or at least a mostly natural fix.  Meanwhile, if you need an excuse, dark chocolate - best if it's 70% or more, and most people say it should have no milk in it at all - is a natural beta blocker and can lower your pulse rate for a few hours, have an ounce or two of the dark stuff.  It works pretty well for me.

​Hope that's all it takes, best wishes!

9

In hospital emergency departments pulse pressure is of no importance.

​What is critical, particularly in your case, is your Mean Arterial Pressure (MAP) which is normally between 70 mmHg and 110 mmHg.

​For normal heart rates (between 60 to 100 beats per minute) this is calculated as:

(systolic + (2 x diastolic))/3

So in your case when dizzy this would be:

​(118 + (43x2))/3  = (118 + 86)/3 = 68 mmHg

providing you are neither bradycardic (<60) nor tachycardic(>100).

​A MAP of at least 60 mmHg is necessary to provide sufficient blood flow to your major organs which means you are slightly below the normal range and explains why you feel dizzy when you stand up when a lot of blood drains down towards your lower limbs.

 

10

Clinical pharmacology studies have demonstrated the beta-blocking activity of Metoprolol, as shown by (1) reduction in heart rate and cardiac output at rest and upon exercise, (2) reduction of systolic blood pressure upon exercise, (3) inhibition of isoproterenol-induced tachycardia, and (4) reduction of reflex orthostatic tachycardia.

​​In an earlier reply I gave the reason why your most important blood pressure for survival is the Mean Arterial Pressure(MAP) and not your systolic (peak) blood pressure.

​In reducing your heart rate with Metoprolol​ it is most likely to be reducing your cardiac output  and therefore not only reducing your systolic blood pressure but also your diastolic blood pressure. The end result is reduction of your MAP to below normal levels.

 

​This does support your thought that a change of medication might be in order.

​As you are worried about your MVP I would have expected your cardiologist to have confirmed that this is not affecting your symptoms by telling you your heart's Ejection Fraction (LVEF) which should be between about 50% and 75%.

​I think a more detailed analysis of your heart function and medication side effects need to be established before further attempts at diagnosis of your symptoms.

11

Hey Bob, I like that MAP business, never seen it before.

I've long simply added the two numbers and gone with the sum, with an up-arrow or down-arrow based on the diastolic - if the systolic is a higher percentage above normal I discount it with a down arrow.

Of course the two numbers from any reading have basically independent degrees of freedom, one might be few points higher than reality while the other is lower, etc, and this helps to get the most value from individual readings.

12

Hi jx.

​Mean Arterial Pressure (MAP) is something that primary care physicians are unlikely to care much about because studies of blood pressure treatments have always mainly involved controlling systolic blood pressure (SBP)because it's easier to measure.

​Because the target for SBP has been decreasing over the years this has resulted in consequential reduction of Diastolic Blood Pressure (DBP) which if not spotted early enough results in reduced blood flow to the heart (low perfusion) with consequential likelihood of heart failure symptoms.

​Treatment of reduced cardiac output through drug therapy necessitates controlling MAP rather than SBP. This is recognised in specialist cardiac medical circles.

​

 

13

I have read the other response and you have been very informative, thank you so much. I will definitely consider a change of medication. Do you know of any beta blockers that doesn't have these effects? But it sounds like all of them would have these problems. I might just go for natural remedies. Hibiscus, garlic, and hawthorn work pretty well for me.

My doctor did not tell me my Ejection Fraction. I'll make sure to ask him once I have my appointment.

I will be getting an angiogram, I just have to wait for my insurance. Is that test good enough to analyze heart function or are there other tests?

I really appreciate the information, all of this has been stressing me out and finally I see some light. Thank you. I'll keep the MAP in mind as well.

14

Bob, that's all very interesting, makes a lot of sense.  I've seen a couple of specialists, or so they said.  I'm very much afraid the science behind all of this is so feeble, being a "specialist" hardly matters.  Need a specialist who is a really good specialist, not just the specialist next door. I've known this about medical care in general for a long time, the average level is just not that good, and you know what - half of them are below average!  But it's hard as a patient to judge.

15

Before the angiogram they usually do the echo cardiogram, or stress-echo, have you done those?  Angiogram is very informative but more invasive and expensive, I'm not sure what it takes these days in the US to qualify for one.  More than BP complaints, I think.

16

Yes I’ve had both of those done, and all clear. But I was still getting the ocassional chest pain and shortness of breath so i think my cardiologist just wants to be thorough. He told me that my chest pain doesn’t sound like angina but just have an angiogram to be on the safe side. Since I have MVP maybe an angiogram would tell the doctor more about it?

17

"Chest pain" can also be gall stone or even kidney stone, among other things.  I'm curious what data modern medicine can get from an angiogram that the echo doesn't show, I'm sure there's something.

I'm so waiting for the Star Trek medical tricorder, they just wave it at you and everything is known!

18

>Do you know of any beta blockers that doesn't have these effects?

Short answer is no - I don't have any experience of other beta-blockers.

However I think you are right to conclude that they will all work in the same sort of way but in tests metropolol has resulted in more side effects than others.

​I am using bisoprolol but then I am much older than you and male - the effect has been similar

 though with resting heart rate reduced from 80 bpm to 55 bpm but it is stable at that rate.

​

19

>I will be getting an angiogram, I just have to wait for my insurance. Is that test good enough to analyze heart function or are there other tests?

​I mentioned resting heart rate earlier and that mine had gone down dramatically with bisoprolol.

​Resting heart rate is quite informative and can be taken by yourself by feeling the pulse on your wrist over a timed period e.g. 15 seconds and multiplying by 4 to get your heart beats per minute.

​However it is important that you do this in a comfortable and fully relaxed state in an armchair with your feet on the ground and your arms supported and after maintaining this state for at least 5-10 minutes without interruption or talking.

​Can you do this and link this measurement to a beta-blocker dosage?

20

Regarding the link I sent about Resting Heart Rate (RHR) measure for heart function from Harvard, here's an image showing how I use the CMS50D+ to monitor my Resting Heart Rate after being seated comfortably for about five minutes.

​My heart rate, blood oxygen level and blood flow waveforms are shown on the device whilst connected to my finger. The display in attached image is what is shown when it is connected by a cable to a computer and is a bit more informative.

​It does however show that my blood oxygen level (SpO2) is stable at 97% for a whole minute and my RHR is 53 beats per minute. The bottom display, which can also be seen on the device whilst on my finger, displays the blood flow at my finger from my heart which directly correlates with my blood pressure's systolic peaks and diastolic lows. I can spot heart waveform irregular beats on this display.