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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
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Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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Why do some blood pressure medications cause breathing problems

Resolved Question:

Why do some blood pressure medications cause breathing problems? I have been through a number of medications wherein I cannot tolerate them because they inhibit my ability to breath. My lungs were tested at 110% of normal. The drugs seem to affect the function of my diaphragm. It's a similar feeling to where one gets the hiccups.

These are some of the drugs which have given me breathing problems: benicar, tekturna, bystolic.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 3 years ago.
Hello
Have any of the medications been tolerated?
Customer: replied 3 years ago.
No.
Expert:  Dr. Thomas, MD replied 3 years ago.
And what is the name of your current med and how is that going
Also what does your BP run without meds?
Customer: replied 3 years ago.

I just started and the name escapes me for the moment. It is an ARB. Without meds my BP spikes at times. I cannot afford the spike since I have afib and take Multaq and Verapamil. They are not enough to keep my BP down.

 

But I am most curious regarding the breathing issue. Does it have anything to do with the frenic nerve?

Expert:  Dr. Thomas, MD replied 3 years ago.
OK
Well verapamil is an anti hypertensive so you tolerate calcium channel blockers
Ask your doctor to consider increasing this, going to sustained release from, etc.
The other meds are in different classes but each can cause side effects, however, they should not cause exactly the same side effect unless this is idiosyncratic....unusual...to you, which can happen with any individual. In fact there are individuals that over react to all medications, I have seen this, and it takes a longer period of careful adjustment for them to tolerate the meds at all. And, since even within the same class each med is different with a slightly different profile it becomes a trial and error event to treat this type of person, as you are experiencing now.
In other individuals, controlling BP to fast, particularly in the face of A-fib, can cause symptoms...you actually need the pre-load "kick" to feel well with A-fib and lowering BP to fast, or too much, can stimulate symptoms due to this reason...which could affect breathing. I would discuss this aspect [even though it is somewhat theoretical not being your doctor] with your cardiologist...start at half the normal starting dose and work up, if needed.

Good luck
let me know if you have further questions
When satisfied, please click ACCEPT to give answer credit. Ask more if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only.
Customer: replied 3 years ago.

We already tried increasing one calcium channel blocker - the Verapamil. It was not effective for lowering my BP after a brief period. It also caused terrible constipation at the upper limit.

 

I don't believe the breathing problem is because of my afib. My BP machine has a function wherein I can verify when my heart is beating irregularly. I am very careful to monitor it when I think I have symptoms and I monitor my BP several times a day, mostly to make sure my meds are working (once I'm stable, I would no doubt reduce it). I can have normal BP, normal heart rhythm and still have breathing problems. I usually give the meds a 3 week time period, although I tried for 6 with the benicar.

 

Yes, I have experienced breathing issues with afib, but this is slightly different. It's more like the same area that one would experience hiccups. However, with the Tekturna, I also had back pain.

 

The "outside the box" things I have tried are breathing exercises that Chi Gong practitioners use, and some vocal breathing techniques I used when I sang opera. I've also tried accupuncture and Tui Na massage. These things gave me temporary relief, but not enough to sleep through the night. The accupuncture targeted a "meridian" which looked like the frenic nerve on the anatomy chart, thus my question about same. It did help temporarily but you can't keep stimulating it all night.

Expert:  Dr. Thomas, MD replied 3 years ago.
Different classes of drugs should not all somehow affect the phrenic nerve, but this is not saying that they do not affect you.
They would not be tested for "phrenic nerve block" side effects in clinical trials so this would be an unknown.
Difficulty breathing is a known side effect though of benicar.
Also of bystolic
For tekturna, more often cough, but since it has respiratory effects this is how it could affect you.
Since these work differently, the common mechanism if there is one has to be an effect at an unknown level and unfortunately will be presumed...we are not going to figure it out based on known mechanisms of each drug.
Therefore, I can also NOT discount your theory.
So at this point ...again...I would start with the lowest dose possible, even if I halved the lowest starting dose recommended. Build up as tolerated.
Good luck again
When satisfied, please click ACCEPT to give answer credit. Ask more if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56851
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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