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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10337
Experience:  14 years experience in the field of Family Practice
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After several ER visits due to my BP skyrocketing, my cardiologist

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After several ER visits due to my BP skyrocketing, my cardiologist thinks I metabolize my meds too quickly. Currently taking in morning, 20 mg enalapril and 50 mg Toprol XL. PM, 50 mg Toprol XL. He added 5 mg amlodipine in mid-afternoon. Sometimes BP is very low (86/50) concerned this is not ideal but preferable to 249/128!). Not obese and follow a low-sodium diet. Worry about taking the amlodipine when BP is this low. I am 83 yo female, also have sinus tach. Otherwise healthy and all organs function normally. Noted that amlodipine not endorsed by Joe Graedon, pharmacist, but seems popular with many doctors. Suggestions?
Submitted: 1 year ago.
Category: Medical
Expert:  Anthony Bray, MD replied 1 year ago.
Hello !
With your blood pressure being so labile ( up and down extremes) plus your heart racing at times I would recommend that you be tested for pheochromocytoma ( that is a rare adrenal gland tumor which releases excess adrenalin) This is a very uncommon problem but could fit with many of your symptoms.
The problem of pheochromcytoma growth may be detected by 24 hour urine test for metanephrines. ( this is a break down chemical from adrenalin) Adrenalin may be measured directly but that is not reliable because levels can change within minutes...
Your calcium level should be checked...
Your kidney function should be checked...
The Toprol XL 50 mg twice a day should be effective e with this dosing schedule even if you are a fast metabolizer...
The enalopril is an ACE inhibitor...my preference would be to stop that and use an Angiotensin 2 receptor blocker instead. The 2 classes are similar but in my experience a higher percent of people respond to the latter class than the ACE inhibitor class....( Options would include Cozaar, Benecar, Avapro, Micardis, Diovan)
Your blood flow to your kidneys might need to be checked. Renal artery stenosis may cause very high and resistant to treat high blood pressure ...that problem would for less with your BP being too low however...
Renal function should be checked by blood tests and urine tests and imaging to check the renal arteries...
Your thyroid function should be checked. Too high of thyroid hormone may cause rapid heart beat and spikes of blood pressure as well...
The amlodapine is a good blood pressure drug and has benefit of slow elimination ...effect of pill spans 48 hours so you taking daily with Your other meds should help to avoid spikes up and down so much. You are not as likely to get spikes of BP medicine wearing off with that choice...
Do you have any swelling of legs or feet? Fluid retention may I do care possible benefit of diuretic in your case...
So your case it seems to me to need a more detailed look! The tests I mentioned above should be considered .I advise that with your meds that you check your own BP outside the doctor's office...check after 10 minutes rest in seated position ...wrote down your results ( in your case for a few weeks check daily at random times)
I hope that this helps.Let me know if you have further questions.I will be happy to get back with you.If my answer has been helpful and to your satisfaction then please remember to leave positive feedback.Thank You and Best Regards,
Anthony Bray MD