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HTN - Hypertension, Meds and exercise...

Bacstar

Bacstar

Golden Member
UPDATE 06-11-2009

It's been awhile since I last revisited this topic, but instead of starting a new one, I'll just give this one an update.

Well, back in Oct/Nov 2008, as noted below, I was working on my Open-water certification. I was able to pass my swim test and complete the classroom and pool sessions and was doing my checkout dives in Whittier Alaska. I had some issues with shortness of breath in 15-25ft of water. Thinking it was due to nerves and conditions being rather extreme (we were practically diving in heavy snow/blizzard conditions), we gave it a couple tries and after 20-25 mins, I would have the same problem. Instructor decided to call off the rest of my dives and suggested I revisit the doctor.

Following week, I see my primary, and he referred me to a cardiologist for an echocardiogram. Apparently, my heart murmur had gotten worse from its original diagnosis from several years ago, and I was suffering severe Mitral Valve regurg which required immediate surgery for a repair or replacement. I ended up having open-heart surgery in January 2009, and thankfully my heart only needed a valve repair. It was quite the experience I never want to go through again. At least, in the testing prior to surgery, we dicovered my arteries are all clean.

Now, my cardiologist finally gave me medical clearance to continue my diving. This weekend I'll be diving in Seward, AK. I'm a little apprehensive about it, but wish me luck!!!

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Ok. I'm currently taking my Open Water Diving classes and had my swim test last night. About 2 laps into the swim, my body just quit: fatigue and light headed-ness. Then, it took me 20 mins to recover sitting at the side of the pool, and the instructor and I couldn't detect a pulse to figure out my heartrate. After doing some research, I suspect the Atenolol screwed me up and may have caused me to suffer from low blood pressure causing me to bonk.

Just a history, I'm currently on a bunch of meds to control my blood pressure and a borderline high bloodsugar:

Atenolol - 100 mg 1x/day
Diovan/HCT - 320/25 mg 1x/day
Metformin - ER 500mg 2x/day
Provostatin - 20mg 1x/day
Amlodopine - 10mg 1x/day

I've been on this regimen for the past year but in the past 6 months I've lost 36 lbs (215 to 179 lbs) with plans to lose 15-20lbs more. I've also been working out, so I think i should have done better on the swim test. I just recently had a doctor's visit to get medical approval for my scuba classes and he recommended that since I lost so much weight to come in to maybe readjust my meds in 6 months. I'm afraid to go back to the doctor just in case he decides to rescind his approval for diving...so is there anyone on ATOT with any experience in this matter, will this disqual me for diving, should i take my chances and go to the doctor, were my dosages the actual culprit? The diving instructor says I have the entire month to pass the test so I got a little time.
 
From what I know, exercise and diet will do more than any medication for both blood sugar and pressure, genetics notwithstanding. Seeing as how you've lost that much weight and are consistently working out, I don't see a reason to be on anywhere remotely close to that amount of meds unless your case is extremely severe. I'm no expert, just my 2 cents.

There are doctors who overmedicate. This is a more extreme example, but my mom has cancer that causes her severe abdominal pain, so the moron doctors put her on a heavy narcotic pain killer. When that didn't alleviate the pain, they put her on another. Then they upped the dosage, and added another med, and so on and so forth until she was literally taking enough to put down a horse; and the pain was STILL quite severe. Had to go into professional drug-detox for a week to get off of them; and these were supposedly the best in the world. Never mind the fact that they made her crazy (they are narcotics). She finally found a doctor who knew something. Now she's weaning herself off the meds and controller her pain almost completely with diet (turns out some of the stuff the other doctors were telling her to eat was a decent bit of the problem).

Get a second, third, and fourth opinion about the meds.
 
You're on a beta1 blocker which could reduce your ability to exercise maximally. I'd definitely go see your doctor and possibly get that adjusted. How has your blood pressure been lately? I doubt he is going to tell you not to go diving, it seems like you're doing well so he would want you to keep it up.
 
Originally posted by: rezinn
You're on a beta1 blocker which could reduce your ability to exercise maximally. I'd definitely go see your doctor and possibly get that adjusted. How has your blood pressure been lately? I doubt he is going to tell you not to go diving, it seems like you're doing well so he would want you to keep it up.
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It's been pretty good.... 110-117/72-86 depending on what time and when i had my last cup of coffee in the morning.. imagine when i was first diagnosed 4 or 5 years ago... i was at 238/140. hehehe...after telling my sisters and mom whom are all nurses at the time, they begged me to go to the ER.
 
Pretty good? That's great. Most people do not do so well and your doctor will recognize that. Even though they might be resistant to changing your prescriptions, you might be able to wean the atenolol. One problem with prolonged use of a beta1 blocker, though, is that you'll become more sensitive to normal signals once you stop taking it which can result in high blood pressure. But if you talk to your doctor and keep good track of your blood pressure maybe you can work it out. Good luck.
 
Thanks Rezinn. I'm waiting to hear back from my doctor. I spoke to my sister who works at a Cat-lab(sp?) for some advice, and she did warn me about the dangers of immediately discontinuing the use of atenolol. I'm covering my bases and joined a gym last night to start concentrating on some cardio-based exercises. Who knows...maybe I'm just out of shape even after losing the weight and working out on the bow-flex. It also gives me a chance to do a bit more swimming. Pools in Alaska are hard to come by 🙂

 
Originally posted by: Bacstar
Thanks Rezinn. I'm waiting to hear back from my doctor. I spoke to my sister who works at a Cat-lab(sp?) for some advice, and she did warn me about the dangers of immediately discontinuing the use of atenolol. I'm covering my bases and joined a gym last night to start concentrating on some cardio-based exercises. Who knows...maybe I'm just out of shape even after losing the weight and working out on the bow-flex. It also gives me a chance to do a bit more swimming. Pools in Alaska are hard to come by 🙂
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Bingo! Your meds are certainly a contributing factor, but swimming endurance helps enormously. Can you swim 400 meters non-stop? If not, some pool training will help you a lot. Breast and Freestyle. Was your swim test done with the breaststroke? If so, you should know that breaststroke is the most demanding stroke aerobically. Anyone who can do 400 meters of breaststroke in under 8 minutes is fairly fit for swimming. You should be able to do 400 meters of free in under 7 minutes if you aren't old as dirt or handicapped. 🙂

Also, how old are you? Do you have any known other health issues? Have you had a GTT?
You need to go back to the doctor if it's been 6 months and your meds are problematic. Don't change your meds yourself!

Good luck!
-Robert

 
100 mg of atenolol is a very high dosage, which would make sense for your blood pressure of 238/140 but with your blood pressure being a little low now it is definitely time to lower that dosage significantly (taper it off). It is a beta-1 blocker that is working specifically on your heart, decreasing heart rate, contractility of the heart muscle, and thus the output of blood from your heart to your lungs and body. I'm guessing that with all of the exercise you have been doing your resting heart rate is low, and being on 100 mg of a beta blocker is just gonna make it lower, possibly too low to meet the requirements of heavy exercise such as diving. At high doses beta blockers have been shown to help precipitate type 2 diabetes as well. Imo you should go sooner rather than later to your doctor, and get checked up and meds adjusted.
 
Doc never called me back, and after talking to the nurses in the family, I decided to cut back to 25mg/day. So after about a week at this dose and still taking the other meds, my BP is great at 108/80...just checked, and last night swam a few laps. I was able to do 5 laps for about 125 meters freestyle, and got a little winded. I need to better manage my breathing...otherwise, I think i could have done the whole thing. I'm also getting over a cold i picked up over the weekend, so i'm not quite 100%.
 
Originally posted by: chess9


Bingo! Your meds are certainly a contributing factor, but swimming endurance helps enormously. Can you swim 400 meters non-stop? If not, some pool training will help you a lot. Breast and Freestyle. Was your swim test done with the breaststroke? If so, you should know that breaststroke is the most demanding stroke aerobically. Anyone who can do 400 meters of breaststroke in under 8 minutes is fairly fit for swimming. You should be able to do 400 meters of free in under 7 minutes if you aren't old as dirt or handicapped. 🙂

Also, how old are you? Do you have any known other health issues? Have you had a GTT?
You need to go back to the doctor if it's been 6 months and your meds are problematic. Don't change your meds yourself!

Good luck!
-Robert
Click to expand...

I just turned 41....relatively young....all the doc's think my HTN is genetic, and I may have exascerbated the problem by smoking, being overweight, and having a questionable diet. Apparently, meeting a special someone has inspired me to cleanup my act 🙂. I quit smoking too. Not sure what you mean by GTT? I've also been diagnosed with a heart murmur, mitral regurg, and had a sonogram of my heart which showed i had a backflow issue.
 
I guess I'll throw my 2 cents in

The hypertension - It's not uncommon to have multiple meds needed to control HTN. It's actually more the norm. Especially when you're talking genetic primary HTN. Also, atenolol 100mg is not a "very high" dose. It is simply the top usual dose. It's either usually either 50 mg or 100 mg daily.
Two issues I see - 1. with your lifestyle changes (weight loss, exercise and smoking cessation) it is very possible that your HTN drug therapy can be pared back, HOWEVER, now that you mention the murmur, and the mitral valve issue, you shouldn't make any changes that don't come from a cardiologist. The diovan/HCTZ work on fluid balance but the atenolol and to a lesser extent amlodipine have actions that go beyond HTN and deal with heart rate and rhythm control that you may need. I would defer any decisions there to only a cardiologist, and I have a Doctor of Pharmacy degree.
Diovan is an ARB - ARBS do basically the same things as an ACEI such as lisinopril. All of the ARBs and especially that combo are still brand only. You could save money if you were switched to a ACEI/HCTZ combo, such as lisinopril/HCTZ
HCTZ is a great medication because it is effective cheap and we have 30+ years of data on it. With that said there is another drug in the class, chlorthalidone, that has fallen by the wayside but is gaining attention again. It looks like it may be more effective in controlling difficult cases of HTN. If you were switched to it it may improve your control and allow for another med to be dropped.

The sugar thing: You didn't really say but it sounds like you may fall into pre-diabetes? The diagnostic criteria for Type II Diabetes is two fasting (12 hour fast) plasma glucoses of equal to or greater than 126. If you fall in the 100-126 range they'll call it impaired fasting glucose or pre diabetes. A GTT is a glucose tolerance test, which is another tool. They give you 75g of sugars which somehow still tastes bad so I hear and check your blood sugar level 2 hours after that. I think the line for that is 200 but I'd have to look it up again.
Anyway, three issues. Where do you stand right now? Have you been checking you blood sugar in the morning? Are they normal? It's possible right now that with the weight loss and lifestyle modifications you may not need the metformin at this point. People who lose the abdominal weight do sometimes get their blood sugar under control and get weaned off. Also, metformin ER is taken once daily. That's the point of the ER, you don't have to split it twice daily. I'm not sure if you meant you take 2 once a day or 1 twice a day. Metformin is a good drug. It's first line for people with diabetes because it has the best blood sugar effect of any of the oral meds and it is also associated with weight loss.
If you fall into any diabetes category I'll note that it's automatic to be put on an ACEI or ARB. They're known to be renal protective, and fend off long-term nephropathy associated with diabetes, but kind of sounds like you're not a full diagnosis, which is good.

These are just points you can bring up with your doctor. Don't make any changes without consulting your physician. And most importantly don't sue me - I don't have my umbrella policy in place yet 😉
 
hehehe no worries... my physical I had for the diving thing, the doctor who was filling in, my regular doctor was on vacation, has me taking my glucose levels once daily. It varies from 90-110 depending on when in the day I take readings, usually two hours after eating. I do take metformin 1 pill twice a day, morning and evenings.

I definitely will see the doctor again, probably after vacation, and other than being sick, I'm feeling pretty good.
 
Everything that getbush is correct.

Your hypertension has significantly improved (most likely because of the weight loss and exercise).

Your doctor should be able to taper you down on atenolol (which most likely caused the symptoms you talked about). Reducing the dosage should be enough to prevent similar symptoms.

I don't think your doctor will want to discontinue it completely - when taking a calcium channel blocker (amlodopine) you need to give a beta blocker to prevent rebound tachycardia (rapid pulse). In addition to helping with hypertension, both of these meds (calcium channel blockers and beta blockers) are indicated for various heart issues, such as mitral regurgitation.

Don't make any changes without consulting your physician.
 
Congrats on your successful surgery. GL with your certification but swimming/diving in cold water doesn't seem enjoyable to me. 🙂
 
Originally posted by: RKS
Congrats on your successful surgery. GL with your certification but swimming/diving in cold water doesn't seem enjoyable to me. 🙂
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We dive in a dry-suit, so it isn't so bad. In the winter though, the tough part is getting out of the water. The water is warmer, believe it or not 🙂
 
I'm glad you had a successful valve replacement. You need to be a lot more careful now you're on coumadin. 🙁
I was going to suggest that the B-blocker wasn't your problem and that you needed to get checked out ASAP. I see I'm about 6 months too late though!
Good luck to you in the future. Just curious if you know the etiology of your mitral regurg?
 
Originally posted by: interchange
I'm glad you had a successful valve replacement. You need to be a lot more careful now you're on coumadin. 🙁
I was going to suggest that the B-blocker wasn't your problem and that you needed to get checked out ASAP. I see I'm about 6 months too late though!
Good luck to you in the future. Just curious if you know the etiology of your mitral regurg?
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It was actually just a repair. I wouldn't be diving if I got the replacement. Whew it was a relief when I woke up and found out that everything went well.

If you're interested in reading the surgeon's report, send me a pm and i'll email it. I think it says that there was little prolapse, and there was a cleft in my posterior leaflet or was it anterior...hmmm... and because it looked odd, he had a sample tested, and it came back negative. Surgeon and cardiologist have no idea what could have caused it, especially after cutting me open, maybe a childhood disease or an accident??? guess i was just lucky 😉
 
Well...I completed all my dives over the weekend, but I think I may have over worked the ole ticker. I had shortness of breath again upon surfacing from my last dive, so I went back to the doctor, and my murmur is back. I had an echocardiogram redone yesterday.

I'll be going in a couple hours for the results. Hopefully, it's nothing serious...

:brokenheart:
 
Best of luck, man. You really gotta take a step back and realize where your limits are. I know you want this scuba thing, but I know you want to live a fair amount more as well. Be careful.
 
Originally posted by: SociallyChallenged
Best of luck, man. You really gotta take a step back and realize where your limits are. I know you want this scuba thing, but I know you want to live a fair amount more as well. Be careful.
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I second this,

I hope your test comes in okay. But also know diving isn't for everyone.
 
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