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Foundation Staff
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Posted: Mon Sep 26th, 2005 04:13 |
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My blood pressure is already low. Can I take Benicar?
There are no standards for what is a low blood pressure, nor is there any proof that the values normally used to indicate low blood pressure in healthy patients have any relevance to Th1 inflammatory disease patients. Even patients with extremely low blood pressure (85/55 or lower) have been able to continue taking Benicar.
An accurate assessment is complicated by the malaise/fatigue which is caused as the bacteria die (immunopathology). The endotoxins totally upset the body's hormonal balances and the readjustment process can cause symptoms such as vertigo and dizziness which are from the disease not from the lower BP.
Benicar acts as an antihypertensive only up to a dose of 40mg per day. Beyond that the hypotensive effects are minimal. Therefore, taking Benicar more often will not continue to lower the B/P or deplete sodium. The fact that Benicar is such a weak anti-hypertensive is why doctors don't use it more often. Many MP patients see little change in their B/P with the MP schedule of Benicar.
Some folks see their BP low at the same time as their hormones are out-of-whack and incorrectly assume that the BP is a cause of problems. But they are wrong. The BP is a sign of problems.
Your BP will stabilize back towards 'healthy normal' as the MP progresses, and the disease is removed. The symptoms thought to be due to low blood pressure will resolve even if the low blood pressure persists.
People who function well while maintaining low blood pressures have lower rates of cardiovascular disease events than people with normal blood pressures.
Blood pressure fluctations are due to the inflammatory disease not Benicar. Reducing the dose will eliminate the inflammatory blockade and make the situation worse.
You must expect that Benicar will allow the immune system to function better and that the bacterial kill will cause an increase in inflammatory symptoms. There is also the hormonal adjustment that is coloring the picture.
Advice given by Dr. Blaney on DVD. When low blood pressure and other debilitating symptoms occur, lay low, stay in bed, drink adequate fluids, eat salty foods and wait for the symptoms to wane.
It is not necessary to monitor your blood pressure. Consult your doctor if you are concerned about any symptoms.
Some MP doctors do not recommend blood pressure checks. They simply tell their patients to lie down if they feel dizzy. We don't want people to be overly concerned about the number that their blood pressure monitor says. The MP phase one guideline includes the suggestion to monitor your blood pressure daily only because at that time doctors seemed to need the reassurance. We now know that symptoms which appear to be caused by hypotension (dizziness, fatigue, lightheadedness) are a result of the disease and will resolve as the inflammation resolves no matter the number of the blood pressure. Monitor your blood pressure only if your docctor insists.
In 2004, the NIH issued new blood pressure guidelines for clinical practice. Now, only blood presssures below 120/80 are considered to be normal.
See When and why should I vary my Benicar schedule?
If your doctor suggests that you should start at a low dose of Benicar and ramp up, explain to him that this will likely make you feel worse and it will not make any difference in the antihypertensive effects. The following papers should help him understand:
Valsartan Dosing Regime Modulates Psychotic Events in Two Sarcoidosis Patients
Putative Antibacterial Mechanisms for Angiotensin II Receptor Blockers
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"The latest recommendations regarding blood pressure is that anything over 120/70 is to be considered hypertension (high blood pressure) and the physician is charged with trying to get the pressures below those figures.
Your nephew is right where he is supposed to be (110-120 over 60).
Actually, we really don't consider blood pressure to be low unless the pressure will not support the person when (s)he goes from laying to sitting to standing. If (s)he can do that without blacking out, the pressure is fine." ~madwolf
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Please let your symptoms be your guide, not numbers. This FAQ may also be relevant:
Why does my BP fluctuate?
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"A significant number of people in the test cohorts for the initial FDA ARB trials exhibited an increase, rather than a decrease, in blood pressure. The FDA commented to me that they already knew about that.
Our molecular work has shown that this is because the hypotensive effect of these medications is primarily mediated by action upon the nuclear receptors controlling the disease state, more so than upon the Angiotensin receptor, which, in any case, has never been shown to directly control blood pressure."
..Trevor..
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Do you have symptoms that Dr is attributing erroneously to low blood pressure? See Why am I dizzy and/or fainting? What should I do?
If you cannot persuade Dr that low blood pressure is not an obstacle to continuing the MP, then you will need to find another doctor.
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When I started Benicar and became dizzy, I assumed it was my very low blood pressure. Trevor told me it was the disease causing the dizziness. I didn't believe him until months later when the dizziness had gradually subsided. I did notice once when I was hypovolemic that the dizziness was worse. But drinking enough fluids and getting enough salt in my diet is not a problem. I'm still taking Benicar every six hours and my blood pressure is usually 75/55 on a busy day. I experience very transient dizziness rarely now which I attribute to the immunopathology. Surely if it were my low blood pressure, I would be dizzy all the time.
My B/P in the middle of a busy workday is routinely 75/45. I have no symptoms related to this low blood pressure. I had some lightheadedness in the early days of the MP which gradually resolved as my inflammation resolved. I suspect that when Th1 inflammation is conquered, the medical community will have to redefine normal blood pressure. ~Meg
-Our PCP, who has not been MP supportive, was visibly surprised and said she was amazed. Implied--at her clinical improvements since her last appt in July and her normal blood pressures while on the high off-label dose of benicar. ~Caroldeleah
Last edited on Sun Oct 5th, 2008 09:08 by Foundation Staff
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Posted: Thu Dec 15th, 2005 14:37 |
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Reports from others with low blood pressure
(filelink)
Petervda51 wrote:
...CHECKED MY BLOOD PRESSURE FOR THE FIRST TIME FOR MONTHS THE OTHER DAY AND WAS SURPRISED TO FIND IT AT 87/55,AND I AM NOT HAVING DIZZY SPELLS AS I WAS EARLY IN THE PROTOCOL WHEN MY BLOOD PRESSURE WAS LOW,I ASSUMED MY BLOOD PRESSURE WAS BACK TO 120/80 OR SOMETHING CONSIDERED MORE THE NORM,IT WAS A PLEASANT SURPRISE TO FIND MY BLOOD PRESSURE SO LOW AND MY CONDITION IMPROVING...
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Kas wrote:
Your doctor is reacting the way most do to very low blood pressure. You have to convince him/her to allow you to stay on the correct dosage of Benicar for a bit longer. Taking less, as I know from experience, will only make you feel worse, but will not have any effect on the low numbers. Go to "Kas in Phase 1" to see my reports there. One day, I took less, felt worse, and my BP was even lower than it was on the correct MP dosage! When my doctor realised that, she allowed me to take my Benicar as recommended, and with time, things settled down very well and she ( and I ) stopped worrying about low BP altogether. These day, four months into the MP, I still have some really low BP ( around 75/45), but, ironically often feel much better then than I do at higher readings, which goes to prove that the Benicar is not causing your problem, but the disease process is. At my last doctor visit, I had a BP reading of 100/70, which is the highest I have ever been - even not on Benicar, and that day, I had taken it every 6 hours. Today, I am back to 76/46, and feel just fine there ( I took it to show you!).
Even with my low BP, I have never passed out, I am able to lead a full life within the MP parmeters, and work as a teacher. I keep a bottle of water with me at all times, as the more hydrated I remain, the more stable my BP is, even if it is very low. If I feel bad during my working day, I take an extra 20 mg of Benicar, my BP goes UP and I feel heaps better.
Benicar is an amazing drug. You have to start viewing it as your friend. Since being on it, my lung crackles are much improved, my dry eye has vanished, my leg and feet pains are so much better and even my liver enzymes, although not perfect yet, have stabilised- all this after a mere four months.
Hang in there and educate your doctor on an ongoing basis. If that does not work, it may serve you well to try and find another if you are adamant about wanting to do the MP.
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Claudia:
Have been to have my kidney function and BP checked and everything is much improved! Having increased my Benicar frequency to 6-hourly my blood pressure has risen to a respectable 94/57. This is remarkable, as it had stabilized at 80/40 since I was in Phase 1.
So this is a lesson to others whose doctors panic and say "woah! your BP is dropping, you should take less of that Benicar". The counter-intuitive answer is to TAKE MORE instead.
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Grace:
I was one of those who felt worse when started benicar. My POTS was really bad. Within seconds my bp would go to 120/90 to 80/40 and pulse 80 to 120 with feeling faint etc pre MP. I have no POTS now. My BP is still low 80/50 but I never 'feel' the low pressure, or faint or rapid heart rate.
My husband also has CFS. His BP was always really very low, he took a few 'turns' out in public, his poor doc would get readings 80/50 or less.. But late 1990's/early 2000 BP lowering drugs were being used for CFS folks to improve their low pressure and it did help him, so we knew that MP using Benicar was on the right track again. see also Grace All the things I can do.
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Posted: Fri Oct 13th, 2006 15:45 |
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Dr Marshall re low blood pressure
(filelink)
How could Benicar be the culprit? The FDA found it to be one of the safest drugs in the US formulary after it had gone through the very latest, and most rigorous, of approval processes. The FDA concluded it will lower blood pressure by an average 12mm of mercury. There is a graph given on the prescribing instructions (package insert).
Your disease is therefore the culprit. Possibly your other medications, it is not possible for us to guess at that.
Dr Greg Blaney covered this topic excellently during his presentation at our conference, last June, on how to interact with your health care providers. He gives your precise situation, that of hitting the panic button for perceived low blood pressure, as an example. His advice is excellent. I suggest you listen carefully to what he said.
The Sampler DVD (with his talk on it) is already available, I will mail you a copy if you send me a PM with an address to send it to.
I would, of course, be happy to discuss the issues with any of your physicians, if they call me.
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