Family, Internal Medicine, General Medical Questions/COuld This Low BP Be a Heart Thing??

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QUESTION: I am scared--here is why-after I explain why I will list all meds that I have been on daily for 8 years.  I am female, post menopausal, age 53, white, hypertensive, uncontrolled type 2 diabetic(A1c for 4 yrs ranges 8.3% to last months 10.3%). But all in all I have been a diabetic since 1990. About 3 weeks ago I noticed my diastolic blood pressure was staying in the 60-69 range no matter if I sat, stood, walked, stressed, was scared, any time it stayes like that -and I do have anxiety attacks and always have-so this is unusual AND I am under great stresses-disbility is only income- 3 college kids at home, single, caregiver for 93 yr old mom with dementia,e tc(so u see I am stressed). My BP on Benicar HCT 20 mg a day  and it has ALWAYS (for 8 yrs) been between 130/76 to 140/85, pulse has ranged normal to 110-BUT for 3 weeks it has all changed-and that is not me and frankly I am terrified-it is all I think of.  I do not feel tired; I am dizzy sometimes(but I also have Meniers Diease in right ear and BPPV in left so that could be the dizziness); when I bend over and raise I see spots and somewhat dimmer vision a few seconds then it passes. I figure my dizziness is 1 of 2 ear conditions OR my chronic sinusitis-now I wonder with BP staying mainly 114/60-124/69, and in the last 2 days the pulse is now 66-72 a lot and as the days go into late nights the diastolic stays 60-66, rarely 70 and pulse gets ok at 80.  The 66-70 pulses just started...I thought being thru menopause that this is the new me(3 yrs post) then I read online (yes I did) that it can be heart attack, heart failure,bad heart valve, stiff arteries and plaque from uncontrolled diabetes...and I have flipped.  I have an echo doppler every year and in 2012 (Feb) it was normal and so was carotids(not tested this year.).Everytime I haev called my Dr the staff he has is not great-they hear me and say all is good and never tells the Dr why I called...one nurse did tell me on her own to cut the Benicar HCT from 20 to 10 mg 16 days ago and I did-that only raised the systolic about 8 points,from 106 to 114 alot, and did nothing to the diastolic.Meds for 8 yrs are: LAntus 55 units, Benicar HCT now 10mg one daily, Glucophage 1000mg one daily (was just cut from 2000mg due to high liver enzymes and fatty liver)Glucatrol XL 10 mg, twice daily, Nexium 40 mg, one daily (horrid reflux),Zocor 20 mg (just started back after a year being off) and Tranxene 7.5 mg as needed for anxiety(I only have enought o use 2 pills a week). Sugars were for months everyday fasting or not 300-410--now with me taking it serious(which I should always have done) it is 170-220 range-I am afraid something has happened to me from the diabetes or whatever and I dwell on it--I need your expertise in evaluating all I have said-Myghastro MD refused my first colonoscopy last week due to the high sugar...my liver enzymes both have been moderately high one straight year-I do not drink nor smoke; the Gastro scared me worse saying I am killing myself-he would not discuss the BP issue.. My last workup in lab was early June-CBC CMP, thyroid all good. Lipids 220 cholesterol, 400 triglycerides, electrolytes good, vitamin D low, a1C 10.3% (no surprise). Dr says nothing much except that it is UN acceptable (I know that already).Just spell out what MAY be the issue I know it is just a hypothetical thing...

ANSWER: obviously something is changing.....   I would check blood counts... kidney function, cbc, and thyroid tests.  I think the decrease in Benicar was a good idea but I would be looking more for a cause.   I would also re-evaluate your diet with the A1C so high.... typically back way off on your carbohydrate intake and see if you can get those numbers improving.  Keep working on reaching your doctor......

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QUESTION: I agree although in May I had the recommended tests u advised me to and all was normal-again though, this bp issue started late June-July 1st-I realize u cannot diagnose via internet BUT I just need an opinion-I have never smoked nor drank, and do u think that there is a big chance I could have had a mild MI or valve disease? I am 3 yrs postmenopausal as well-could it be I am finally "settling down". I have so much stress I am told that I can get low BP by stress and even drinking a lot of water- and ER nurses I know are the ones saying this--i sthi strue? I started back today on half rather than 1/4 of the Benicar HCt 20 (making it 10mg) and till about 6pm I felt weird and yucky-starts about an hr after I take it with breakfast. The reading now at 11pm is 100/60...today was 128/68 and 138/66 then back down to 118/70 and 104/62--all with manual stethoscope testing. I appreciate any guesstimate u may offer; please do not be reluctant to just spell it out to me...I would neverthink these numbers were bad but it is just that for over 15 yrs I have never ever been known to have numbers so low, especially during stress

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I am not sure I buy the concept of increasing fluids and increasing stress lowering your blood pressure.  Something has changed and without other symptoms, I am not really thinking about MI or valvular heart disease.  I would recheck kidney function, (easy and cheap to do) and see how the medicine transition affects everything.

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Robert Borucki

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