AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question Last year I had a false positve reading of pulmonary HTN on an echo. It kept showing up so they finally did a right and left heart cath in March of this year. The heart cath was perfect. No blockages, no pulmonary HTN, everything was fine. I have panic disorder and that is what started me on meds for high BP in June of 08. I was put on a 5 mg dose of Bystolic beta blocker and 1.5 mg of Klonopin. Recently I noticed I was getting very tired and I checked my BP and it was around 90/60. My heart rate was slow too. Around 59-60 BPM. No dizziness or syncope though. I called the cardio doc to ask if I could cut the 5 mg of Bystolic to 2.5 and they said yes. I did so and two weeks in now I am having some spikes of BP around 137/90 and every morning around 5:00 I wake up with a racing heart rate of around 120. I can calm it down back to normal by doing deep breathing but it is very scary. I have read horror stories about what beta blockers can eventually do to your heart and really wanted to come off of it or at least lower it. Now I am not sure what to do. I know the body can react to weaning meds like this and when I call my doc they do not seem one bit concerned but it's very scary and I am afraid my BP will spike even higher eventually in my sleep and I will have a stroke. I was thinking maybe a better plan would be to go back up to the 5 mg of Bystolic and start trying to wean the Klonopin since I have weaned it anyway by .5 w/no withdrawal symptoms. Maybe I need to stay on the 5 mg of Bystolic and work on getting off that instead? High BP runs in my family and mine was labile for a while and finally went to sustained however I have been able to control my panic disorder on and off over the years w/o meds such as Klonopin but my parents are both on high BP meds to stay. I just hated feeling so tired on the Bystolic and felt as if I was losing interest in the things I used to enjoy. What are your thoughts? Is taking a beta blocker long term really that harmful to the heart and are these spikes and the racing heart at 5:00 AM temporary or dangerous? Or can you really even know for sure? Thanks for your time and any advice you can give me. I am 41 years old, female, 5'3 and weigh 128 pounds. I do not exercise enough but want to but am afraid to do it with a BP as low as 90/60.
Answer This is an interesting yet complicated set of questions. First off, the awakening at 5:00 am more likely represents a "panic" episode and not withdrawal from the beta-blocker. Second, the long-term negative effects with beta-blockers and their harming the heart is more an urban legend than a true fact? Third, the low blood pressure and fatigue are related to the Bystolic and your best bet would be to get off this medication and treat your panic tendencies/episodes more aggressively. Although I am not able to see you face-to-face if i were treating a patient such as yourself I would most definitely address the panic issues first and thereafter if needed tackle heart rate/spiking blood pressure if it remained necessary. One final thought, beta blockers are good drugs for anxiety as an adjunct feature and it may be that your panic tendencies are being suppressed by it and become manifest with dose reduction. I hope this helps some. If you need follow-up thoughts please feel free to e-mail back.
