Expert: Newell R. Falkinburg, M.D. FACP - 10/7/2007

Question
i am treating my patient with hydrolozine for her hypertension. her blood pressure came down now her heart rate is elevated what to do

Answer
Dear Tenesha,

Can I assume that you are a physician???

Hydralazine is a potent vasodilator that has been around for many decades.  It is, unfortunately, fraught with undesirable side effects.  The most common of these is tachycardia that results as a consequence of the vasodilatation and the RELATIVE intravascular volume depletion it causes. The vasodilatation causes a dramatic increase in vascular capacitance.  Tachycardia ensues, as well as a great tenancy to sodium retention, edema and headache.  The most feared complication is coronary insufficiency, precipitation of angina and myocardial infarction related to the fall in ventricular diastolic filling time due to the tachycardia. Generally speaking, it is no longer a good medication for the treatment of hypertension. There are many other options with fewer side effects.

I would suggest that you change to an ACE inhibitor like lisinpopril with or without a low dose thiazide.  This will almost always result is a smooth and predictable fall in blood pressure without significant side effects.

Thanks for your question and please feel free to follow up.

Sincerely,

Dr. Falkinburg