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Geraldine asked...

Is there any alternative to beta blockers?

I am 67 years old and have suffered from medium to severe ME for over 15 years. 10 years ago I had breast cancer and had a lumpectomy. Just over a year ago, I started suffering dizzy spells and had several vasovagal syncopes episodes which my GP said was due to low blood pressure (I have had low bp most of my life). The dizziness occurs at any time and whether I am active or not. I have had palpitations but the dizziness doesn't always occur when they do and occurs at other times. I also have developed quite bad tinnitus. I tried tablets for vertigo and had an MRI scan on my head. An ECG showed no abnormalities.

In January I had an Echocardiogram and wore a heart monitor for 4 days. Results from these show that I have an ectopic heartbeat and the consultant told me I had a slight heart murmur but he didn't include this on his notes to my GP. The consultant has suggested I take beta blockers. However I couldn't cope with any more weakness or tiredness than I already do with the ME. At the moment my GP has put me on a 10 day supply of Zopiclone to try to regulate my sleep - I have been going to sleep at any time between 2.00am and 7.00am and sleeping for maximum 5 hours for several months now. I have 3 tablets remaining of the course and the GP will then double my dose of Amitriptyline from 10mg to 20mg.

My blood pressure when I saw him was normal, however it was 170/80 when I saw my GP last week; this week when I had a blood test for Hypothyroidism after a few nights of 7-8 hours sleep, it was 159/80. (I have taken 75mg of Levothyroxin for several years). If there is no improvement, then he wants me to try beta blockers.

I am overweight mainly through lack of being able to exercise but try to eat healthily. I lost 5 stone but have put 2.5 stone back on - trying to lose it again. I have a box delivery of fresh vegetables (in addition to those I grow myself), rye bread, meat and fish and buy from my local market and rarely have ready meals, but obviously eat too much! I eat loads of vegetables, have more chicken than other meats, don't eat much fruit (I had a burst stomach ulcer 50 years ago) other than apples, plums and blueberries and I don't have a sweet tooth. I do drink red wine, probably more than I should but obviously not while I am on sleeping tablets.

Is there any alternative to beta blockers and is there anything I can do myself to avoid having to take them?

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The answer

Thank you very much for your question and for taking the time to provide us with a detailed medical history.

From your question I can’t be sure whether the beta-blockers have been suggested to control your blood pressure or in relation to the ectopic heartbeat or palpitations, or indeed for another reason. Therefore it is difficult to comment as to whether an alternative is a possible option. If it is being recommended for your blood pressure then there are a number of other medications that could be prescribed. Beta-blockers are not usually a first choice for high blood pressure treatment these days, although sometimes they are still prescribed for this in a patient not suited to the other options. However, it is still a first-line choice in the case of palpitations and anxiety.

Current guidelines recommend that medication is started in all patients with blood pressure of 160/100 or greater. However, some patients are started on tablets if their blood pressure is regularly 140/90 or above, depending on their medical history. It is also now recommended that in order to ascertain whether a patient has hypertension, they should undergo ambulatory blood pressure monitoring (ABPM). This is where a patient wears a device which measures their blood pressure over a 24 hour period, whilst the patient goes about their normal activities or daily life. This then gives a realistic measure of their blood pressure, as measurements in the surgery do not always give a true picture. Sometimes instead of using ABPM the patient is loaned a blood pressure monitor by the surgery, which they use at home. They then take a measurement in the morning and evening for 7 days and record the results. These results are then discussed with the GP who makes a decision, alongside the patient, as to how to proceed.

It sounds like you have tried hard to address the areas in your lifestyle that add to your risk of high blood pressure. Certainly maintaining a normal body weight is beneficial. A loss of 10kg in weight has been shown to reduce the systolic blood pressure by between 5 and 20 mmHg. Consuming a diet rich in fruits, vegetables and low-fat dairy products with reduced saturated and total fat can reduce the systolic pressure by 8 to 14 mmHg. Reducing salt intake as much as possible can cause a lowering of 2 to 8 mmHg systolic pressure. Moderating alcohol intake down to 1 unit per day can cause a 2 to 4 mmHg reduction. I know that physical activity is difficult for you. Somebody who is able to undertake aerobic physical activity of at least 30 mins per day, on most days of the week, can lower their systolic blood pressure by between 4 and 9 mmHg.

I hope that this information has been helpful for you.

Answered by Health at Hand nurses.

 

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