Blood Presuure during a stress ECG

['I' in the sky]

During a recent stress ECG my blood pressure peaked at 160/80.

Whilst I know the 160 is high for a resting BP I would have thought it normal for it to rise during a stress ECG but the cardiologist wants to put me on beta blockers. Was this BP excessive ?

Has anybody else had problems with beta blockers ? I normally do a lot of running but the first time I went after starting the beta blockers my legs felt absolutely lifeless.

Thanks

[QDMQDMQDM]

That does not seem an abnormal BP response to me. Failure of blood pressure to rise with exercise is a poor prognostic indicator with a strss ECG.

[gingernut]

I wonder if he may have commenced beta blockers for a slightly different reason, a beta blocker wouldn't usually be the first line of treatment for uncomplicated hypertension.

Why were you undergoing the stress test in the first place?

[SJG1]

During my Class 1, my BP was 156/80. The doctor didn't even question it. He put it down to white coat hypertension.

It's worth getting it checked out though.

[slim_slag]

Hmmm, 156 isn't a good number. Probably worth getting yourself a decent home BP machine and measuring it yourself half a dozen times. If the doc is right then no worries, if he is wrong then you can go to your GP with your measurements and discuss. Anything above 140 means off to GP. 120-140 means do the lifestyle modifications you hear about, and if they don't bring it down then off to your GP.

[MarcJF]

I'd also question the use of Beta Blockers in the first instance. I had a slightly raised BP and was given the same, next doctor told me they were completely innapropriate and went for ACE inhibitors. I've never looked back, low dose, no tiredness etc. Worth a second opinion maybe?

[Flyin'Dutch']

Few folks with 'straightforward' hypertension will be doing an exercise tolerance test so 'I' may well be on a B-Blocker for other reasons than hypertension.

Until recently they were pretty much first line treatment, certainly in the UK. However additional research and the lowering in cost of ACE-inhibitors has moved them a few rungs down the ladder.

They do still have a place in certain cardiac conditions.

['I' in the sky]

Sorry for the delay in acknowledging and responding.

The reason for the stress test was because of some chest pains which I had last summer which I thought were probably muscular or tendon damage but weren't clearing up. Onemorning they were particularly acute so I went to the hospital just in case. After 4 ECGs, 3 blood tests and an X-Ray they agreed it was probably muscular as there was absolutely nothing abnormal in any of the tests they had done, but as I was on an ACE inhibitor (20mg per day) for my bp and statin for my colesterol they recommeded I see a cardiologist as a precaution. I saw one about two years ago ( required by the CAA) when I first started the bp medication and everything then was fine - he never did a stress ECG but did do an ultrasound scan.

This time the cardiologist wanted to do a stress ECG so it was done. His report said the ECG was good and I was at low risk of any serious cardiac problems but suggested being prescribed 5mg per day of this beta blocker to "further minimise my risk and reduce blood pressure"

The report didn't state what my bp was during the test, he only told me because I asked. Resting before the test was 110/60 which for me anyway is low. About 5 minutes into the test it was 130/70 and peaked at 10.5 minutes at 160/80.

Nor did he say what my pulse was which is what I thought beta blockers were mostly about controlling but from my own monitoring with a bp machine and cardiac belt I use when running and cycling, my proper resting pulse, ie first thing in the morning averages about 58. If I just sit down in the middle of normal daytime activities and take a pulse it is about 80 - 85.

Yesterday I checked whilst running, average pulse over 20 minutes 148. That's without beta blockers.

I'm living and working in Spain at the moment and it's difficult to discuss this in any detail with my GP. It just seems to be prescribe, prescribe, prescribe.

[gingernut]

We're all having a bit of a guess here, as we're not in possession of the full facts in your case, but reading between the lines, it's probably a reasonable decision on behalf of the cardiologist. Unfortunately the "heavy muscles" are a bit of a pain with these drugs.

As stated, Beta blockers arn't the first drug of choice for hypertension, now, but thousands of people are taking them safely for this condition. Interestingly, they sometimes have other "spin off" desirable effects, such as controlling the physical manifestations of anxiety.

It does sound like your in pretty good physical shape.

It might be worth making the effort to speak to your GP, he's probably got a clearer picture than us. Hopefully this could allay your worries. Most are accessable via the telephone.

(do the CAA communicate with GP's - I don't know?)

[priapism]

Beta blockers can be entirely unsuitable for some people. Although they certainly have anti-hypertensive properties , as their name suggests, they are beta-adrenergic blockers. Adrenaline and nor-adrenaline are the chemical neuro transmitters for the sympathetic nervous system which is responsible for the rate and force of contraction of the heart.

By artificially inhibiting these neuro transmitters , the net result is a drop in blood pressure together with a slowing of the heart rate. The combination of the two means that it render some people dizzy , faint etc. In an unmedicated person this drop is automatically compensated for by vaso constriction and an increase in heart rate to increase circulating volume.
A person on beta blockers has this reflex inhibited.


I think I would be asking my doctor for ACE inhibitors - Angiotensin converting enzyme inhibiters . They work by inhibiting an enzyme which causesthe kidneys to retain sodium and therefore water. Instead they are excreted and blood pressure is reduced simply by reduced volume without the secondary effect of slowing the heart.

[corsair]

I have hypertension, which they annoyingly discovered on my class 1 renewal. Initially went on ACE inhibitors but while they worked to some extent I was still marginal on a 24 hour monitor, so I was put on a beta blocker as well and have remained nicely below limits since.

While I have some muscle tiredness, I attributed that to age and a general lack of fitness. I suppose it is possible it's caused by the beta blocker. One thing I have noticed with beta blockers is a vague sense of well being which I have heard that people experience when taking beta blockers. But it's too subjective to be conclusive. What I did notice when I foolishly ran out of medication for a week or so, was an increase in headaches partucularly on waking in the morning, (not a hangover!).

It's hard to draw any conclusions. I'm lucky to be without side effects, except the possible 'sense of well being', which as side effects goes is a pretty good one to have.:cool:

[Thomas coupling]

Just had my licence pulled due to SVT's on my stress test. Prescribed Betablockers (Bisoprolol) but heard that BB's cause some neasty side effects namely tiredness/fatigue/depression/ erectile disfunction!!
Also heard that ACE inhibitors increase the rate of morbidity by damaging the kidney/liver over time.
Anyone out there on BB's who has some good news..............?

[gingernut]

Yes, beta blockers have recieved a bit of bad press lately, and any drug has the potential to cause adverse effects. Having said that, they have been used for many years, on many of thousands, safely and effectively.

Hopefully, your prescriber should have weighed up the pro's and con's of your treatment carefully, the key, Thomas, is to liase closely with him, and report any undsirable effects.

As far as ACE's are concerned, on the balance of things, they're more likely to prolong the quality and quantity of your life, rather than shorten it.
:)

[corsair]

Thomas, I'm on bisoprolol and have never felt better. No sign of tiredness/fatigue/depression/ erectile disfunction!! In fact my wife has just had a baby, so no dysfunction :p Same goes for the ACE inhibitors.

[priapism]

Thomas - SVT's , or supra ventricular tachycardias are an entirely different medical problem from hypertension. It is an episodic dysrhythmia of the conduction system of the heart which results in it beating way too fast. I have dealt with patients who have had rates of well over 200.
ACE inhibitors would not be at all appropriate for this condition.