Avoid BP meds if pulse is on slow side

Dear Dr. Roach: My systolic blood pressure is high (155), and my pulse is low (55). If I take blood pressure medicine to lower my systolic pressure, will that lower my pulse and create a bigger problem?

A.K.D.

Answer: Although some blood pressure medicines do slow down the pulse, most doctors would avoid using them in a person who already has a pulse on the slow side.

While 55 is not dangerous, it could drop further with a beta blocker or some calcium channel blockers, which slow down the heart and lower blood pressure.

If your diastolic pressure is normal, then you have “isolated systolic hypertension,” and in many cases the best blood pressure medicine to use is a diuretic such as hydrochlorothiazide or chlorthalidone. These have been shown to reduce the risk of stroke better than other blood pressure medicines in older people with isolated systolic hypertension, and they do not lower the pulse rate.

Choosing a blood pressure medicine should take into account a person’s underlying medical conditions, not only to avoid side effects and toxicities, but hopefully to get additional benefits from one medicine.

Dear Dr. Roach: I would like to know more about dropsy. I can’t take water pills because of hard stools.

R.R.C.

Answer: Dropsy is a very old name for swelling, or edema, from the Greek word for water.

The term is most often used to describe the feet swelling common in congestive heart failure, but it can also be used to talk about swelling of other parts of the body or from other conditions.

Diuretics (“water pills”) are commonly used for people with congestive heart failure resulting from a variety of conditions, but do not always have to be used. Other classes of medicines are effective not only at improving symptoms, but also in reducing the risk of death due to heart failure, which diuretics do not do.

Further, if a medicine is so important that it needs to be used, doctors sometimes prescribe a second medicine (such as a stool softener, in your case) to counteract side effects from the important medicine. This is inelegant but sometimes necessary.