Discussions that mention spironolactone

High & Low Blood Pressure board


Hi Beerzoids,

I am sure you've done plenty of research before deciding to add this beta blocker to your therapy. I would have done the same. My book about cardiovascular pharmacotherapeutics has some interesting information that might explain your rise in blood pressure upon initiating the beta blocker therapy.

Apparently, non-selective beta blockers can cause peripheral resistance to rise by leaving alpha stimulatory mechanism unopposed. They say that one should ask if there's a clinical correlation between the beta blocking effect on the plasma renin activity and the lowering of blood pressure. :confused:
High renin patients do not respond to beta blockers and may even show a RISE in blood pressure.

Some beta blocking drugs can antagonize symphahetically mediated renin release. (one of several mechanisms utilized in the release of renin). Other major factors are renal perfusion pressure, posture and a sodium balance. The COMET trial with Carvedilol and Metoprolol is mentioned here. There is also a long list of possible mechanisms by which the ventricular function is thought to be improved with the use of this drug in heart failure. The beta blockers' effectiveness lies in blocking the neurohormonal cascade which leads to progression of the disease.
The beta blocker I take, Bisoprolol, is also approved for use in heart failure. Spironolactone, an aldosterone antagonist, is supposed to be helpful in treating CHF. I take 5mg of Bisoprolol, which is not a very high dose. It does not interfere with my breathing at this dose the way the non-selective beta blockers do. I wouldn't know what (if any) side effects I might be experiencing from this drug because of the other drugs I also take. Probably shortness of breath if I exert myself too much - which I try very hard not to do. :D
I wish you the best of luck with Carvedilol - it seems like a perfect drug with very impressive results in the trials. I hope your blood pressure levels off and eventually gets back to normal.

flowergirl
[QUOTE=flowergirl2day;3507228]Hi Beerzoids,

I am sure you've done plenty of research before deciding to add this beta blocker to your therapy.

Hours and hours, days and days. The medical stuff can be difficult to read. Right now I've got six web pages open about Coreg. I'm trying to find out about interactions with my other medications, especially with Verapamil. Coreg makes for a very powerful and beneficial combination with an Ace Inhibitor and Digoxin, which I am on. But what happens when Verapamil is added to the mix? Could a conflict with the Verapamil be causing the rise in blood pressure? Does the rise in blood pressure mean that the Coreg is helping to improve my heart failure, and Atrial Fibrillation, or making it progressively worse?!

[QUOTE]I would have done the same. My book about cardiovascular pharmacotherapeutics has some interesting information that might explain your rise in blood pressure upon initiating the beta blocker therapy.

Well......... thanks very much for your efforts! :)

[QUOTE]Apparently, non-selective beta blockers can cause peripheral resistance to rise by leaving alpha stimulatory mechanism unopposed. They say that one should ask if there's a clinical correlation between the beta blocking effect on the plasma renin activity and the lowering of blood pressure. :confused:

:confused::confused::confused:

[QUOTE]High renin patients do not respond to beta blockers and may even show a RISE in blood pressure.

Thanks for this find and the other interesting, albeit complex info. I'm doing a little research on this, and am finding conflicting articles. The important thing, though, is "high-renin"/"low-renin" gives me something to study, that I would not have studied prior to your post.

[QUOTE]The beta blocker I take, Bisoprolol, is also approved for use in heart failure. Spironolactone, an aldosterone antagonist, is supposed to be helpful in treating CHF. I take 5mg of Bisoprolol, which is not a very high dose. It does not interfere with my breathing at this dose the way the non-selective beta blockers do.

How often do you have problems breathing?

I can just about cope, pretty good, with any symptom except for breathing difficulties. My breathing difficulties have greatly improved, but I still get, what I call, "Labored Breathing". Normal breathing is when it doesn't take any effort to breath, and I don't notice my breathing. "Labored Breathing" is when I am conscious of my breathing, and it takes a little effort to breath. Not much effort, but just enough to make it annoying.

I lift two ten pound hand weights several times a day, 30 lifts and 30 curls. If I do the lifts too soon after eating, or when my heart is not beating well, I'll get the "Labored Breathing", and it can last for many hours. Since I am also Asthmatic, the "Labored Breathing" also happens at other times, for other reasons. I hate it, when it happens!

[QUOTE]I wouldn't know what (if any) side effects I might be experiencing from this drug because of the other drugs I also take.

What drugs are you on? What time of day do you take them?

[QUOTE]Probably shortness of breath if I exert myself too much - which I try very hard not to do. :D

Do you get shortness of breath everytime you exert yourself? How about when you lie down? Do you notice symptoms worse at night?

Are you aware of your heartbeat? Would you say that it is normally strong and steady? How often do you feel your heart jump around or race?

Do you have a stethoscope, so that you can listen to your heart?

[QUOTE]I wish you the best of luck with Carvedilol - it seems like a perfect drug with very impressive results in the trials. I hope your blood pressure levels off and eventually gets back to normal.

flowergirl

Thanks!

I am starting Day 6 of Coreg. Coreg is supposed to allow for more physical activity by keeping the heart rhythm/rate in check, but, if anything, I am having more difficulties when lifting weights. I'm hoping for an improvement as I get closer to the crucial 7-14 day window.

Thanks again for taking your time, in order to do research about Coreg for me. It reflects on your good heart. Compassion towards others is what separates humans from beasts, and too many of the two legged lack compassion.

Flowergirl, have a great weekend! :wave:
[QUOTE]Coreg makes for a very powerful and beneficial combination with an Ace Inhibitor and Digoxin, which I am on. But what happens when Verapamil is added to the mix? Could a conflict with the Verapamil be causing the rise in blood pressure? Does the rise in blood pressure mean that the Coreg is helping to improve my heart failure, and Atrial Fibrillation, or making it progressively worse?!

I have been researching similar issues. As you pointed out previously, medications affect us in different ways because no two people have identical physiology, geneological traits and a degree of health problems.

[QUOTE]Well......... thanks very much for your efforts
Beerzoids, I had been READING about these issues just before seeing and replying to your post...so no effort whatsoever on my part! I have several books about hypertension and related cardiological and renal issues on the coffee table. I just pick one and read a bit whenever I have a few minutes and feel alert enough to read that kind of stuff. A chapter or a paragraph at a time. I have learned a lot. It is time consuming.

[QUOTE]How often do you have problems breathing?

I feel very lucky I can get through my days without any problems as long as I don't overexert myself. If my breathing starts being labored, I slow down or stop. I brought some groceries in yesterday and measured how many times I could go up & down the steps and outside to the car in the driveway (a very short distance -15 or 20 feet) before becoming breathless. I walked up about 2 1/2 times and that includes carrying the shopping bags. When my breathing difficulties were at their worst, I couldn't make it even once all the way up - 14 steps- without stopping, carrying nothing. My breathing difficulties have greatly improved also. :)I will have to research the terms you mention, labored breathing as opposed to normal breathing. I breathe loudly somehow. I wish I could not hear myself and hope that others can't hear me!

[QUOTE]If I do the lifts too soon after eating, or when my heart is not beating well, I'll get the "Labored Breathing", and it can last for many hours. Since I am also Asthmatic, the "Labored Breathing" also happens at other times, for other reasons.

I don't do anything requiring exertion right after eating because it interferes with my stomach and sometimes breathing. I used to go for walks right after dinner and would have to stop shortly after leaving home because I couldn't breathe and was getting pains in the chest and lungs. Being as determined as I was then, I'd stop, rest, go, stop, rest, go as needed during my walks. I like to put myself to a test. I took the "Summit" trail the other evening to see how I'd make out and had to hurry to make it out of the woods before it got dark. Sure enough, I had to stop frequently to catch my breath. :(The terrain is steep.

[QUOTE]What drugs are you on? What time of day do you take them?
I take most of them in the morning. A CCB, beta blocker, ACE inhibitor, Spironolactone, Hctz, Lipitor, Aspirin, Nexium, Atrovent, Tylenol 3 and my supplements. I stopped taking the asthma meds last year. Did you have asthma before the CHF, I wonder? How could your doctor determine which problems arose from asthma and which from your HF? How can one tell the difference? The symptoms are so similar! When I had my pulmonary function tests, I asked whether the results were consistent with asthma or CHF. The tech thought asthma but could not be sure. That's what went into her report -that other causes could not be ruled out. My doctor thought it possible but not likely. Another doctor wouldn't say.

[QUOTE]Do you get shortness of breath everytime you exert yourself? How about when you lie down? Do you notice symptoms worse at night? Are you aware of your heartbeat? Would you say that it is normally strong and steady? How often do you feel your heart jump around or race? Do you have a stethoscope, so that you can listen to your heart?

Beta blockers used to be contraindicated in both asthma and CHF. They still are in ashtma. Is it possible that they might have played a role in the breathing problems? I was on 800mg of an alpha/beta blocker previously. After I stopped taking this medication (with great difficulty), I got a little better. To my dismay, my breathing problems returned. Started improving again several months later. I am currently on 5mg Bisoprolol.
I had all of the symptoms you mentioned last year. I'd get short of breath just sitting down doing nothing, when eating and talking, lying down. Not now, thank goodness. I don't get breathless at night but have to sleep elevated for other reasons.
I am aware of my heartbeat when I am experiencing pain, tightness/pressure, or irregular heartbeat. I have had heart murmur since I was little. I think the valves are fine and don't leak. I get irregularities every day, sometimes several times a day. Lastly, I would consider my heartbeat steady some of the time. I guess it must be strong - I don't know how to tell. Purchasing a stethoscope is something I have not yet considered. :)

take care, Beerzoids. :blob_fire
flowergirl
[QUOTE=flowergirl2day;3508871]As you pointed out previously, medications affect us in different ways because no two people have identical physiology, geneological traits and a degree of health problems.

Plus... everyone has differences in lifestyles, environment and diets. The combinations of differences are endless.

[QUOTE]My breathing difficulties have greatly improved also. :)

You must be doing something right. I'm happy for you. I can just about put up with any of the nasty symptoms of my diseases, but labored or difficult breathing drives me nuts! I hate it! Chest pains? Who cares! Rapid heartbeat? Who cares! Weak heartbeat? Who cares! Hard, thumping heartbeat? Who cares! Fatigue? Who cares! But... breathing difficulties drive me over the wall! :mad:

[QUOTE]I will have to research the terms you mention, labored breathing as opposed to normal breathing.

I'll be interested in any goodies that you find!

[QUOTE]I breathe loudly somehow. I wish I could not hear myself and hope that others can't hear me!

What kind of noise? Raspy? Wheezing?

[QUOTE]I don't do anything requiring exertion right after eating because it interferes with my stomach and sometimes breathing. I used to go for walks right after dinner and would have to stop shortly after leaving home because I couldn't breathe and was getting pains in the chest and lungs. Being as determined as I was then, I'd stop, rest, go, stop, rest, go as needed during my walks. I like to put myself to a test. I took the "Summit" trail the other evening to see how I'd make out and had to hurry to make it out of the woods before it got dark. Sure enough, I had to stop frequently to catch my breath. :(The terrain is steep.

I am not a doctor, but your breathing problems are worrisome. Do you feel that your breathing problems are because you are out of shape? Are you overweight (if you don't mind me asking)? I associate breathing problems with heart problems, especially if they can't be associated with asthma.

[QUOTE]I take most of them in the morning. A CCB, beta blocker, ACE inhibitor, Spironolactone, Hctz, Lipitor, Aspirin, Nexium, Atrovent, Tylenol 3 and my supplements.

Wow! That's a lot of medication!

For one thing, if I was you, I would separate the CCB and the Spironolactone by at least three hours! Both of them work on the heart's calcium channel, and I would not be surprised if you weren't having some type of drug interaction between those two drugs.
Hi Beerzoids, :)

thank you for your valuable insight.

There was a time I thought my breathing problems were a side effect of my beta blocker. After I stopped the 800mg of Labetalol, my breathing improved briefly for a couple of weeks and then returned to the way it had been while on that medication.

[QUOTE]What kind of noise? Raspy? Wheezing?
It's not a wheezing noise, more like a nasal breathing as I have to take deep breaths to fill the lungs. The noise is from me trying to take in as much air as I can. Sometimes (like right now) it hurts.

[QUOTE]Do you feel that your breathing problems are because you are out of shape? Are you overweight (if you don't mind me asking)? I associate breathing problems with heart problems, especially if they can't be associated with asthma.

My breathing problems are not due to being overweight. Prior to starting the therapy I was out of shape (exercise-wise), ate bad foods and breathed normally and quietly. I was in a very good shape several months later when my breathing problems started. Now I have a spare tire and can pinch not one, but two inches. One could certainly say I am overweight, though I look healthy. My stomach is the problem area. I want to lose some of that excess fat this spring and summer. My ex-doctor said walking should be enough.

I'd like to do more than just walk to improve my exercise tolerance. I wonder if my beta blocker is affecting it. Bisoprolol is supposed to enhance and improve exercise tolerance. This increase in exercise tolerance is said to be dose-related. In one study, the participants saw an improvement of 105% on 5mg, 122% on 10mg, 131% on 20mg of Bisoprolol. These numbers represent the final results, so in actual fact the increase in exercise tolerance was 5, 22 and 31%. I am on 5mg. I have a feeling there's going to be a change in my medications very soon.

[QUOTE]For one thing, if I was you, I would not only separate meds by an hour, I would separate the CCB and the Spironolactone by at least three hours! Both of them work on the heart's calcium channel, and I would not be surprised if you weren't having some type of drug interaction between those two drugs.

That is a great idea! I never thought of a connection between the CCB and Spiro and their combined effects on the heart. When I was on antibiotics recently, I found that I forgot to take them at work at the time I was supposed to. I forgot to take them, period. Practically every day. So remembering to take the Spiro later in the day would probably pose a problem. I'll give it some thought and try to find a solution. I could take the supplements and Spiro at night with my evening meds. (I hope my stomach would handle that OK in the evenings :eek: ) and see if my daytime BP control is adequate.

P.S. I know that Spiro alone doesn't lower blood pressure very much, hardly at all in lower doses. Do you think that Spironolactone, combined with my evening dose of the CCB and ACE, would reduce my blood pressure too much? It really scares me when that happens at bedtime.

Many thanks once again! :)
flowergirl