Beta Blockers

[Scardoc]

For approximately 15 years I have had high blood pressure. Initially, the Doc was happy, after testing for 24hrs, that the issue seemed to be when I walked into the surgery so no medication required. After being diagnosed T1 diabetic 7 years ago I was eventually put onto 5mg Lisinopril and this eventually was increased to 10mg.

My diastolic level has always been good and better than ever over the last couple of years. Systolic has always been the problem and for the last four years has been consistently high, 150-160.

I have an appointment on Monday to discuss with my GP and feel there could be an attempt to try me on something else as it’s the one diabetic target I just don’t ever get close to! So, I am thinking Beta Blockers but have some concerns over the little I know about them.

1. Can they contribute to hypoglycaemia?
2. They lower heart rate, my heart rate is normally pretty low to begin with so this worries me.
3. Do they impact on exercising (part of 2 really)?

Any experience shared would be appreciated.

My preference would be to have a 24hr BP monitor to wear for a few days and get a good picture of what is going on, but on a daily basis and not just every time I go for an appointment! If that shows consistently high then I will be up for trying something new.

 

[zand]

I took beta blockers for a few years. I am diet controlled type 2. I'll answer the questions as well as I can.

1. Don't know. I've never had a problem with hypoglycaemia, so I couldn't tell you.

2.Yes I took them to lower my heart rate as I had atrial fibrillation and my resting heart rate was anything from 110 bpm - 155 bpm. When my AF was rectified after a heart procedure I would estimate that beta blockers took my heart rate down around 10 bpm from 74 to 64 bpm. This was fine for me, but may not be for you?

3. Yes I found they did impact on exercising. This was probably mostly because I am asthmatic as well. They are known to make asthma worse, but they were necessary in my case. I was breathless anyway due to the AF, so it was 'swings and roundabouts' really :- the rapid heart beat improved, but the asthma worsened.

 

[zand]

There's other alternatives to beta blockers. You could take an ACE inhibitor like ramipril which some diabetics take to protect themselves from kidney damage. I was given ramipril first, but it didn't suit me as it made me cough. It did bring my B/P down from 240/180 to 180/150 in 3 days though. I am also a bit sceptical about taking a drug to protect the kidneys, but that's just how I am. I know some people on this forum take it for this reason and are happy to do so..

 

[catherinecherub]

This article will show you about how blood pressure medications are chosen for you and also there is plenty of information about possible side effects.

http://www.bloodpressureuk.org/BloodPressureandyou/Medicines/Choosingmeds

Beta blockers sometimes raise blood sugars and can cause weight gain but there are newer ones now available that work better for diabetics.

http://www.livestrong.com/article/286086-effect-of-beta-blockers-on-cholesterol-glucose/

 

[Scardoc]

@catherinecherub & @zand - thanks for the info.

I'm already on Lisinopril which is an ACE inhibitor isn't it? This is why I was thinking they may go down the beta blocker route. My pulse generally measures in the 40-60 range and this is never a proper resting pulse rate as I've always just had to travel to get to the surgery/hospital. I was told by the doctor that BP and pulse rate are completely independent of each other as I found it curious why one was high and one was low!

Whatever the Docs advice, I would be happier with more data first to understand the extent of the problem.

 

[zand]

Yes I'm sorry I didn't notice the mention of Lisinopril in your post. It is an ACE inhibitor.

So the other options seem to be calcium blockers (like amlodipine) and diuretics (like bendroflumethiazide) I was on a mix of a small dose of all 4 of the main types of BP medications at one time. They prefer to give smaller doses of a mix of drugs to cut down on the risks of complications. Read around the pros and cons of all of them. When my BP started to improve I went to my GP and asked if I could stop them in turn. The ramipril went first as it made me cough, then I chose the calcium blocker, then the diuretic and stayed on just the beta blocker for a while because that was beneficial to my heart as well as my BP. Your preferences may well be different.

I tend to agree with you that a monitor for 24 hours would be a good idea. Let's hope you can persuade your GP of this!

 

[Spiker]

I use a beta blocker, propranolol, from time to time for anxiety. I can tell you it really plays havoc with hypoglycemia warning signs. The adrenalin based warning signs completely disappear. You are left only with the last-ditch neurological warning signs. And I don't know about you but I have not trained myself to spot those. So a few times I have found myself in some very weird states, protracted near-hypos that went on for ages (OK I have no explanation of that). But propranolol really interferes with hypo warnings and so makes hypos more likely, even if it doesn't directly cause them as such. Other beta blockers might not have this side effect, but I doubt it, since by design these drugs are used to block these adrenalin (etc) pathways.

 

[Scardoc]

I use a beta blocker, propranolol, from time to time for anxiety. I can tell you it really plays havoc with hypoglycemia warning signs. The adrenalin based warning signs completely disappear. You are left only with the last-ditch neurological warning signs. And I don't know about you but I have not trained myself to spot those. So a few times I have found myself in some very weird states, protracted near-hypos that went on for ages (OK I have no explanation of that). But propranolol really interferes with hypo warnings and so makes hypos more likely, even if it doesn't directly cause them as such. Other beta blockers might not have this side effect, but I doubt it, since by design these drugs are used to block these adrenalin (etc) pathways.

Thanks @Spiker - I was aware that they block adrenaline and whilst removing the "fight or flight" instinct may help with anxieties etc I also know that when doing an intensive running session, the same response sends blood sugar levels high. Sounds like a good way of keeping them down but if I injected insulin during a session as I normally do........? Hypo seems a real possibility.

 

[Spiker]

Yeah I think you need to take care, the risks are significant.