Slow pulse, and reducing Bisoprolol leading to lower BP

[Belle11]

I had a successful cardioversion nearly 3 weeks agoand following that, my pulse got slower and slower - sometimes down to 44. I saw a GP a week ago and he reduced my bisoprolol from 10mg to 8.75mg. My pulse has gone up a little - lowest recently has been 46, and more often 50 or occasionally 52.

Interestingly my systolic BP (top number) has come down between 150 and 160, to 130 to 140, with diastolic around 60. Latest reading was 140/60.

I'm hoping to be offered another reduction in bisoprolol, and wondering if this will bring my BP down further too. Has anyone else experienced similar please?

[Belle11]

Sorry - typo. Should have read "my systolic BP has come down from between 150 and 160, to 130 to 140, with diastolic around 60.

[pottypete1]

I was taken off Bisoprolol completely because of a slow heart rate. I still take the rhythm control medication Flecainide.

I am still regularly below 50 bpm.

Pete

[Belle11 in reply to pottypete1]

That's interesting Pete. Does your slow heart rate cause you any problems?

[pottypete1 in reply to Belle11]

Yes I get very nauseous when it is at the lowest rate particularly as I wake up in the morning and the heart rate is in the low 40s.

Otherwise I do get short of breath easily these days and cannot do any significant physical exercise nor can I cope with any stressful situation.

Overall I am fine as long ss I respect the situation I am in.

Pete

[cuore in reply to pottypete1]

Hi Pete, from your previous posts, you have been on Flecainide for over twenty years and after numerous ablations ( I believe you said 7). And you say, "I am still regularly below 50 bpm."

I am in sinus rhythm eight months past my third ablation and now taking Propafenone, and like you my rate is below 50 bpm. So, my question is have you been advised to stay on antiarrhythmic drugs for the rest of your life?

[pottypete1 in reply to cuore]

I discussed this at length with my EP.

I have been the most stable for 30 years since my 7th ablation 2 ½ years ago therefore I decided to keep taking the Flecainide.

My EP did say that I could experiment and try stopping Flecainide by reducing the dose gradually, but it has really been my decision to keep taking the tablets.

I have been taking Flecainide for the vast majority of the years I have experienced AF and if the current approach works I have no problem taking Flecainide for the rest if my life.

After all I am 72 and I don’t have any identifiable side effects and feel better from my heart rhythm perspective than I have for years.

We are all different - remember that.

Pete

[Belle11 in reply to pottypete1]

Sorry you get all these symptoms Pete.

[pottypete1 in reply to Belle11]

I have heart block and my conductivity between the Atrium and the Ventricles is not good which is why I have the problem with physical activity shortness of breath and stress.

The good news is I now rarely get AF having spent 30 years going in and out if AF sometimes on a weekly basis.

Pete

[CDreamer]

Years ago I was prescribed Biso but was hesitant to take it as though I had very high HR my BP would crash when in AF. On a good day in NSR it would be 100/70, most days it didn’t exceed 90 systolic. My GP reassured me that Biso would help stabilize my BP & that was my experience. I couldn’t tolerate Biso though so didn’t take it for long.

It may not answer your question entirely but you may find a lower dose suits you better.

I don’t think I ever exceeded 5mg but I can’t remember too well but do recall that it’s important to titrate dosage up and down.

[Belle11 in reply to CDreamer]

Thanks for sharing your experience. When my AF suddenly started my heart rate didn't come down adequately until the Bisoprolol dose was upped to 10mg. It seems an unusually high dose, but my heart rate was still 75-90 on it before my cardioversion. I shall need to discuss with my GP again - it'll be weeks or months before I get to see the cardiologist again. I've been sent an appt for an ECG at the hospital in late Feb, but no follow up appointment.

[Nick1957]

I had similar response after successful ablation in December- contact your arrythmia nurse or consultant or doctor - see attached link to my initial request when suffering low heart rate!

healthunlocked.com/afassoci...

[Belle11 in reply to Nick1957]

Thanks Nick - very interesting to read the thread from your previous post. I contacted one of our GPs yesterday afternoon, and he recommends staying on the 8.75mg for a few more weeks then reviewing about lowering further. Access to the hospital services is v limited here - other than in an emergency it takes weeks or months to get to each stage, so I'm thankful to have a responsive GP monitoring things.

[Nick1957 in reply to Belle11]

I contacted Arrythmia nurse when my pulse lowered to 45 bpm. Advised it was ok for me and to keep taking 5 mg Bisoprolol. We’re all different and we all respond to differing amounts of meds - you’ve done right to check with your doctor!!

[harrigate1]

Bisoprolol is a beta blocker to slow your heart while in AF. It's usual to come off it fairly quickly after successful CV

[Belle11 in reply to harrigate1]

Thanks for your reply, harrigate. I have hypertension, so imagine I will need to be on something. I contacted my GP yesterday, and he advised staying on the current dose for a few more weeks - hopefully then i can cut down further gradually.

[Bob56]

Hi. Although I’m on bisoprolol and have a history of high blood pressure I can’t comment on whether there is any correlation between taking less and lowering BP. More often than not taking more of it assists in lowering BP, so your experience is a bit puzzling. I would be more inclined to link your improved BP to your ablation. You are only 3 weeks out of this, and the heart is still recovering. My EP had said the ablation might help with my high BP. It didn’t, but you never know if this is an outcome for you. Either way it’s positive, as if you are taking less Bisoprolol it’s better for your general health anyway, and fewer side effects to worry about. If your heart is behaving better after the ablation, then that’s also good news. You pulse rate is still pretty low, so no reason your doctors won’t reduce the bisoprolol further, so you’re in a good place right now. I hope it continues .

[Belle11 in reply to Bob56]

Thank you Bob. It did indeed seem puzzling for my BP to come down on less beta blocker - your idea that my BP has improved as my heart recovers makes sense. It is great to be back in rhythm after 9 months continuous AF. Thanks for your good wishes for it to continue.

[Sean_C]

Yes I’ve had exactly that experience. After calling the arrhythmia nurse they gave me a new script for 1.25 mg of Bisoprolol. This only helped a bit and eventually they said I could stop the Bisoprolol altogether. This was about 4 months ago. Now I only take 1.25 of Ramipril and the usual 20mg Rivaroxaban. I’ve had no problems since. Good luck!

[Belle11 in reply to Sean_C]

Thank you for your reply Sean. How much Bisoprolol were you on before it was cut to 1.25mg? An arrhythmia nurse! That would be good. I did contact my GP later yesterday, and he recommended staying on the same dose for another few weeks then reviewing about cutting further. Because I needed such a high dose to slow my heart rate enough in AF, I imagine he doesn't want to trigger me relapsing into it. I hope you continue with no problems.

[Belle11]

Thank you Jon. Good to know there are alternatives.

[Sean_C]

Hi Belle, I started on 5mg but felt like I had a lead overcoat on (I was in AF at the time) so they quickly reduced my dosage to 2.5mg. This was to manage my BP which was a bit too high. I started to focus on my health and lost a stone in weight and got fitter and that naturally lowered my BP (my autocorrect keeps wanting to change BP to BO, perhaps it’s trying to tell me something ) so the 2.5 mg then started having the effect lowering my HR too much, hence the drop to 1.25.

The arrhythmia nurse works for my EP over at St Peters, not for my GP practice. Wouldn’t it be great if GP surgeries had those too!

[Belle11 in reply to Sean_C]

Congratulations on your weight loss, and it lowering your BP. 1.25mg sounds a nice low dose.

Sadly I'm not aware of any arrhythmia nurse at my hospital - certainly I've never been offered anything like that. I saw a cardiologist just after diagnosis last April, a registrar in November, and the EP 3 weeks ago when I had my cardioversion, otherwise have seen no-one till the GP now.

[Becksagogo]

Bisoprolol doesn't seem to affect my blood pressure but the Bumetanide - wow! I take 3 or 4 daily depending on how much water I am retaining. I get blue lips and fingers, cramp, am always cold and if the top line of my BP is over 90, it's a good day. Hopefully after my next valve replacement things will settle down.

[Belle11 in reply to Becksagogo]

Wow indeed! That sounds hard. Hope your valve replacement comes soon. A friend's husband who had one last year is so much better since his.

[pablojack]

As your biso is reduced your BPM will rise and your diastolic BP will increase. No idea if your systolic will be effected. I suspect your cardio is taking things step by step.

[Belle11 in reply to pablojack]

The strange thing is that my systolic went down after reducing the Bisoprolol! And the diastolic (already quite low) stayed the same. It will be interesting to see what happens if the GP lowers my dose in a few weeks' time. It's one of the GPs dealing with it, as there's v little opportunity to see anyone at the hospital. My cardioversion was in mid Jan, and I have an appt to have an ECG in the hospital late Feb, but no appt to see any hospital doctors.

[pablojack]

I have bradycardia with a resting heart of low 40's with no symptoms. This came about after a cardioversion to cure atrial flutter. I do not have high blood pressure but after cardio version my diastolic dropped immediately to 60. My new cardiologist explained that the lower heart rate gives more time for blood pressure ( diastolic) to drop further before the next beat. Therefore the lower the heart rate the lower the diastolic. No next beat and blood pressure would drop to zero!`( his explanation not mine) He has no concern about this though my previous cardiologist had no explanation other than saying it was curious. I have no knowledge about biso as regards blood pressure but it clearly lowers heart rate which is why it is was not prescribed for me.