Low Blood Pressure

[Familyk]

Evening, Advice please.

I started on entresto 3 weeks ago, lowest dose and coping well. Consultant has now added bisoprolol 2 5mg since Friday. I feel awful. My BP is between 80/50, 82/47 and 90/54. Im cold but sweating, head spinning and feeling so tired.

I've been told I need to get upto the highest dose of entresto but with my blood pressure so low its not looking promising.

I'm so scared I just want to get better and without medication I can't see how that will happen.

My HF nurse has asked me to ring her on Tuesday after monitoring over the weekend.

Should I stop the bisoprolol? Has anyone else had such a low BP?

Entresto is the magic drug I need to get better 😪

Thank you

[Hidden]

+1 on what Hidden has said. Seek advice from recognised health professionals.

[Cherrelleford]

Hey. I'm on the lowest dose of entresto because of my low blood pressure and I can't tolerate a higher dose. I take 7.5mg of bisprolol daily. My BP is around 85/54 I suffer with dizzy spells and tiredness but still manage daily activities. Talk to your heart nurse and voice your concerns. Take care xx

[am1875 in reply to Cherrelleford]

Hi. Would like to know if you’re still on lowest dose? I was started on middle dose but it raised my creatinine. I was reduced to the lower dose and creatinine numbers went back down. I think I’ll be prescribed half pill of the middle dose in the a.m. and a whole pill of the middle dose in the p.m. My cardiologist mentioned maybe lowering the dose of Eplerenone if necessary.

Is the lower dose working and if so what effect is it having? I was only on middle dose for a month but I seemed to notice a difference in energy level. I’ve only been on the lower dose for a week and don’t know what effect it’ll have yet. I will continue on the lower dose if necessary because it is a good bp med. it keeps it around 105-114/60-70. First med that’s been as consistently effective for bp for me. Cheers.

[Cherrelleford in reply to am1875]

I've been on entresto 24/26 for almost 2years. I take one in the morning and one in the evening. I don't know if it's helped my heart at all as I'm still having issues. Other than tiredness and the dizzy spells I manage with it.

[Ewloe]

yes I’ve had experience of a BP of 70/40. OMG. I felt awful. I’m on medication to help ejection fraction that’s reduced after heart attack. I’ve never had a raised bp but some medications that help ejection fraction are used for people with high bp. I take ramipeul 2.5mg at night so if bp drops I’m in bed. But it was bisoprolol that was dropping my previously normal bp so low. Immediately After a heart attack they tried to get me to 10mg but as soon as I went over 7.5mg by bp was in it’s boots. I’m now on 5mg but split into 2 doses morning and evening which works well and my 2 arrhythmia’s ( PAF and none sustained ventricular tachycardia) the heart attack left me with are so far okay with that dose. After a heart attack the bisoprolol is kept at the highest dose you can tolerate.

[Familyk in reply to Ewloe]

Thank you. I feel dreadful again today unfortunately x

[Beardie100]

I couldn't tolerate my drugs either. Not everyone responds the same way. Your drugs need to be optimised for you....and it can take time to see how your body responds to different medications. Work with your professionals and discuss all.

[Familyk in reply to Beardie100]

Thank you. What alternative did they offer you? And are they as successful as Entresto? X

[Beardie100 in reply to Familyk]

In my case, I blacked out and collapsed on the highest dose of Entresto. This wasn't acceptable and I had to accept that the high dose of Entresto wasn't for me. The current medical evidence is behind Entresto but if I couldn't tolerate the high dose. I tolerated weeks of low BP, cold hands, light headedness etc to build up to the high dose but it wasn't for me.

An ACE inhibitor Ramapril was my replacement.

I have copied a segment for you GlobalData Healthcare

Evidence from previous trials had demonstrated that Entresto was superior to the ACE inhibitor, Ramipril, for patients who have symptomatic HF with reduced ejection faction (HFrEF), in terms of reducing HF events and total mortality.20 May 2021

My interpretation is the evidence/medical opinion is behind Entresto but it doesn't suit everyone.

[am1875 in reply to Beardie100]

Hi. Have you considered a lower dose? I’ve read where all three doses can have a positive effect.

[Hidden]

Hi. Yes i also had low bp like that and even my heart rate was average 35 bpm after the heart nurse increased bisoprolol to 3.75. When i went to the check up and my heart rate was in the 30s she was shocked. She said wow. Ermm we need to lower that right now. It was around 6 months after i was in ICU and my heart was in a bad way anyways so didnt notice the difference really.

With entresto i have always felt rubbish on this med. Yes apparently it has helped increase the EF % but the fatigue and brain fog it causes, sometimes to a point your no good to anyone. I have had to split my middle dose tablets in half and spread them out through the day as they knock me off. The brain fog and aniexity they cause is ridiculous. It also causes lower back pains and diarrhoea.

Sometimes i think is entresto doing any good because it seems all negative to me. I have experimented by skipping morning doses and even whole days not taking it and those times i feel great! Full of energy, no symptoms and feel almost 'cured'....

But i just don't know. Quite lost off with it. In the early days my ef increased dramatically with the same time of starting this drug alongside a cardioversion which worked. So just dont know if it was coincidence or if the drug really is a miracle drug.

I mention these to the cardiologist nurse who is 2ic to the professor and she just basically says to put up with these sides as its good for the heart. 😒

[Qualipop]

NO one on here can give that kind of advice. I suggest you phone the BHF nurses. All I can say is that when I was put on the lowest dose of bisopralol after a heart attack, I was exactly the same. My BP dropped so low I couldn't function at all. I just slept in a chair; didn't even have the strength to stand up. Some people just can't tolerate beta blockers. If you can't get hold of the BHF nurses, I'd suggest phoning 111 to speak to a doctor.

[Familyk]

Thank you x

[Doublef]

My bisoprolol was increased from 5 to 10 mg and the cardiac nurse told me that was to much as my BP was to low. I am now on 6.5mg and being monitored.

[Deejay62]

No never stop your medications yourself ring your nurse and tell her it’s urgent or even make an urgent appointment to see your GP make sure you take in all the readings. If you can’t travel because of how you’re feeling let the surgery know. But first call should be your nurse. I’m on both medications plus Spironolactone and Bumetanide a lot of these lower blood pressure so I take 2 entresto a day. Speak to them about it and don’t do anything unless they tell you too. I had your issue blood pressure too low it’s awful but most of the time it’s ok now. Always low but manageable. They want it low but not too low.

[Familyk]

Thank you for your reply. I haven't stopped my medication and have kept heart rate and BP for her. I'm speaking to her on Tuesday. My BP has dropped further which is really unpleasant. I'm due to increase entresto in a weeks time. Really hope I'm going to be able to start higher dose. Also due to start Eplererone. Next mri is in April to see if ef has increased from 32. Worrying times x

[Anon2023]

hi. I’m gutted that you are feeling so awful. Bisoprolol can do that but when I reduced my dose (with medical guidance) my heart rate shot right up and I probably felt worse. I know that you must be feeling worried so maybe you need to go and get checked to give you some reassurance. I don’t know if you have a walk in Center near you where you could pop in for a check. You might need to wait but it might put your mind at ease. The other option is to ring 111 and see if they can make you a gp appointment at the local hospital. At our local hospital they have an out of hours gp service which you can access through 111. Hope you feel better soon let us know how you get on x

[Familyk]

I am sweating and sharp pain between shoulder blades, on and off. Trying to rest and hope it wears off. Thank you for your concern means a lot x

[Anon2023 in reply to Familyk]

hi. Keep an eye on that and get checked out if it doesn’t improve. I’m sure that you will be fine but it does no harm to get things checked. You could always ring 111 and ask them for their opinion. They’ll probably get a nurse or a doctor to ring you back in the first instance. X

[Familyk]

Thank you. I know entresto and bisoprolol are supposed to lower it. But this is awful. X

[am1875 in reply to Familyk]

Hi. Sorry for your experience but maybe they’ll prescribe something for the side effects.

[Hobbledehoy]

No, best not take any action yourself, but report & seek medical a.s.a.p.