Blood pressure has shot up since having a pacemaker and a further episode of Atrial flutter, any ideas why?

[Borderterriorist]

Previously on 1.25mg of Bisoprolol and perindopril (can't remember the dose but not high). My blood pressure ticked along OK within acceptable levels (130/75) sometimes lower sometimes higher. I have atypical atrial flutter which had responded well to a cardioversion but because I have LBBB and grade 1 heart block (neither seen as a problem without taking bisoprolol) I had a pacemaker fitted as I'd started getting the odd episode of flutter and consultant wanted to increase the bisoprolol. A week after having the pacemaker I had a really bad episode of flutter, fib and svt which put me in hospital. I'm now on 5mg bisoprolol twice daily + 125mcns of digoxin and because I had developed a very nasty cough on the perindopril I changed to Losartan. Initially 12.5mg daily but upped to 25mg as my BP was still rising.

I'm on the waitlist for pace and ablate so I had an echocardiogram recently just to check the general condition of my heart. I'd had one in 2020 and apart from the LBBB I also had a slight regurgitation of the tricuspid valve but now it is moderate, so there's been some deterioration but everything else was OK . However my BP is now 160s/high 80s despite all the medication. Anyone got any ideas what might be going on. I'm just doing a BP check for the GP. I have white coat syndrome but is it possible that I'm starting to react to me taking it? I don't feel worried or anxious when I take it but who knows?

Might be of relevance but my pacemaker is set to 60 and most of the time my resting HR is 56bpm so I think it's kicking in most of the time to keep my HR up. Most of the time I feel really well apart from feeling headachy and a bit nauseous at times, still get the odd bad day when I am so tired I can't do much apart from sit in a chair, the rest of the time I'm living a pretty active life for someone nearly 76, I just don't want any damage to my heart because of high blood pressure.

[onadiet]

I also have high BP.Plus Angina & Left Block in my case.Been on lots of BP meds.Losartan is less side effects but not so potent.You may need a different Sartan such as Valsartan or Candesartan