Corticosteroids & Hypertension

[winfong]

I was diagnosed with hypertension for many years before getting a further diagnosis of GCA just recently. Am currently taking 20mg of prednisone, which is doing a number on my blood pressure. I'm taking 50mg / day of metoprolol for that. Any tips or tricks to getting my readings down (140s / 90s right now)? Thanks

[Tonch]

Hi, 140s/90s is not very high especially after 20mg of Prednisolone. My BP is around 135-140/95 and my GP said it was OK and didn’t need any medication for it. I wouldn’t worry too much, but if you want to get it lower I would recommend exercise and losing weight. The latter can be achieved by cutting out carbs and sugar. I do still eat the latter, but as I do a lot of running, it keeps my weight and BP down alone. NB I’m only on 1-0.5mg of Prednisolone now for PMR, so can’t blame that any longer for BP.

[winfong in reply to Tonch]

Thanks. Weight's not a problem, as I lost a fifth of my body weight with constitutional symptoms from GCA. Just starting to get it back now.

[DorsetLady PMRGCAuk volunteer]

Are you regularly monitored by doctor in respect of BP - or do you just do that yourself?

As Tonch says, 140/90 would probably be acceptable to medics bearing in mind the Pred - and as you reduce that your BP should go back down to your usual readings.

As also stated - less carbs more exercise (not quite so easy on 20mg compared to 1mg though).

[winfong in reply to DorsetLady]

Yes, the measurements are very consistent. Seeing plenty of docs these days, but as a long-time hypertension sufferer, I've calibrated my own sphygmomanometer, calculate my BP regularly, divide my meds between a.m. and p.m., etc.

[123-go]

Some tips for diet: don't add salt in your cooking, eat small portions of lean red meat only occasionally; chicken, turkey and fish are fine; good fats/oils like olive oil and coconut oil; no preservatives/additives; no processed foods like sugary cereals, cakes or biscuits; limit your alcohol intake (stay well within recommended guidelines which you can find online; eat plenty of green veg.

If you are able to walk every day that would be really beneficial-half an hour 5-7 days a week. Try not to sit for long periods: get up and move around every hour or so.

[winfong in reply to 123-go]

Definitely eat healthy, but I find the exercise difficult. I'm still working, so have to find the time. I've walked some, done yard work, and even biked some. I honestly don't feel like it all the time, though, and sometimes I'm just totally exhausted after any effort. And this is from someone who was very active - tennis, kayaking, long-distance biking, backpacking - before all this.

[123-go in reply to winfong]

Have you done all that activity today!? It's a mistake to overdo things and you should definitely stop when you feel that first onset of tiredness. Like many of us you led a full and active life before the onset and it's a big blow when we have to slow down and give up hobbies, etc. As you're still working I can imagine you want to catch up with chores at weekends, but you do have to let some things go and space out chores so you don't get to the point of exhaustion.

[winfong in reply to 123-go]

Oh my goodness, no. I think I've biked once, done yard work a couple of times, and walked maybe four times ... since the end of July!

[123-go in reply to winfong]

Thank goodness for that! 😁 You had me worried there!

[PMRpro Ambassador]

Taking your BP medication as instructed and checking your BP, not everyone responds the same to BP meds so you do need to know how it is responding. The others have made several good suggestions - weight control and exercise if possible are key.

GCA itself can lead to hypertension as the arteries are narrowed with the inflammation and good control of that is also important and you may find it falls just because of that - and of course, it is likely to fall as the pred dose goes down providing it is still enough to manage the GCA symptoms.

[winfong in reply to PMRpro]

Good to know about the GCA - makes total sense

[winfong]

I was in the 120s/70s range (with meds) before the prednisone. That seems to be the newest recommendation from the experts, and I know my GP and all the specialists I'm seeing are all wanting to see me reach that as an ultimate goal. Hopefully, I'll be on actemra soon.

[winfong]

Good news! I got approved for actemra. Should start infusions in a couple of weeks.

[winfong]

That's good to hear ... I hope it works for you. I seems you have been diagnosed recently with LVV. I would be interested in how Actemra works for cases diagnosed relatively soon and when Actemra is administered early.

>> I'll let you know

Your medical work-up is also impressive. I remember my PMR diagnosis was based on mostly symptoms, inflammatory markers and response to prednisone --- no fancy tests. However, multiple rheumatologists did confer with each other. It was funny because my GP said he thought it was PMR at the start and apologized for sending me to the rheumatologists!

>> It helps to have friends who are hematologists and oncologists!

In any case, I sincerely hope it works for you. Out of curiosity, why the infusions as compared to the injections??

>> I think you start out with the infusions, then move to the shots. Not totally sure why.

Another question, was it difficult to get approval for Actemra infusions? I'm somewhat confused if LVV is considered to be the same as GCA. I think Actemra is FDA approved for GCA only so there might be insurance issues. I received it for PMR but it needed to be approved by a medical panel and my insurance company was bypassed.

>> Seemed pretty straightforward. My rheumatologist said he'd take care of it, then I simply got a letter in the mail.

>> As for diagnoses, they seem to be pretty fuzzy. My condition is closer to LVV than classic GCA. Who knows? Maybe that was what was behind the diagnosis!

[SusanEleven]

Thank you for posting this because it has encouraged me to plan some follow-up care or at least some investigation by a cardiologist. I've been so focused on PMR ups and downs for just about 5 years now including an impressive flare four months ago.

My BP has hovered around 140/90 for years. I was told I could start a BP med but that my pressure wasn't high enough to be considered worrisome. I tried Lisinopril and used a home monitor. The med gave me the infamous cough side effect but did nothing for my BP so it was discontinued. Again, I was told my BP was no big deal.

Several years later I started feeling awful and felt my heart was pounding in my head. My pressure read 180/100! I went to my primary care doctor immediately and saw the nurse practitioner. The EKG results were not normal and showed left ventricular hypertrophy (LVH). She did not seem concerned at all about the LVH. She simply said "we see this when someone has had high blood pressure for some time." Excuse me! What happened to my pressure not being a big deal!?

She said in the past they'd have put me in the hospital until the pressure came down but she just had me wait with her until it eventually dropped. I was started on a BP med that day. She asked me to bring in my home machine and we tested it against her machine a few times and the readings were close in number so she felt I could do ok with monitoring at home. She asked me about my medications and diet and said she had no idea why my BP had spiked so badly. No other follow up was ever done, and no suggestion that I see a cardiologist. My readings eventually got better, but I think that has more to do with being diagnosed with sleep apnea (29 episodes a night where I stopped breathing) and doing really well with a CPAP machine (typically now less than 1 episode per night).

Sorry for the ramble. And thank your for sharing your experience.

[winfong]

Quick update ... My BP basically got totally out of control. Had to up my metoprolol to 100 mg and add procardia to it. :^(