GENERALIZED ANXIETY DISORDER, BACK PAIN AND HIGH BLOOD PRESSURE

[Missus835]

The title looks a lot, but it's all related. I've been diagnosed with high blood pressure and taking Perindopril 4 mg. About 2 weeks ago. NP has asked me to monitor BP at home. On Tuesday past, BP was 166/106, rhr was 97 (which is not bad for me). I had stopped the med because it was causing stomach issues (on advice of pharmacist). I called my daughter and off to ER we went. Of course the anxiety had kicked in. As soon as I see the high numbers, it does. By the time I was in triage heart rate was up to 157, beating regularly. They at least had a room for me as it wasn't wall to wall with sick folk. Long story short...they gave me 2, so 8 mg. Perindopril and my pain meds for my back. Things started to sort and then the heart rate decided to go for a jog. I asked for my anxiety med, clonazepam .5 mg. This sorted that, plus a warm blanket.

They did more bloods and things had simmered down. ER doc confident she could send me home. Liver good, kidneys good, heart good, etc. No stroke, no heart attack. Oh yes, CRP was good, which she emphasized and I didn't bother mentioning that the Pred was controlling this. She had read my history.

Result of all this, I am now too anxious about the numbers and can't bring myself to take my blood pressure. I do take the pill, but yesterday I could NOT do the BP. Some may think this is ridiculous, but it really isn't when the anxiety "what if's" kick in. As the PMR saga continues, I find my anxiety is increasing, particularly where new meds or procedures are concerned.

On Tuesday, the back was particularly nasty. Muscle spasms are still wrapping around diaphragm and stomach. So pain is from spine right round. I am told and have read that back pain can contribute toward high blood pressure. I have 8 fragility fractures. 2 have been plastied. Had the Zolendronic Infusion last Friday. Of course, they couldn't understand my rheumy's sketchy instructions. Was very anxious about this. I explained the anxiety to the nurses, who kept me well distracted.

Anxiety has been with me since I was 14. Medically triggered anxiety since 33.

I have a phone appt. with my NP tomorrow morning and will discuss this with her. However, she is another who doesn't like benzodiazapenes.I will try to do the BP later today. I think twice a day is too much for me. Lucky for the once. Fingers crossed. Will I ever know if it's the anxiety driving the BP up, the back pain, or whatever?? Diet is as salt free as I can get it. Sorry for the epistle. TIA

PS: I have also started Rasuvastatin for high cholesterol. Pharmacist reduced it to 10 mg. from 20 (more stomach issues). Will discuss this with NP tomorrow.

[PMRpro Ambassador]

I don't see it resolving unless the anxiety is dealt with. SHE may not like benzodiazepines, but her personal preferences should not cloud good symptom management.

[Missus835 in reply to PMRpro]

Oh thank you Pro. I agree totally. My Neurologist was going to talk with her about this, because the Clonazepam is known to help back pain particularly after vertebroplasties. And it does actually. Thanks for your quick reply.

[Missus835 in reply to PMRpro]

UPDATE: She suggested I switch off of the clonazepam, wanted to know who the "one" was who prescribed 120 clonazepam (it's actually one .5 tablet, 1x day), fir 4 months. They gave me a 10 question test for GAD, which my score was 9. This was in September. The other NP said I def have it; this one says "it's not that high" and then clonazepam is only effective for 4 to 6 hours. I reiterated from a previous conversation that it lasts me for 24 much the same as Pred. When I flatly refused, she reminded me that she is just my temp NP and to make sure my info on the Need A Fam Doc list is up-to-date. In fact, she was going to call them for me. Why do medical professionals bring their personal beliefs and biases into practise, when it involves a drug that is obviously helping a patient, to the extent they want said patient to switch to something else...her suggestion was sertraline or an opioid. I am not depressed and the opioids have no effect on the back pain. Then pregabalin....which gives me suicidal thoughts and double vision. I got off the phone and wrote an email to my Neurologist about my lifetime of (childhood and adult) abuse, which has caused this GAD and probably C-PTSD. He was the "one" who prescribed the 120 tablets. They will be putting this email on my digital file. So tired of explaining and justifying why I need this very low dose. Sorry Pro for long reply.

[Chiqui1950]

i am sorry you are dealing with so much. But all your tests suggest that your organs are doing well and that is great news! i do empathize! How many milligrams of pred are you taking now and for how long? I have also been riding with the high BP issue. I tried to learn at what time of the day was my BP higher and discovered that it was after 4 pm in my case. So with the help of my doctor i take my lozartan at 4 pm. —This is how I prevent my high BP: i iake 25 mg of lozartan—- if i stay on a no added salt diet— if my BP is 140 or higher because of salt or stress, i take a second 25 mg. Your situation may require a different dosis. It is not perfect but this regimen has helped me a lot! and i do understand the anxiety around it! Best of luck!! May you find yourself on the other side one day at a time!!

[Missus835 in reply to Chiqui1950]

Thank you! I'm on 15 mg. Pred. and tapering. I've been on Pred in various doses since Jan. 2022 for PMR. Just trying to find out if lozartan is still banned in Canada. My BP is higher in the mornings. Thanks. I don't add salt to my diet and use only low-sodium products, which aren't that low. Stress seems to be there in one way or another. I will ask NP about lozartan on our next appointment.

[PMRpro Ambassador in reply to Missus835]

I don't think it is BANNED. There was a recall of various products because of contamination on a couple of occasions but only certain batches, Many but not all patients were switched to other products.

[Missus835 in reply to PMRpro]

Thanks Pro. As usual, I Googled for the most recent update. Will have to run it by the NP. If she still is, as we had a disagreement about the clonazepam yesterday. She wanted me to switch to something like sertraline. I refused. She asked who was the "one" who prescribed 4 months of clonazepam (one .5 tablet per day) but she said 120 in total. Makes it sound more impactful. When I told her my Neurologist, she said she was going to call him. Tried to explain that it also helps with muscle spasms.

[Chiqui1950 in reply to Missus835]

Dear Missus835,

I am always humbled by the realization that we are each on our own path of healing. I started on Predinzone at about 70 mg in November 2019 with GCA and had a rocky trajectory. I am now at 3 mg. so there is always hope.

I must admit, that when my BP started going up, I eliminated all processed products. In my experience, "low sodium products" raised my blood pressure. Avoiding them completely has made a big difference in the management of my blood pressure.

From what you tell me, it sounds like the morning would be a good time to take your BP medication and with your doctor decide how many mgs to take. you can always start with 25 mg in the morning and then check your BP later that day so see if that was enough.

You may keep a daily record for your doctor of your BP and also of what you ate that day that might explain your BP. I found this daily routine quite revealing.

About tapering, it has been challenging for me also--- bottom line for me and what has worked best is to take my blood tests of my ESR and CRP before I consider any tapering. Sometimes waiting an extra two weeks allows for these levels to lower further and maximizing a smooth taper. Keeping a record of my levels has also been really helpful to be able to reflect what has worked the best. In general, the tapering routine suggested by my rheumy that works best is two weeks of transition (eg.: Monday 15/ Tuesday 14 or 12--- depending on what you and your doctor decide would be best for you--- alternate this way for 2 weeks-- this has worked quite well for me--- although experts on this forum may suggest other ways to transition. After two weeks my body is ready for the new dosis of prednisone (14 or 12mg) and will remain there for additional 4-5 weeks and maybe two more weeks depending on my imphlamation markers. When I got to single digits I do 1/2 mg at a time and follow the same tapering routine. I hope this is helpful.

Best of luck!!

[Missus835 in reply to Chiqui1950]

Thank you for all this wonderful information. I'm so glad you've found methods which work for you and also a rheumy who is willing to work with you. All the best to you my friend.

[Chiqui1950 in reply to Missus835]

Ohh, one day at a time always!!

Just to clarify--- tapering between 15 and 10 I did reduce prednisone by 2 mg at a time--- I tried every 3 weeks --- I had a flare--- I found waiting 4 weeks better. At 6mg I went to reducing by 1/2 mg and for longer periods of time, especially at and below 4 mg and depending on my symptoms and inflammation markers.

I trust you are slowly finding your way to recovery!🙏

[Hunter134]

I have had anxiety since I was very young.If iam anxious the bp will go up.I take 3 in a row and try my best to relax.I take the better of the 3.Good luck it's hard living with anxiety and I know it's exaggerated.Hugs

[Missus835 in reply to Hunter134]

Thank you so very much. I take my BP the same way. Just taking it makes me anxious. Lol. Its very difficult especially when someone asks 'what's making you anxious'. It's not even about that. If you've had it all your life, I'm sure you know what I mean. Hugs to you Hunter.

[Hunter134]

Truly hard to explain to the lucky people that don't have generalized anxiety.Sometimes we don't even know why Keep me posted on how you make out!

[Missus835 in reply to Hunter134]

And you. Will do.