Fluctuations in blood pressure

Can anyone advise? I have been on 5mg Ramilpril for 5 weeks after initially being diagnosed with high blood pressure. The first couple of weeks it was still unstable. This week it is dropping daily and today it's 114/72 pulse 53. Being new to this, I wonder if it's too low considering l am 66? Also l have noticed my pulse is often ranges from 50 and never above 70.

[SeasideSusie Remembering]

Sueiso

Welcome to the forum.

Whilst our many experienced thyroid patients are happy to share their experiences and make suggestions about thyroid related items, it may be better for you to post your blood pressure question on a dedicated blood pressure forum or discuss with your GP.

If you click on MY HUB at the top of the page you will see FIND A COMMUNITY, click on that to look for a blood pressure one.

I'm on BP medication which was recently changed, during a follow up conversation with Advanced Nurse Practioner at the surgery I mentioned my BP was 113/66 (average on previous medication was 125-135 over 70-80) and he was not at all concerned. I also mentioned that my heart rate was going as low as 55, again he was not concerned and said a Cardiologist would have no problems with that. However, that is just my experience and I discussed it with a medical professional, I think maybe you should do the same which I would have thought your GP may have arranged a follow up appointment to discuss your progress.

[Hidden in reply to SeasideSusie]

Thank you so much for taking the time to reply and for your wise advice. Unfortunately feel pretty abandoned after being prescribed BP meds. No monitoring or follow up. I will give my surgery a call and ensure l get some much needed support. Keep safe and well.

[Afaghieh in reply to Hidden]

Hi On ramipril you should have a blood test as well.

[SlowDragon Administrator]

Can see you also are hypothyroid

How much levothyroxine are you currently taking

Do you always get same brand of levothyroxine

Important to only ever take levothyroxine on its own on empty stomach and then nothing apart from water for at least an hour after. No other medications within 2 hours

When were thyroid and vitamin levels last tested

What vitamin supplements are you currently taking

High blood pressure can be linked to poorly managed thyroid issues

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Have you had thyroid antibodies tested

Ask GP to test vitamin levels or test privately

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

Please add most recent results and ranges

Or come back with new post once you get results

[Hidden in reply to SlowDragon]

Thank you for your comprehensive reply SlowDragon definitely lots to look into there. I am on 75mcg of levothyroxine and always the same brand. I find this is my optimum dose despite the GP often suggesting I drop to 50 daily. In the past l have tried this but from experience now know it's not good for me. I take vitamin D, C, B complex Garlic, and Magnesium and zinc. My normal blood test isn't very informative and normally the only information given is 'no further action needed". Thank you for advising to take my thyroxine 2 hours after my Ramilpril. I was advised to take them together. 😖 l always take my levo on an empty stomach. I will look into security the other tests privately. Thank you.

[SlowDragon Administrator in reply to Hidden]

Unless very petite 75mcg is low dose

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...