Clonidine for hypertension

[Peppa_pig]

Hello,

Does anyone have experience with taking clonidine for hypertension?

My FWP has been experiencing fluctuating blood pressure (anything from 102/66 or lower to 180/90 or even 200/80 on occasions) and his cardiologist has been adjusting his meds but they don’t seem to be that effective.

We saw a new cardiologist today for a second opinion and he’s confirmed postural hypotension. He admitted it’s tricky to treat as you have to try and balance the two extremes. However he’s prescribed clonidine, in addition telmisartan that my FWP is currently taking. I haven’t found any posts on clonidine in this forum so am curious as to why it doesn’t seem to be commonly prescribed.

He also prescribed GTN spray to use if bp goes over 180.

My FWP also starting taking Betmiga a few months ago for overactive bladder and this is around the time when the bp started increasing. He’s since stopped and I’m wondering if we should give it a few weeks to see if the bp comes down before starting clonidine as I just read it is not one you can just stop as it can cause very high spikes in bp. At the same time worried it might decrease the bp too much and lead to falls especially with nocturia.

Thanks!

[park_bear]

Yes, Betmiga can cause hypertension. Were the doctors not aware of this?: proquest.com/openview/ae18e...

"Serious cases of hypertension and increased BP have been reported in patients receiving mirabegron [Betmiga], as well as some reports of hypertensive crisis and cerebrovascular and cardiac events associated with hypertension with a clear relationship to use of mirabegron. As a result, the use of mirabegron is now contraindicated in patients with severe uncontrolled hypertension (defined as systolic BP ≥180mm Hg and/or diastolic BP ≥110mm Hg). It is recommended that BP be measured before starting treatment and regularly monitored during treatment, particularly in patients with hypertension."

> I’m wondering if we should give it a few weeks to see if the bp comes down before starting clonidine

I agree.

What you should know about postural hypotension:

It is also referred to as orthostatic hypotension and causes loss of blood pressure upon standing. This is the result of impairment of the fast acting postural blood pressure regulation system. This can be caused by a variety of neurological deficits. Parkinson's is one possible cause. Another is dopamine agonist medication.

There is also a slow acting blood pressure regulation system that operates over a period of hours. During the day when the patient with orthostatic hypotension is not lying down the average blood pressure is too low. As a result it slowly rises during the course of the day and peaks in the evening. At night when the patient is laying down blood pressure is now too high - This is known as supine hypertension. It slowly drops over the course of the night and it reaches its nadir upon waking in the morning.

To mitigate night time supine hypertension he should sleep reclining with his head elevated.

If you are able to confirm his blood pressure pattern conforms to the typical orthostatic hypertension pattern of low blood pressure in the morning and high blood pressure in the evening, we can talk about a simple mitigation to improve his morning low blood pressure which would thereby also reduce his supine hypertension.

[Peppa_pig in reply to park_bear]

We did ask the urologist who prescribed the Betmiga but was told risks were low…

I can confirm that his bp is typically low in the mornings and start to climb in the evenings. Although in the last couple of weeks there were a few days where it was also a bit high in the morning.

I should add that he started taking sinemet 100/25 recently (week 2). He’s starting with 1/2 tablet once a day, building up to 3 a day over the next few weeks as prescribed by the neurologist.

[park_bear in reply to Peppa_pig]

First thing in the morning, when his blood pressure measures low, he can drink one quart or 1 liter of isotonic saline. isotonic saline is prepared by adding 9 grams of salt to 1 L or 8 grams of salt to one quart of water. This will expand his blood volume and thereby raise his blood pressure. Plain water works poorly for this purpose because it will be quickly excreted. This may also help to mitigate his supine hypertension in the evening.