BP: How low is too low?

[lilyjack]

Here's something I'm curious about: how low is too low when it comes to blood pressure? I've done some quick and dirty research and didn't really find any hard and fast numbers like there are quantifying too high.

I ask because I was averaging 80-90 over 50s for a few weeks shortly after I initially started my meds. After a while, I started feeling lightheaded a lot of the time. My GP cut my Toprol XL dosage in half and my pressure averaged 90-100 over 60s. When I went in for my cardio appointment two weeks ago, my doctor took me off the Captopril 3x a day and on Lisinipril (sp?) once daily (a much more convenient drug regimen for me). My pressure stayed the same for a few days, but now it's dropping down into the 90/50s range again. I was so light headed in the grocery store today, I almost couldn't drive myself home. However, most of the time I feel fine.

(1) is there a range where BP is too low? What is it?
(2) is it dangerous for BP to be too low (other than the lightheadedness)? Obviously, it can't be good to get dizzy when you're driving, but are there other issues I should be aware of?
(3) is it possible to have a BP that becomes too low to stay on the medications?

I would like to have more information before I bother my cardiologist about this. Right now, the lightheadedness is pretty infrequent, but if it gets frequent again, I'm going to need another adjustment. Thanks in advance for your input/advice/info.

[Janelle]

I too suffer from low bp--not sure what is considered too low, I know that when my top # gets below 100 I get lightheaded as well. I find that when I get up too quick this is especially true so I try to be more aware of this.

My first cardiologist kept lowering my Coreg for 2 months b/c my bp was dropping. My current cardiologist (at Genesis Heart Institute) told me that he doesn't care how low my bp drops--that it is crucial to increase the Coreg, which have now made it to 25mg 2x daily.

[jasper]

Sounds about the same for me. I am also on Coreg 25 mg twice a day and I frequently am 90's/50's. They have tried to increase my ARB ( Diovan), but it goes too low. Last try I was at work with 72/48, feeling horrible. My cardiologist finally gave up and let me take a half dose during the day and the full dose at night. AT least whbile I sleep I don't get dizzy.
I am interested to see what others experience.
Jennifer

[marissar]

It is to low if you are passing out lightheaded. It is poissible to have a bp that won't tolerate the meds and have to be taken off of them( I did). It can be dangerous if it is to low because of the arrythmias it causes. Good news is if your bp won't stay up you are probably improving in heart function or size.

[lilyjack]

Melissa -- really? This might be a positive sign? :D

I'm glad to hear others have the same problem -- I thought it was just me! I never had a high blood pressure reading until right before I was diagnosed with ppcm. Maybe this means my heart is going back to normal! :D

I can tough it out as long as it doesn't get any worse...

[miracle baby]

Coreg is a powerfull drug that for me has mess with my bp alot as they switch dose.As long as you feeling good my doctor told me not to take my bp because it scares me when I think it low.Dont quote me but I think it in the 40's to be consider dangerous.But one of the nurses here should be able to tell you.

[miachic]

Hi ladies! I do believe your pressure can get too low. I didn't tolerate BBs very well because of such good response in my blood pressure. Dr. Fett has stressed the importance of being on a BB after diagnosis even a low dose to keep the BB circulating in your system. However, I believe he's also said that there are people that can't tolerate BBs, ACE or ARB because of the effect on their BP. They can lower your dose to a very low dose and it still have an effect on your heart. I believe the normal first starting dose for Coreg is 3.125 mg b.i.d. but that can be halved and lowered to 1.5 mg b.i.d. if needed. I actually talked with my heart failure doctor about this.

My normal blood pressure runs 100/60 or less. I notice that I start to feel dizzy if it drops to around 90/60 or below (doesn't happen very much anymore now that I'm exercising all the time). I would definitely call your doctor if you are feeling dizzy or lightheaded. That is in itself is dangerous because you could fall, pass out while driving and cause an accident or other potential problems.

Here's some links for you (from the researching crazy woman :D ):

http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm

http://www.americanheart.org/presenter.jhtml?identifier=4643

http://www.bpassoc.org.uk/information/low_blood_pressure.htm

http://heart.healthcentersonline.com/bloodpressure/hypotension.cfm

Hope that helps!

[heartfulloflove]

I agree with those who are saying that BP when it starts getting around the 90/50 range becomes symptomatic for me. This was a big reason I was so hesitant about the beta blockers my cardiologist was considering.

During my pregnancy I was always around 90/55 at my check ups. One time I didn't feel well and was seeing stars, and it was 84/49. My OB was noticeably concerned, and sent me over to have a non-stress test for the baby. I'm guessing a number that low would have caused concern even if I wasn't pregnant at the time. My GP says as long as you don't pass out or nearly pass out it is probably okay. If you pass out, then that's pretty bad and something needs done.

Maybe this is a good sign that your heart is getting better, more efficient? I hope so!

[lilyjack]

Thanks for the links, Emily! I'm not going to worry so much about it unless the lightheadedness becomes more frequent. It looks like 90/60 is good, and that's where I'm usually at. I just get woozy when it heads to 90/50 or 80/50 -- and I think that usually happens shortly after I take my meds, which is in the morning (Beta Blocker) and before bed (ACE).

[tabs]

Blood pressure is pretty subjective on the subject of being too low. If you are not supporting another life (pregnant), then usually your doctors will go by how you are feeling. It seems that many women here become symptomatic around 90/50, I, on the other hand, don't become symptomatic until it is much lower (like 50-60/pulse rate). Before I get to that level, I will notice some postural dizziness, but that is it.

Unfortunately, I have never heard of a relation between being unable to tolerate meds to due BP and improvement to the heart. It is possible that a heart could be getting better, but.....it really isn't a cause and effect since most of us started with pretty low BP's while in heart failure.

A big concern with low BP is dehydration. Dehydration will lower your BP and make your symptoms more pronounced.

If your dizziness becomes an issue, I would definately talk to your doctor.

Twilah

[SerenaWelsh]

slightly related...

my BP has always been low. BBs lower it even more. A year ago when my BP was hanging out in the 68/40 range it was decided I may be over beta blocked (you think?!?), so my Toprol XL was reduced from 200 to 150mg. Same thing this year - BP hanging out in the low range again, so I'm reduced from 150mg to 100mg. When I posted about it, Dr. Fett's answer was that it's not common, but sometimes people do stop tolerating medicines they have been on for a while - and there doesn't seem to be an explanation for it. In my case, my EF has improved - but still only to 25-30%, so it's unlikely that the healing is what's making the BBs lower my BP too much.

As for the dangers of a low BP, I know in trauma patients the concern is blood effusion to the organs. I'm not sure if that's the same for us, but I routinely undergo screenings for kidneys and liver - I presume because of the CHF.

Now, as far as symptoms go. I'm a very dizzy person. I can't remember when I wasn't, but there must have been a time. Mostly it's postural, but there are times when I can get dizzy just standing around, or just sitting around, and sometimes even lying down. I'm not suggesting that everybody should do this, but since my doctor isn't concerned I've just come to enjoy what I call my little tipsy moments until they pass.

[LauraNP]

You need a BP of 60 to perfuse your kidneys. Other than that most people go by symptoms.. as long as you can stand up, you're ok.

There is a fine balance between giving you the max possible dose of meds and making sure that you can tolerate the meds you are being given. If you have no blood pressure, that's a problem. You need blood pressure to get blood flow to your organs. If your meds are making you feel like crap because your BP is too low, you need less meds.

My own experience was when I was diagnosed I was on 50 mg bid of coreg, .25 mg of digoxin and 5 mg of vasotec. I couldn't stand up.. my BP was routinely in the 80's. I drank tons of water to keep it up and this was when I began self medicating with sodium. Eventually they started to lower my meds and I felt better. I don't think there is any correlation between not being able to tolerate meds and your heart function getting better.. my heart function is crappy at the moment and I still have low BP. Remember, these are all BP meds. If you didn't have high blood pressure to begin with they're going to cause low BP.

My suggetions would be to drink lots of water and talk to your doctor about lowering the dose if you can't tolerate them. Research says you need to push the dose as high as tolerated.. but if you can't tolerate it you can't tolerate it!

[Dani]

slightly related...

Mostly it's postural, but there are times when I can get dizzy just standing around, or just sitting around, and sometimes even lying down. .

Serena,
Same here. I have always has low BP, ever since I can recall, and it wasn't that elevated while I was pregnant, either. It's not unusal for me to be in th 80s/50s range, and I generally always feel crappy. Dizziness is part of my life. What I can't stand is when it happens when I am trying to sleep. One of my doctors calls it positional vertigo when it happens while I am lying down trying to sleep. It feels like I am swinging back on forth, like a pendulum. Basically I have to move my head until it passes. I can't begin to recount the number of times I have said to my husband, "Am I moving?? I swear, it feels like I am moving!" and I am clutching the edge of the mattress as if I am about to be flung off of it.
Back in the early 90s, I was having brutal migraines and a doctor put me on Inderal. I felt even worse. . . well, three days into the Inderal and once I was in the ER insisting that I was dying, my BP had plummeted to 52/35. Miserable.
Crazy to have something go wrong with your heart when you never had a problem with HIGH blood pressure before.
Dani