Enalapril user has low blood pressure

In My Humble Opinion
1

I’m blatantly asking for pharmaceutical/medical advice. My regular cardiologist left the country years ago. It would be a 3-hour drive to get to a doctor I trust.

Many years ago I was prescribed enalapril (5 mg daily) for an infarcted heart and was told I’d be taking that for the rest of my life.

Yesterday I went to the hospital to pick up my monthly meds and was surprised to see my blood pressure at 13x/55. I was shocked to see the low Diastolic—so shocked I ignored the systolic which might have been 130-something. The doctor noticed it also and told me to reduce the enalapril to 2.5 mg. (Almost everyone around here treats that drug as remedy for high blood pressure, but cardiologists insist that’s not the main function in my case.)

Why was my blood pressure so low? I had 1 mg Lorazapam the night before (I usually have 0 or 0.5), a good night’s sleep, skipped my usual morning decafs, but eaten my usual 5mg Enalapril. (I ate just half a pill this morning, per doctor’s instruction.)

I realize you are not my pharmacist. You are not my doctor. You are not my lawyer. Still, I wonder if that low pressure should be a concern. What questions should I ask my cardiologist when I make the 3-hour trip?

2

I’m actually surprised that they adjusted your dose (for the whole month?) based on one kinda low diastolic reading. But I am not a cardiologist. 55 doesn’t freak me out*, especially if you were not feeling dizzy or weak, but it would make me want to keep an eye on things. Anything under 60 is where I usually have to call the doctor just to inform them, but they rarely do anything about it.

I’m less concerned that the diastolic was 55, but more concerned that the systolic was simultaneously 13x. That puts your pulse pressure - the difference between the two - at more than 75, which is officially a “widened pulse pressure.” This is sometimes a sign of myriad issues, ranging from anxiety to an aortic dissection. (It’s not an aortic dissection. Just saying that LOTS of things can cause a widened pulse pressure, some not very dangerous, some immediately life threatening.) Given your history, this might very well be normal for you, I don’t know. In fact, it may be why you’re on the enalapril to begin with - not for hypertension per se, but for widened pulse pressure.

I’d recommend asking the cardiologist if they think it’s a good idea for you to take your blood pressure daily before taking your enalapril, and to give you a number at which to “hold” the medication or take a half dose. And when you do so, ask about widened pulse pressure, and if you should still take it even with a low diastolic number if the systolic is high. Basically, get guidelines for both numbers, and for your pulse pressure, rather than “don’t take it if you’re under 60.” (If they do recommend daily BP checks, I’d suggest getting one of the automatic machines that goes around the arm, not the wrist. I have nothing but trouble with the wrist machines.)

Decafs are only lower in caffeine than fullcafs, not completely free of caffeine, so if you drink multiple decafs on a regular morning, you may be getting enough caffeine to raise your blood pressure a little bit, and didn’t get that yesterday. Or you might have been a little bit dehydrated yesterday, which will also give a lower blood pressure.

Lorazepam will lower blood pressure a little bit, but usually not to a significant degree, and it’s believed that the reason it lowers blood pressure is because it relieves anxiety, not because it has a direct effect on blood pressure.

*Diastolic under 50 freaks me out, because that’s the point at which the kidneys start protesting.

3

Thanks very much for your comments WhyNot. I should have stressed that I may have misremembered the systolic reading. The numbers aren’t meaningful to me, but the low diastolic freaked me out.

I should also have stressed that I live in rural Thailand where doctors’ competence is an issue. It’s a 90-minute drive to a cardiologist in whom I’ve little confidence, and a three-hour drive to the good Western-trained cardiologist who installed my stent.

Just now I tested under similar conditions. I got 133/82 with 73 pulse. My plan is to revert to 5mg enalapril but to check blood pressure at least once a week. (There’s a nearby clinic with a self-service BP tester.)