Systolic blood pressure before/after dual chamber PMs and possible explanation

I had low heart rate and occasionally high heart rate and recently had a pair of dual chamber PMs implanted. I also had high blood pressure and had been taking medications (still am taking the same medications).

Because of my HR lower than 40bpm, almost all electronic BP measurement devices that sold on Amazon or elsewhere did not work for me. I had to buy a high quality stethoscope and a large pressure meter and learned how to measured BP myself. 

Before PMs, even with medications, for the systolic pressure(the 1st number), it  dropped off initially then after about 1/2 hour leveled off. The starting BP was 190ish then dropped and  leveled off at 140ish in about 30 min. (i am not concerned about the diastolic BP because it has been lower than 60). I had been very worried about the 190ish BP because it could cause a stroke. My doctor and cardiologist didn't know what to do except ask me to try different BP medications. My EP and I thought the answer could be PM.

After PMs, with the same medications, the initial value is now 120ish and drops off then leveled off at 110ish in about 15 min

Because the BP has an initial value and a leveled off value, I really don’t know which one to use. I incline to use the leveled off value, but this is not the value measured at the doctor’s office, there it measures the initial value.

There is a significant drop in BP before and after PMs. Does anyone has similar situation? 

A possible explanation would be : when the heart rate is so low (34bpm), the heart or body tries to compensate by increasing the blood pressure so that the cells could get enough supply. Following the same line of reasoning, after PMs, such compensation is no longer needed, thus blood pressure drops to a lower value. Make sense?

Since my BP is sufficiently low now, I intend to do an experiment by dropping one of my medications, amlodipine which is a calcium blocker. From the article that Lavender sent me, Ca++ ions are the key ions that generate the electric pulse that tells the heart to contract.  It also causes swelling of the angle. Amplodipine blocks calcium; I am concerned.


blood pressure

by new to pace.... - 2022-11-05 06:09:33

A pacemaker only controls your low heart rate which is generally set at 60.  since you just had your PM implanted , why don't you give it a chance to work. before you start fiddling with your blood pressure.

  also you should not stop or drop the amount of blood pressure medications without your doctor's knowing.

new to pace  

Amlodipine blocks calcium absorption?

by Gemita - 2022-11-05 07:20:40

Brady, couldn't agree more with new to pace.  You need to work with your doctors to remain safe.  

When measuring blood pressure, always take three readings to get an average reading and take blood pressure three times a day for say a week to get a more realistic idea of what is happening.  I note you say your blood pressure has normalised though following implant and with a higher heart rate, which I have no difficulty understanding but you shouldn't just drop a med instantly without consulting your doctors.

Yes Amlodipine can cause ankle swelling but there are many calcium channel blockers (CCBs) that can be tried or alternative meds to control blood pressure that may work better, with fewer side effects.  Your statement that Amlodipine blocks calcium is in my opinion misleading.

CCBs work by preventing calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze (contract) more strongly.   CCBs allow blood vessels to relax and open which helps reduce blood pressure.

As an osteoporosis sufferer, I was also concerned about the possibility of a CCB blocking calcium generally and causing worsening bone loss, particularly since I was asked to take more calcium supplementation (Calcium/Vit D).  I was told a CCB would not prevent me from absorbing calcium from my diet.

It is true that the body has powerful mechanisms to keep the calcium level in the blood at a regulated level. A small change in blood calcium leads to dramatic changes in physiology. For people who don’t take in enough calcium, one tool the body has is to break down bone from the large supply of calcium there. That’s not good for long-term bone health, which is why adequate calcium intake is recommended. That can be either from diet or from supplements, but since supplements increase the risk of kidney stones and may increase the risk of heart disease, dietary calcium is preferred.

Calcium from diet or supplements can help reduce or reverse calcium flow out of bones.  So just keep having calcium rich foods throughout the day to prevent calcium being leached from your bones and please do talk to your doctors about a blood pressure med which you might feel happier with if indeed you need one??  

high blood pressure

by new to pace.... - 2022-11-05 08:26:53

Am wondering if yours is caused by stress, eating the wrong foods, not enough water causeing  dehydration.  If you stopped worring about every thing should cause your stress level to drop, hence your blood pressure might level out.  Stop eating processed foods which are quite high in salt.  Would also help with lowering and mantaining a better blood pressure level.  And of course drink plenty of water.

new to pace 

not the value measured at the doctor’s office

by Persephone - 2022-11-05 12:46:12

I understand your desire to try to figure it out, Brady, but self-diagnosis is fraught with peril. I object to the typical approach of calling me into the exam room, sitting me in a chair, and immediately applying the BP cuff - or worse, instructing me to hop up on the exam table for the check. So I monitor at home for what I think may be more predictive BP values and do a quality check of the home monitor against what the medical practice uses.

Thank you all

by brady - 2022-11-05 20:25:55

Hi new to pace, Gemita and Persephone,

Thank you all for your advices. I appreciate them. I will keep your advices in mind.

new to pace: the blood pressure measurements were long time measurements and were not taken under stress,  but definitely will remember to drink more water.

Gemita: if I stop amplodipine , my calcium level should go up as you said it is a calcium blocker.

Persephone: I agree that some of the nurses do not take BP correctly. They release the pressure in the cuff very quickly to save time. 2mm pressure drop per heart beat is not observed.

"dropped off"

by AgentX86 - 2022-11-05 20:57:19

I don't understand you when you say "The starting BP was 190ish then dropped and  leveled off at 140ish in about 30 min". "Started off" after what?

I'm with everyone else here.  Never change drugs or dosages without discussing it with your doctor. At least if he knows and wants to try something else, he has some idea where he's starting from. He may want to talk you out of it or discuss further where he's going.  If you tell him everything, he's lost.

I too have the problem of nurses sitting me down and taking my BP immediately. I tell them that if my pulse isn't 80bpm, they're taking it too fast. 80bpm is a more or less arbitrary time but it means that my heart has settled down to its base rate.  It doesn't  mean that they'll listen to me but...

One thing to try is breathing exercises.  A slow inhale, hold, and slow exhale.This will help return control of your body back to your parasympathetic nervous system. When you're stressed the sympathetic system takes over (fight or flight) and, among a thousand other things, raises BP so the body is ready for action.  The idea is to put back in the grazing state.

I've found that the BP machines they use are worthless.  They always read 20pts., or more, than a manual test.

Thanks for advice

by brady - 2022-11-05 21:22:36

Hi agentX86, 

imagaine at time 0, the BP is 140mmHg, and every 10 mins, the BP drops 10mmHg, so 

(0, 140), (10, 130), (20, 120), (30, 110) but after time-3pm in, BP leveled off. No longer drops, so (40m 110, (50, 110).

thanks for your advice, I will be careful.

like your idea of "colegen plug". Wish I know it when I had my implant and could request for one to be used on me.

a decreasing BP over time is not uncommon. If you could measure your own BP, give it a try, do pause 2 minutes between each measurement. 


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