These Meds & Blood Pressure

Q: These Meds & Blood Pressure

Dr. Phelps,

First, what a fabulous and informative website that will take days to sift through. I skimmed the topics of questions asked and answered (and read those that were relevant) but saw nothing on blood pressure other than as it relates to metabolic syndrome. My systolic readings seldom reach 140 and are more frequently in the 110-120 range. However, my diastolic readings very seldom fall below 80 and can go as high as 100. I feel that even 80 as a consistent reading is too high for the long term. The rise in diastolic may have coincided with the use of trileptal. We (therapist and I not an imaginary friend) have halfed the trileptal dosage from 300 mg twice daily to 150 mg twice daily and have started to add in lamictal at the recommended low dose. We have also stopped the prozac (originally given for PMDD and very likely one reason for the exacerbated bipolar symptoms and rapid cycling). I also take 400 mg of seroquel at night for it's use in treating insomnia with the added benefits of a mood stabilizer. My therapist is surprised that the seroquel has not lowered my diastolic pressure and we are continuing thrice daily bp reading for two weeks before any decisions are made.

So ... the short form of this question is -- is there a correlation between any of these drugs and diastolic pressure and how concerned should I be even though it is only the diastolic pressure that is high.

Thank you for considering this question,
Cindy

Dear Cindy --
Thanks for the encouragement. As for blood pressure: yes, I too would be hopeful that good symptom control might lower blood pressures. But, if you've already got good bipolar symptom control, here are some thoughts:

1. If the Prozac was stopped less than 6 weeks ago, you're not quite "there" yet -- it takes about that long to really clear all the Prozac out (it very slowly approaches zero over the last weeks 5 and 6).

2. Trileptal product information from the manufacturer does list "hypertension" as an associated bad reaction, though it's down in the fine print where this usually means the reaction is not common. However, stopping the Trileptal may help, as you're hoping.

3. If you ended up having to treat the blood pressure, don't forget that verapamil, a standard antihypertensive, may also have some mood stabilizing properties, so you might get some extra benefit there (the evidence is not very strong, so I'm not sure I'd even push your primary care doc' in the direction of using it rather than some other antihypertensive that she/he might otherwise recommend).

4. Regular physical activity is known to: lower blood pressure; lower cardiovascular risk; increase insulin sensitivity (the primary problem in "metabolic syndrome"); and improve mood. So, if that's not a regular part of your day, you'd do well to add it. Here's my little essay on that: "not the usual rap" about exercise from my education website.

Good luck with all that -- your exercise and your blood pressure and your mood control!

Dr. Phelps

Published August, 2004