Also worth noting that it’s pretty common for people to use low dose beta blockers specifically for performance anxiety, since they work immediately and do not need to be taken consistently. Lots of musicians, public speakers, etc, use them. I sometimes take a little extra of mine before particularly anxiety-inducing events. Of course, for a lot of things (like performances and test-taking) there’s a sweet spot of moderate arousal you’re trying to hit for peak performance (see the Yerkes-Dodson law/curve), so you don’t want to overdo it either.
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Fascinating…" hypertension runs in my family and mine is still normal but will not likely stay that way. Also have some (social) anxiety issues on mild side— as long as I stay away from and don’t think about boys I’m fine. Speech in front of 1000 people, no problem, but first date with a cutie, big problem. Usually mid120s/mid80s up to 160/?? with mild-for-a-kidney-stone-pain. Wish those numbers wouldn’t increase but 10 year trend and family history says no matter what I do nutrition and exercise, my blood pressure will need meds by the time I’m 40…
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Unfortunately, the parents you picked determined the lion share of what is going to happen to you health wise. Of course, doing the right thing helps, but in the end, your family genes will eventually catch up with you.
At least it is a super treatable condition with lots of data. The main drugs used to treat hypertension have all been studied for a very long time and there are many many options in case one has a side effect you don’t want to live with.
And remember, next time, pick better parents
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@CarolynA, you might try beta blockers and see how you like them—a low dose could take the edge of your BP and your anxiety. Worst case, you don’t like the side effects and stop. They wash out of the system quickly, so it’s an easy med to try, and one physicians are generally very willing to prescribe (as long as asthma is not a concern).
And yes, agreed re: genetics being most of it—one side of my family has a major history of cardiac disease including hypertension and high cholesterol, and it’s pretty blatant by now that my brother has those genes (including the body shape to match) and I do not. I got the short straw on enough other stuff though, so fair enough.
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Even if asthma is a concern, there are cardio-selective beta blockers that have less of an impact on the lungs than more general ones. I’ve taken both bisoprolol and propranolol. The former works very well for me even in a super low dose. The latter I need a much higher dose and it ends up having a big impact on my breathing. I also notice that low symptoms are “hidden” to a much greater degree with the latter compared to the former.
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That makes sense and is good to know—the flipside of that is that the more cardiospecific ones are also going to have less of an effect on anxiety than the more general ones, which is exactly why propranolol is the go to choice for psychiatric applications of beta-blockers.
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Which beta blockers are more /less cardio specific ?
The one I tried was bystolic? Apparently it’s pretty cardio selective according to dr Google… but apparently it’s complicated
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I don’t know that much about all of them, so I’d be googling as well; I just know that’s why in psych we use propranolol, but also why it’s not commonly used anymore for cardiac purposes.
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I frequently have heard that ACE Inhibitors have kidney protective effects in people with diabetes. What I’ve never understood though is whether that is simply because they reduce blood pressure or is there some other magic mechanism at work that makes the ACE inhibitor more protective than any other class of blood pressure meds?
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It is absolutely about the mechanism of action. Here is a short blurb. Basically, interrupting the renin-angiotensin system is good for your kidneys when you have a disease process which involves vascular damage to the kidneys, which is what ACE inhibitors do.
“Experimental and epidemiological data suggest that activation of the renin-angiotensin-aldosterone system plays an important role in increasing in the micro- and macrovascular complications in patients with diabetes mellitus. Not only are ACE inhibitors potent antihypertensive agents but there is a growing body of data indicating that also they have a specific ‘organ-protective’ effect. For the same degree of blood pressure control, compared with other antihypertensive agents, ACE inhibitors demonstrate function and tissue protection of considered organs.”
Drugs. 2001;61(13):1883-92.
Role of ACE inhibitors in patients with diabetes mellitus.
Cordonnier DJ1, Zaoui P, Halimi S.
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@cardamom - this is truly interesting. It is so reasonable that anxiety could lead to higher BP. If one is under stress, or if one is a type A, perfectionist, then that person may tend towards general higher BP. What would be the low dose beta blockers that you would recommend? Would it be propranolol? It’s not for me, it’s for my husband, who is not diabetic, but borderline hypertension. My best friend from college is also borderline hypertension. The two of them may benefit from the low level beta blockers. My best friend has been under a great deal of stress, family and work life. My blood pressure range has always been in the 100/70 range. Frankly, I was puzzled by one internist who prescribed Lisiniprol for me, knowing my blood pressure range. I ignored his instruction to fill out the prescription. The internist’s reaction was very automatic, oh, you’re a diabetic, you should be on an ACE inhibitor. Duh…if my BP were lowered any further, I would get light headed.
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@Chris, I, too, like Sam have heard of the kidney protective effects of ACE inhibitors. When the blurb refers to diabetes mellitus, was the study specific to Type1, 2 ?
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I take it as a preventative, even though I have low blood pressure. I get dizzy sometimes from the low blood pressure.
ACE inhibitors aren’t just for low BP. They are used to lower the risk of kidney damage.
There is an enzyme that acts as a vasoconstrictor in your body (tightens or constricts the blood vessels). The one the ACE inhibitor targets is angiotensin, it is a protein hormone that causes vasoconstriction and an increase in blood pressure.
What an ACE inhibitor does is inhibit this enzyme, so it reduces its effect of constricting the blood vessels.
It does lower BG, but there is a benefit that is particular to the kidneys.
By blocking angiotensin it reduces pressure directly in the kidneys. Reducing pressure within the kidneys reduces the damage to the vessels that make up the kidney.
The ones they generally use for kidneys are ACE and ARBs (angiotensin receptor blockers).
They have found that angiotensin is the one to go after for kidney protection.
@lh378, for what it’s worth, I don’t ever listen to doctors. But in terms of the ACE inhibitors, and what I researched, I actually did follow the standard diabetes protocol for it and I am using a very low dose.
BTW, one way to help prevent your BP from getting too low is to try and always be well-hydrated! Hydration will help raise your BP. Dehydration will lower it. So drink plenty of water to help you from getting low BP dizziness.
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Thanks- do you use ARB’s - angiotensin receptor blockers?
Kidney health is important. Gosh, none of us would want to be on dialysis. If there were ever a problem that requires a solution, it would be better quality of life for those on dialysis. A colleague of mine, a diabetic, about 10 years older went on dialysis about more than a year ago. He now performs dialysis from home. It’s my understanding that it is exhausting. It is unfortunate that he uses Dexcom CGM, is on a pump and yet, his A1c was routinely around 8. His doctor deemed this to be acceptable. That my colleague’s A1C was 8 may have been a contributing cause to his requiring dialysis, but one never knows for sure. As a side anecdote, at my recent general eye checkup, the doctor was pleasantly surprised that my A1C was 6, stating that wow that’s really good. In general, doctors seem to have such low expectations for us, diabetics…
so unfortunate.
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I use an ACE (angiotensin converting enzyme). I have never used an ARB.
I don’t think there is too much down-side to an ACE inhibitor. Some people have a slight cough from it. It may lower your BP which can be a problem if it is already very low. But compared to some of the other meds, an ACE is not nearly as horrible.
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The paper I referenced is a review of existing publications (mostly with Type 2 patients) that proposes through the review process to establish a proposed mechanism of action for ACE inhibitors as opposed to other blood pressure lowering drugs.
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As well as not be horrible, it is a well studied medicine that has been on the scene for a good amount of time, i.e. since the early 80’s.
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I’ve never had a doctor suggest it. I’ve never heard of the protective effect of blood pressure medications for kidneys. My blood pressure is usually 110 over 70, but sometimes it’s lower. I occasionally get a little dizzy if I get up too fast, but I probably wouldn’t consider it low.
I wonder why none of my doctors have suggested it. Seems strange based on this conversation. I feel like I might be missing out on something I should be using.
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I would say that at this point it is a theory, that hasn’t been proven in a large population of diabetics. The more highly read your physician the more likely they are to have been exposed to this. I wouldn’t consider it a bad thing that your physician hasn’t suggested it, but I think it would be worth discussing with your physician. You may be a good candidate or not. That is what you have doctors for.
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Me too! Therefore I did think it odd when one physician wanted to prescribe Lisiniprol for me.
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