I have had high blood pressure for the last year. What antihypertensive medications do not lower heart rate? I have tried several different medications, and have had episodes of severe dizziness and almost fainting with heavy activity and also exposure to the heat. I have made several trips to the ER with these episodes with a low heart rate and low blood pressure. My doctor has had no success with different medications in preventing these episodes. Can you advise us what to do next?

Hx: Male 74 Very active and young for age
50-70% block R carotid
Slight narrowing aortic valve
Irregular heart rate for many years with numerous tests and no significant problems when younger, even running.
For past year has been on numerous different antihypertensives. Has had episodes of severe dizziness and almost fainting with heavy activity and also heat related.
Several times to ER over past year via medics after these episodes. BP low and heart rate low with some dehydration do to heat and limiting fluids.
Has had echocardiogram with no significant issues.
What has been discussed with cardiologist is BP meds lower heart rate and exercise/exertion lowers BP.
Last episode with HR 38 AND BP 119/50. To cardiologist and EKG done with HR 41. Took him off all BP meds.
Lying to sitting/standing BP drops 20 points. After exercise or heavy exertion BP can drop up to 50 points. This is when he was on meds. Now off all meds 2 weeks and BP 202/88 to low of 124/68. Off meds he took a 20 min. walk and BP 198/84 prior to walk and 126/68 after walk.
I am his wife and a RN. Went to reputable cardiologist, but now concerned with treatment. Dr. seems frustrated and does not know what to do next.
PLEASE HELP us to proceed in the right direction.
Thank You for your time.

Submitted by Lyndall from Charlotte, North Carolina on 09/09/2014

by Maher M. Nasser, MD

Dear Mr Nicholson,
I reviewed your letter, it appears to me that you are sensitive to BP meds. Those meds that slow heart beat include Beta Blockers, Calcium Blockers and Clonidine.
Alpha Blockers, given for prostate enlargement, may give you orthostatic hypotension.
BP meds that should not affect HEART RATE INCLUDE: Amlodipine(although it is a calcium blocker), Hydralazine (direct arterial vasodilator), ACE Inhibitors, ARB’s and other medicines that we do not use often at the present time.
I hope this answers your questions. Of course following a low salt diet is helpful for BP control as well as exercise. Regards.