I asked Grok. Of course your cardiologist knows you best.
For 20 years I've taken 10 mg of Lisinopril and my bp has always been
nicely in check. However, a month ago, my cardio has added Matzim LA 180
once a day in an attempt to keep my periodic Afib in check. He was concerned
that the combination of Metoprolol, Lisinopril and Matzim might lower my bp too
much.
What I've ended up with is my bp going nuts and way high and even after a visit
to the ER yesterday after bp hit 200/100 the docs have no idea why it's high. Nothing
was gleaned from all the labs and tests they ran and now I'm taking 40 mg of Lisinopril
on top of everything else.
I’m sorry to hear you’re going through this—it sounds incredibly frustrating, especially after having your blood pressure under control for so long. Let’s break this down a bit and think through what might be happening, though I’ll emphasize upfront that I’m not a doctor, and you’ll want to keep working closely with your cardiologist or another specialist to get this sorted out.
You’ve been on Lisinopril (an ACE inhibitor) at 10 mg for 20 years, and it’s kept your blood pressure stable—great track record there. A month ago, your cardiologist added Matzim LA (diltiazem, a calcium channel blocker) at 180 mg daily to help manage your periodic atrial fibrillation (AFib). I assume you were already on Metoprolol (a beta-blocker) before this, since you mentioned it as part of the combo, though you didn’t specify the dose or how long you’ve been on it. The concern about the trio dropping your blood pressure too much makes sense on paper—all three meds can lower BP, and combining them could theoretically overshoot in that direction. But instead, you’re seeing the opposite: your BP spiking, even hitting 200/100, which is wild and understandably alarming.
So why might this be happening? One possibility is that adding Matzim LA has thrown off a balance your body had adapted to over years on Lisinopril (and maybe Metoprolol). Diltiazem can affect heart rate and blood vessel tone, and while it’s often used to control AFib by slowing the heart rate, it might not be playing nice with your system. Sometimes, when you tweak one part of the cardiovascular puzzle, the body compensates in unexpected ways—like raising BP through stress hormones or other mechanisms. Another thought: Matzim LA is a long-acting form of diltiazem, and maybe the 180 mg dose is either too much or not the right fit for you, triggering some paradoxical reaction. It’s rare, but calcium channel blockers can occasionally cause BP spikes in some people, possibly due to reflex activation of the sympathetic nervous system.
The ER visit suggests they ruled out immediate emergencies (like a heart attack or stroke), but it’s odd they didn’t have a theory about the cause. Did they adjust your meds, check your electrolytes, or run tests like kidney function or thyroid levels? Issues like kidney stress (Lisinopril can affect this over time) or an adrenal problem (like a pheochromocytoma, though that’s a long shot) could spike BP, but those would likely have been flagged. Drug interactions are another angle—any new meds, supplements, or even diet changes around the time this started?
Here’s what you might consider next: track your BP at home a few times a day if you aren’t already, noting when you take each med and any symptoms (dizziness, palpitations, etc.). Share that data with your cardiologist ASAP—yesterday’s 200/100 says this isn’t something to sit on. Ask if the Matzim LA could be the culprit and whether a lower dose or a swap (say, to a different rate-control med for AFib) might help. Also, double-check your Metoprolol dose hasn’t changed recently—beta-blockers can sometimes mask other issues if the dose is off.
This is a puzzle, and it’s maddening when even the ER doesn’t have answers. Hang in there, keep pushing for clarity, and let me know if you want to dig deeper into any part of this! |
