BP Meds -- which safest for divers?

[ScubAtlanta]

I hope I'm posting this in the right place --

I have had persistent, moderate high blood pressure for years, and my doctor recently switched me from lisinopril to bystolic (sp?). The former, as I understand it, is an ACE inhibitor, while the latter is one of the "new generation" of beta blackers (whatever that means). I tolerated the lisinopril well (rarely had any coughing episodes), but it just wasn't doing its job well for me -- the bystolic has controlled it much better, and I haven't noticed any untoward side effects to date.

My doctor has several patients who are divers, and he's very interested in an answer to this question -- what bp meds are considered more or less safe for divers? Is there a ranking anywhere where they are listed based on what's considered most to least safe? Has DAN issed anything on this subject? I ran a quick search, but wasn't finding what I was looking for.

Thanks for any help.

 

[Bonuss]

I ain't died yet taking Bystolic... Accept paying for it.
Bob in CO

 

[ontdiver]

I would give DAN a call rather than seeking online advice for a medical issue.

 

[Doubler]

Duke Dive Medicine?

 

[TomZ]

I can't speak to the safety of BP meds, but can add a bit of info. After taking Lisinopril/HCTZ 20/25 mg for years, I developed severe nocturnal leg cramps. Severe to the point of sleep deprivation, resulting in falling asleep at a traffic light. After trying potassium supplements, chelated magnesium supplements, stopping all vitamins, altering diet, exercise, etc. I discovered it was the BP medication (process of elimination). Two days after stopping the BP meds, the cramps went away. The HCTZ was eliminated and the 20 mg of Lisinopril continued. My BP is actually better without the HCTZ, and no leg cramps.

 

[DocVikingo]

I would give DAN a call rather than seeking online advice for a medical issue.

Okay, then, ontdiver, what do you see as legitimate functions of this & our Diving Medicine forum?

Thanks,

DocVikingo

---------- Post added April 15th, 2013 at 04:30 AM ----------


BP Meds -- which safest for divers? By SubAtlanta


Hi SubAtlanta,

Bystolic (nebivolol) is a beta-blocker. This class of drugs interferes with the action of adrenaline on beta receptors. Among other things, they slow nerve impulses traveling through the heart. The heart therefore does not work as hard and arterial BP is decreased. If an existing HBP treatment regimen such as an ACE inhibitor (e.g., lisinopril) begins to lose effectiveness, a beta-blocker sometimes may be added to or altogether supplant the other antihypertensive agent.

The desired limitation in cardiac output may undesirably reduce exercise tolerance such that possible unexpected rigors of diving (e.g., intense currents, a buddy rescue, a long surface swim in rough conditions) cannot be negotiated. It is for this reason diving medicine recommends that those taking beta-blockers be able to attain a maximal effort of 13 mets (e.g., Stage 4 of the standard Bruce Protocol) or a sustained effort of 6.5 mets on exercise stress testing without chest pain, shortness of breath, EKG abnormality or other worrisome event before considering a return to scuba.

Additional side effects of concern to the diver include cold hands and feet, vomiting, tiredness, and dizziness/lightheadedness. It obviously would not be good if a beta-blocker's sedative effects interacted with increased partial pressures of nitrogen to exaggerate narcosis. As with all drugs, a beta-blocker should be given an adequate topside trial to assess for problematic side effects before attempting SCUBA, and then diving commenced only with conservative profiles.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your treating doctor regarding meds and scuba.

 

[danvolker]

I hope I'm posting this in the right place --

I have had persistent, moderate high blood pressure for years, and my doctor recently switched me from lisinopril to bystolic (sp?). The former, as I understand it, is an ACE inhibitor, while the latter is one of the "new generation" of beta blackers (whatever that means). I tolerated the lisinopril well (rarely had any coughing episodes), but it just wasn't doing its job well for me -- the bystolic has controlled it much better, and I haven't noticed any untoward side effects to date.

My doctor has several patients who are divers, and he's very interested in an answer to this question -- what bp meds are considered more or less safe for divers? Is there a ranking anywhere where they are listed based on what's considered most to least safe? Has DAN issed anything on this subject? I ran a quick search, but wasn't finding what I was looking for.

Thanks for any help.

First, I am not a doctor, but I have spent years reading biomedical research, and and can easily critique most Journal articles I read. This has led me to consider that the Blood Pressure drug solution "CAN BE" one of the most foolish choices your doctor could make for you, and a GREAT REASON for you to begin doing your own reading--even if it means getting to a point where you need to go over some parts of it, with a Doctor you trust ( and you really should). Doctors are still human--there are Great Doctors ( like many I enjoy reading the posts of on our Diving Medicine Forum) and there are Doctors that are trying to see so many people in a day, in such of an assembly line workflow, that they can only give a few moments of thought to a patient that MAY need more like an hour or more of thought....I think between the impossible workflow, and the horrors of having treatments dictated by an Insurance guideline, or worse....you need to educate yourself and "Help" with your own treatment planning.

First, I would point you in 2 directions.... Learn what Advanced Glycation End Products are....my quick explanation first--then the medical one... When you eat foods with high sugar content, sugar globules end up forming in your blood stream, and can cause massive inflamation in the linings of your blood vessels---which will cause responses to the inflamation, that will ultimately cause high blood pressure. Rather than fight the response to the inflamation, which is stupid( ignoring the inflammation--the key root to a huge list of life threatening conditions), the Pharmaceutical Industry GODS that control the FDA, the government, and the insurance industry and Health Care---these guys make much more money fighting the response to inflamation, for the rest of your life, and then selling you other drugs to help with the side effects....
Your alternative is STOPPING the Inflammation for good, and then NOT getting the responses that would cause high blood pressure.... This may not be the case in 100% of the population, but it will be the case in a huge percentage --meaning it is a SAFE BET that you should try to see if you can be cured by a no sugar, low carb diet, before allowing yourself to use dangerous blood pressure drugs for life...

So here is a more scientific explanation for AGE that I lifted from a website....
What Are AGEs?

AGEs are the end-products of glycation reactions, in which a sugar molecule bonds to either a protein or lipid molecule without an enzyme to control the reaction. A similar reaction, known as glycosylation, uses an enzyme to control the reaction, targeting specific receptor sites on cells. Glycation, on the other hand, “is a haphazard process that impairs the functioning of biomolecules”.
Where Do AGEs Come From?

Advanced Glycation End products can come from two sources: the food we eat and internal production in the body. Let’s look at each of them.
AGE Formation In Food
When proteins are cooked with sugars in the absense of water, AGEs are formed. Water, however, prevents these sugars from binding to the protein molecules. Now, I know what you’re thinking when you hear the word “protein”: flesh. I was too, until I got to reading. However, grains, vegetables, fruits, and such all have protein in them as well, with browning being an indication of AGEs:

According to these new findings, brown foods, such as brown cookies, brown bread crust, brown basted meats and brown beans, and even brown coffee beans may increase nerve damage, particularly in diabetics who are unusually susceptible to nerve damage.
​

These are the very reactions that give certain foods their flavors after cooking. Food-borne AGEs are absorbed with about 30% efficiency when ingested.
AGE Formation In The Body
Once you’ve eaten, the body can still glycate the simple sugars in your food. A small proportion of the sugar in your bloodstream is glycated, while the rest goes to running your metabolic machinery. Consider what happens in the bloodstream of a diabetic with chronically elevated blood sugar. There are many opportunities for this circulating sugar to be glycated, which helps explain why diabetics have such high incidences of the issues discussed in the next section.
Fructose and galactose undergo glycation at about 10 times the rate as does glucose. Considering the dramatic increase in sugar consumption over the past several decades, and the subsequent increase in fructose consumption (recall that most sweeteners are approximately 50% fructose), is there any question why we’re seeing rising rates of heart disease, arthritis, and other inflammatory “diseases of aging”?
What Do AGEs Do In The Body?

The body is able to handle AGEs, though very slowly. The half-life of AGEs is about double that of the average cell life, meaning that damage can persist for quite some time, especially in long-lived cells like nerve and brain cells, eye and collagen proteins, and DNA. Not good!
Here’s a run-down of a few effects of AGEs:

…and are implicated in many age-related chronic diseases such as: type II diabetes mellitus (beta cell damage), cardiovascular diseases (the endothelium, fibrinogen, and collagen are damaged), Alzheimer’s disease (amyloid proteins are side-products of the reactions progressing to AGEs), cancer (acrylamide and other side-products are released), peripheral neuropathy (the myelin is attacked), and other sensory losses such as deafness (due to demyelination) and blindness (mostly due to microvascular damage in the retina).
….
The endothelial cells of the blood vessels are damaged directly by glycations, which are implicated in atherosclerosis, for example. Atherosclerotic plaque tends to accumulate at areas of high blood flow (such as the entrance to the coronary arteries) due to the increased presentation of sugar molecules, glycations and glycation end-products at these points. Damage by glycation results in stiffening of the collagen in the blood vessel walls, leading to high blood pressure. Glycations also cause weakening of the collagen in the blood vessel walls, which may lead to micro- or macro-aneurisms; this may cause strokes if in the brain.
​

How Do I Protect Myself?

There are a few steps you can take to keep yourself safe from a toxic load of these compounds.

• Keep blood sugar low with a Real Foods diet – This will reduce sugar supplies available for glycation.
• Eat vegetables and fruits raw, boiled, or steamed – When eating raw, there is no formation of these compounds because there is no cooking, while boiling and steaming introduce water to the cooking process.
• Avoid processed carbohydrates and browned foods – Food manufacturers take steps to increase caramelization and browning in their foods, directly increasing the levels of AGEs in the foods.
• Cook meats low and slow – Higher temperatures produce more AGEs than lower temperature, longer cooking times. Rare and medium-rare meats will have fewer AGEs than fully cooked meats, like barbeque or well-done steak.

In the end, if you’re not eating well-done meats often and are sticking to vegetables, tubers, and fruits for your carbs, you’re unlikely to be taking in dangerous level of AGEs. The body can deal with these substances so long as it isn’t overrun with them.



And then, Read the Mercola story for what is wrong with blood pressure meds...
Blood Pressure Drugs May Backfire On You

 

[ontdiver]

DocVikingo - Just expressing a personal opinion - that's still OK, right?

 

[DocVikingo]

DocVikingo - Just expressing a personal opinion - that's still OK, right?

Within a medical context it's okay with me to the extent that the opinion is articulately presented, well-reasoned, and consistent with the evidence or otherwise supported. Is yours?

I'm just curious if you think that the Diving Medicine & Divers with Disabilities forums serve any legitimate medical purpose? And if so, what?

The "Call DAN reflex," an involuntary and almost instantaneous abnormal movement of the less than optimally functioning nervous system, provides an easy dodge for the uninformed to all sorts of diving medicine issues. Of course emergency diving medicine inquires should be brought to their immediate attention. And, while it may be a wise idea to inquire of DAN about non-urgent situations, one needs to appreciate the likely limitations of doing so.

For example, when one contacts DAN they first, and often only, speak with a paraprofessional (e.g., registered nurse, diving EMT). These folks often simply thumb to DAN's medical FAQs (DAN | Site Map) and read or email a paraphrasing to the individual. These praprofesssionals frequently are quite busy and give the briefest possible reply. For understandable reasons, DAN provides very limited direct physician access. As such, the answers received from the experts on a diving medicine forum are likely to be longer and more informative than the responses from DAN, even when both are in essence correct.

Also, diving medicine forums typically afford greater opportunity for more rapid give and take between participants than is the case with DAN. Finally, links to previous board threads on the topic, professional magazine and journal articles on the topic, and other reference sources are often given on these forums, another nicety not usually provided in a DAN reply.

Finally, DAN does occasionally give a rather shaky response. I can cite a number of these. It is a very worthy and valuable organization, but it in fact is not the be all and end all of diving medicine fact and opinion.

IMHO, it iswisest to inquire from a range of sources and see how the opinions rank based on the factual and theoretical support given an opinion, the thoroughness and clarity of the response, and similar factors.

In summary, in non-emergency cases I can see no compelling reason not to seek advice from recognized diving medicine forums and other reputable sources that have knowledgeable physician participation and turning to DAN only if that fails. Some diving medicine inquiries are rather easy to answer and do not require DAN's valuable, but limited, medical resources.

Regards,

DocVikingo

 

[ScubAtlanta]

DocVikingo -- many thanks! That's exactly the kind of info I was looking for. I'll share it with my internist for his consideration.