My 67 year-old sister's cardiologist has prescribed 12.5-25 mg. per day of atenolol for her 4.4 size aneurysm. (She can adjust the dose if 25 mg. makes her too sleepy or dizzy.) After this, her general practitioner prescribed her with nitroglycerin. I am concerned because those two drugs taken together could lower her blood pressure to an unsustainable level very suddenly. She could pass out anywhere and hurt herself. Does anybody know why somebody with NO signs of angina would be prescribed nitroglycerin, especially when on atenolol? She has no other heart disease diagnosed at this point.
2009-11-14T13:56:42Z
We both have traditionally had low blood pressure and we both have aneurysms (genetics). I am on atenolol too.
2009-11-14T13:57:51Z
Her bp is on the normal to low range: 120 over 70 and lower, (110 over mid 60s) similar to mine. She has not even begun the atenolol yet, so wouldn't it make sense to see what her bp does before paring atenolol with nitroglycerin?
c_schumacker2009-11-14T16:07:41Z
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Magot, It would depend on the variety of nitroglycerin (NTG) that had been given to here. If its the short acting sublingual (under tongue) variety there are not too many uses other than angina or potential angina (like she had a mildly positive stress test). On rare occassion NTG is used for esophogeal spasm.
Long-acting NTG (take it once or twice daily, every day) is used mostly for blood pressure control and chronic, stable angina. Sometimes for congestive heart failure.
If someone were to be having angina, it usually is accompanied with higher than normal blood pressure so taking NTG actually has benefical effects as opposed to causing dangerously low blood pressure.
You can be on nitroglycerin if you don't have angina. It's often paired with another medication to lower blood pressure and keep it at a normal range. It doesn't normally make a patient pass out unless their blood pressure is at a low level to begin with. (<110/70)
If you're extremely concerned ask the doctor if it's a better idea to take a morning blood pressure before administering the nitro.
EDIT: I just looked in my nursing drug book and it said 90/60. I apologize.
Her blood pressure is low right now because she is taking the atenolol. Don't let her stop taking it. If she needs it for chest pain, she can also use the nitro. If she does use it, it may lower her blood pressure temporarily, but it will do her benefit by opening up those arteries to let the blood flow if she is really having a heart attack. Nitro is not prescribed to treat high blood pressure. These are prescribed together ALL THE TIME and is absolutely fine.
Aneurysms are abnormal dilations of arteries caused by weakening of the arterial wall. Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or acquired connective tissue disorders. Aneurysms are usually asymptomatic but can cause pain and lead to ischemia, thromboembolism, spontaneous dissection, and rupture, which may be fatal. Diagnosis is by imaging tests (eg, ultrasonography, CT angiography, magnetic resonance angiography, aortography). Treatment of unruptured aneurysms is with risk factor modification (eg, strict BP control) plus surveillance imaging or with open or endovascular stent-graft surgery, depending on size and location of the aneurysm and presence of symptoms. Treatment of ruptured aneurysms is immediate repair by either an open surgical synthetic graft or an endovascular stent-graft. 4.4 has 1% risk for rupture.