Should a patient be taken off of BP meds they’ve been on for 30 years?

SavingMom:

When you first posted I answered you; you seemed to have a lot of information and "numbers" and diagnostic information. At that time, and for that reason, I WRONGLY assumed you were MPOA.
As I understand it now, you are not? I think that others may have assumed you "were in charge" and I think it caused this thread to go off into the weeds a bit with advice (including my own).

If you are not the MPOA then this problem above is for A) the MD, B) the patient and C) the MPOA to discuss and make decisions.

Golden is correct. Your Mom was on a Calcium Channel Blocker. One side effect of these meds is lowering the HR. Her MD may have decided her rate was too low to continue this medication without a pacemaker (which he may or may not have discussed with your mom).

There was then the incident of the blood pressure going up. This could have been prevented with daily checks with a blood pressure machine, or caught early, and reported to MD by WHOMEVER is the MPOA or by Mom herself if she is still capable of handling her medical with her MD. A TIA resulted.

The long and the short here is that your mother is 90. Her systems are aging. Her treatment now is up to her, her MD and her POA and should be left in their hands. They will have many decisions to make about what "might work", about what heroic measures are or are not wanted, about possible palliative care, about safe placement for safety and monitoring, and etc.

WERE I YOU:
I would try to allow those who are in charge to be in charge. I would tell everyone that you are available (if you are) and when and in what ways you are able to help if needed.

I wish you and your Mom and extended family the very, very best and hope you can all get together calmly and supportively with one another to work through what measures will work best and I wish you excellence in medical care and advice.

Know that now, for your mom's end of life care, the best thing she can have is a cohesive, cooperative, loving, organized family. I wish you the very best.

At 101 yrs, my Mother was taken off all BP meds (and most of her other meds). She has done much, better without the BP meds. She continues to do well off all the BP meds.
Recently she took a fall and had to go to the ER for some stitches. They kept her overnight to be sure there weren't other problems. Of course her BP was high being in the ER and the hospital and they wanted to put her on BP meds. I did not allow it. I actually stayed in her room all night as they kept pushing for the BP meds (even at 3 am). Her BP had been slowly returning to its normal range.
While BP meds were good for her for many years, but she started developing adverse reactions -- she would be incoherent. At 102 yrs. she continues to be remarkable (without most medications).

Honestly, I would trust the cardiologist. But I do agree that she has some results that are concerning. Your mum is 90 and it may be her age showing. Do what you like, but eventually we all slow down. I know you are doing your best for her. ((((Hugs))))

I remember taking my mom to the ER one evening. She couldn’t exactly explain how she was feeling. She just said that she wasn’t feeling like herself. I thought she should see someone and off we went to the ER.

The hospitalist told me that she wanted my mom to discontinue her BP meds.

I was concerned because my mom had taken BP meds for years. In her younger years, she had high BP.

The hospitalist said, “Your mom’s BP is very low and that is why she isn’t feeling well. She has Parkinson’s disease and people who have Parkinson’s disease tend to have low BP. The meds are causing her BP to drop too low.

No one ever told my mom or I that Parkinson’s patients had lower BL, not her primary care doctor or her neurologist.

Anyway, it made complete sense that the hospitalist took her off of her BP meds.

Sometimes, we are confused due to the lack of information about a situation that we have.

There is a reason why the cardiologist is saying that the BP meds are no longer needed. Just like there was a reason for my mom not to take them.

My mother actually felt better after discontinuing the meds.

Best wishes to you and your mom.

This is a question for the MD. As a retired RN I can tell you that the POA should speak with the MD, not a public forum about the above, as well as about any/every withdrawal or addition of any med after carefully looking up the drug and its side effects.

There are many many reasons for withdrawing medications that you cannot know without discussing the issue with the prescribing doctor. Some include the condition of the kidney at 90, lab results, and the body's ability to tolerate these meds.

Only your doctor can answer your questions about your/your loved one's medication decisions.

At 90 does your mother live alone? If so, the new automatic blood pressure and pulse machines are great. Omron is my favorite. She should keep a log of the daily measurements for her doctor. These machines are under 30.00 on amazon. You should check the machine against the MD office machine before using regularly, and at each checkup.

Verapamil is a calcium channel blocker and a side effect is lower heart rate.

Everything is done with risk vs benefit in mind. Her risk is that her BP might go up, but the benefit is her heart does better.

It might just be that your mom’s end of life might be closer now than farther away. (Said with great compassion). Her body’s functions are likely pooping out from how long they have been working.

But, yes, speak with her doctor. Good luck

I get it, I kind of freaked when my mom's doctor suggested palliative care and took her off 75% of her meds, I took her BP multiple times a day and was convinced she would stroke out and die (or worse, stroke out and not die). But she didn't, in fact she lived several more years and the changes didn't make any apparent difference.

I’ve been reading books by geriatricians, and “de-prescribing”—especially bp meds—comes up a lot. It seems that many of the so-called “very old” do better with fewer bp meds. AlvaDeer provides a medical explanation. I’ll add that my own mom has had some collapses/near-collapses that I think may have been caused by sudden bp drops (I say this because they occurred in the evening after taking bp meds, and after large meals or bowel movements).

Anyway, I’m not a doctor, but I do think that medical staff get a little too fixated on bp targets for adults without sufficient attention to the special circumstances of the elderly.

Another consideration: kidney function can decline with age with the result that smaller amounts of bp med have effects equivalent or even greater than the earlier-in-life doses.

In the ER, my mother’s bp routinely shoots up over 180. What brings it down is getting her back home. The mistake I made the first time was letting her remain in the hospital with bp meds being shot right into her (note: she was not in the hospital for bp but was being *kept* there for that) and aligning myself with the medical staff in trying to calm her down and convince her this was necessary (she HATES blood pressure medications).

(Fun exchange with young nurse…. Mom: [to nurse] Don’t ever take blood pressure medication. Him [nurse]: What should I do instead? Eat right and exercise?)

We do occasionally get high readings (170s) at home. Generally, though, relaxation and deep breathing brings the number down. 

I understand that high bp puts her at greater risk for stroke, but falling is also a major risk.

Again, I’m not a doctor. I’m just sharing what I’ve observed and experienced with my own mother. 

Good luck and take care.

I think by your sister refusing to have people come into care for Mom and telling u not to talk to her Drs. is a form of Elder abuse. She is alienating Mom and not allowing her the care she needs.

Alva said for you to keep a record of Moms BP. My nephew was told to take his first thing in the morning when he got up. You take it always at rest. The right side will vary from the left.
Ask her cardiologist what her normal reading is. What would be lowest. Ask if taking her pause ox would help. Call him only if her B/P seems too high. Your Moms daughter and you have every right to speak to the doctor as sister does unless she holds Medical POA.

If you are going with Mom to the doctor, you need to learn to ask him questions if she allows u in with her. He could have answered your question why he was dropping her BP med.

BP machines record past numbers including date and time stamps. Someone can then write numbers in a journal. As for sending info to the doctor. No device sends info on a daily basis. You make another appointment so that the doctor can review. This is usual and customary. You will also find that sending emails through doctor portals are now subject to charges. Do ask the cardiologist how high numbers have to be for an ER visit. Complex patients will sometimes be at a higher than normal number. I agree with southernwave. Her heart rate should come up. Keep following up with the cardiologist for next steps