I've been on lisinopril 10mg for high blood pressure for 2 years. 6 weeks into keto my blood pressure dropped so low I felt dizzy standing up — 98/62. My doctor said this is too low and I need to "discuss my diet." Has anyone else needed to adjust or stop blood pressure medication on keto?
Very common situation — and a good problem to have. Keto reduces blood pressure through multiple mechanisms: weight loss, insulin reduction (which affects sodium retention), and reduced inflammation. Many people who start keto on blood pressure medication find they no longer need the same dose or sometimes any medication at all.
What to do: your doctor is right to be involved. This is exactly the scenario where medication needs to be actively managed during keto. Ask for a dosage reduction trial — starting with half your current dose — and monitor BP daily at home. Most doctors who understand keto will work with you on this. If yours doesn't, ask for a referral to a cardiologist or find a metabolic medicine specialist.
Blood pressure medications like ACE inhibitors (lisinopril) and diuretics have their dosing based on an assumption of insulin-driven sodium retention. Keto changes this equation fundamentally. Running on the same dose when your body's sodium retention mechanics have changed can drop BP to symptomatic levels as you're experiencing.
I came off my blood pressure medication entirely at month 4 of keto — under doctor supervision with weekly monitoring. BP went from medicated 128/82 to unmedicated 118/74 and has stayed there for 18 months. If you're losing weight and reducing insulin, your blood pressure will often follow naturally.
The dizziness on standing (orthostatic hypotension) you're experiencing is a clear signal to contact your doctor for urgent medication review — not something to wait on. Your BP is too low with your current dose. This is also an argument for keto, not against it — your body is healing and no longer needs the same medication.