<s>[INST] Hi, Im a 46 yr old black female. My BP today is 144/87 with a 101 heart rate. I had s Starbucks coffee this morning with an extra shot of espresso, hence might be the reason for increased heart rate. I take BP med at night ditiazem hcl er 240mg and sometimes zestoretic gen 20/25  in the morning. I also take the following vitamins- b6, k12, garlic, omega 3, calcium d3, and magnesium. I have had pain behind my right shoulder for a week, but no other symptoms. Do u know where this pain might be coming from? And, how bad is it to have that BP and heart rate over 100?? Thanks [/INST] Dear Mrs, Most probably elevated heart rate comes from the excess amount of caffeine. Don't worry, just cut the amount of caffeine. About pain in shoulder, it can have different causes: joint, spine, or it can be a simple muscle pain. Take some Ibuprofen, if doesn't help, you will need to have an X-Rays done. Hope I could help nourishing you good health In case of further questions don't hesitate to ask </s>