Question: I've just been prescribed & started taking Tanzaril (Losartan Potassium) 50mg and Concor (Bisoprolol Fumarate) 2.5mg (each 1x per day), for high BP (167/85) coupled with some upper chest pain (not sure if chest pain is heart/circ related).

I also have previously been taking Xatral 10mg for enlarged prostate. I've have stopped taking the latter, for the time being, as I am concerned there may be a conflict with the BP medication. I did mention the Xatral to the Dr (a cardiologist), and she said no problem, but I'm not convinced that she was familiar with what I was referring to.

The BP meds leave me feeling tired. My questions are:

1. Do the BP meds sound appropriate (I'm aged 65).
2. Will there be a conflict, implications or increased side affects if I take the Xatral at the same time as the BP meds.

I forgot to mention I also sometimes have flare ups of proctitus/colitus for which I use Salofalk Mesalazine (250mg) suppositories. Would there be any conflicts with those?

Thanks

Thank you very much for your assessment, comments and advice re medications.

I have given a bit more detail below about my hospital visit & consultation, and my concerns whether the (upper) chest pain was heart/circ related or skeletal/muscle related. You will no doubt note that I did have an EKG, echo test and stress test:

My recent background/reason for seeking medical advice was that I have been experiencing upper chest tightness/discomfort when exercising - walking briskly or jogging - after about 30mins of jogging or 5 mins of brisk walking. That was over the last few months. My BP has been around that 130/75-80 figure for the last year, although I did go through a period of a few weeks during the year before (2012) when it was much higher, around 140-160/80. However it then fell back and I put the situation down to stress as I had been worrying about something at that time. My BP then seemed to remain at a reasonable level until my visit this last weekend. I do tend to suffer from "white coat" syndrome and worry about things.

Upon arrival at AEK hospital Udon Thani, after a stressful car journey in heavy rain, I asked to see a cardiologist and to have a stress test. My BP was taken and was then 176/85. Later it was 165/80. Both much too high.

Although I had had an EKG in Nong Khai hospital 3 months previously, when my BP was normal - about 130/80, at AEK Udon Thani they required me to have another (both of which showed nothing unusual), before progressing to an Echo/ultra sound test and then onto the stress test.

With the echo test, about 1 hour after arrival, the cardiologist said my heart looked sound, (she showed me the display), and mentioned there was a little bit of leakage at one of the valves, - though she said not a problem and consistent with age. My younger brother by 2 years, has a similar condition, but not high BP so far. Though my Father had high BP. He died at age 90 from emphysema. My father was a smoker. I am not.

The stress test, (about 20 mins after the echo test) they took steadily, increasing the treadmill speed in 3 x 1 min steps, but my BP (upper figure) which started from/at 177, progressed fairly quickly over the 2 or 3 minutes up to 215., which is very high. The Dr told me it reached 235 at the time she stopped it, I think 90% of the way through. The rhythms of the heart and the various "tracers" stayed regular.

The diagnosis was that I have high blood pressure, or have had it for a while (perhaps with it fluctuating over the last year or so), and that that has been causing the pressures across my chest. However BP reducing medication should reduce all the symptoms and allow me to exercise more from a lower (BP) starting point.

I am being started on what I take to be a lowish dosage of meds, and the results will be reviewed in 2 weeks time. (The Meds prescribed were: Tanzaril 50mgs + 1/2 of a Concor 5mg tablet daily. I note the second one (Concur - half a tablet), is a beta blocker.

So now I feel a bit limited in what activities I can do, and a bit tired, if not breathless (affect of the drugs). I'm also not yet sure whether chest pains were high BP related, or muscle/bone related, or something else, and the high BP perhaps as much due to "white coat" syndrome, as my BP was OK earlier this year, though up somewhat the year before.

I would welcome any further comments you may have in the light of the above, and would you still concur re dosage of BP Meds and whether pain high in the chest is usual in relation to high BP.
Thank you.

Regards
XXXX

Correction, my post above should have read within 30 metres of jogging and 4 -5 minutes of brisk walking.

One additional point, I do suffer from a very stiff back, back pain and stiff necks, so thus bone/joint pain was considered as a possible reason, which is what the local hospital in Nong Khai had thought, when I visited them late last year and earlier this year, with occasional intermittent chest pains to the left of my left nipple and not deep down.

The more recent discomfort/tightness, was across the upper ribs just below the collar bone and was initially only when I exercised, but subsequently has manifested itself when I became anxious or excited, -e.g. watching an exciting film.

I understood I could ask 3 follow ups on this subject. I have submitted more information along with additional questions, though haven't received a reply so far.

My BP checked at home after taking the meds for 3 days is: 139/67 and later 125/66 with a pulse rate of: 56

Hello Dr Benard,

Thank you for coming back to me on this.

I purchased a BP testing machine yesterday. The readings yesterday ranged between: 141/67 and 125/66 (Pulse: From 56 -63).

This morning's reading after getting up was: 131/68 (Pulse: 55)
The latest reading 2 hours later and after taking meds: 124/65 (Pulse: 61)

I'm not athletic. I live in a hot & humid country (Thailand) which tends to inhibit exercise, though I try to walk a bit each day, though that usually ends up as only a few hundred meters.

Diuretics are to lose fluids, are they not. I don't think I retain fluids. I'm fairly slim at 62kgs (5' 10" - 178cms), or is that to remove/reduce sodium from the body with the fluids?

I avoid salt/sodium as much as possible, similarly sugar and fatty meats. I occasionally drink a small beer or two, once or twice a week. Am I able to continue that?

I like coffee, but am restricting myself to 1 or 2 real coffees per day, - if I want more I drink a decaff (both types make me sweat).

I am thinking of asking the cardiologist if I can discontinue the Beta blockers (Concor - bisoprolol) when I see her in 10 days time, and just continue with the Tanzaril 50mgs. Does that sound reasonable/desirable?

Maybe I should pursue a short course of anti-inflammatories at some point, (or should have done so previously) to try and determine whether the pains in and around the chest are skeletal/muscle related? The latest one is around my left shoulder blade.

Thanks for your advice.
Regards
XXXX

Thank you Dr Benard,

I will make some enquiries about a mild diuretic.

I'm also tackling this by cutting out meat, eggs, milk, fried food, cooking oils, etc. Will focus on fish, occasional chicken, vegetables, salads, fruit etc. (Though I'm not quite clear on how one gets protein if they don't eat meat or eggs!)

I'm due to revisit the hospital & cardiologist here in another week, to review progress with BP meds, and I think to also check cholesterol and blood sugar levels etc.

As I still get "ad hoc" intermittent chest pains (in varying places), would there be any merit in asking for a Coronary angiography (or arteriography)—the one that uses XXXXXXX and special X-rays to show the inside of your coronary arteries? (If I understood her correctly, the cardiologist seemed to think I didn't have angina).

When I read up on Tanzaril (Losartan potassium) - an ARB, - I saw an article in the McDougall Newsletter saying that "there is convincing evidence that ARB's increase the rates of cardial infaction (heart attacks) despite their beneficial effects on reducing BP". There was also criticism of ACE inhibitors, calcium channel blockers and beta blockers. (So what does one take?) Chlorthalidone seemed to be the drug of choice. My understanding is that it is a potent diuretic and can cause to fluid or electrolyte imbalances, thus the latter have to monitored..

One final question, am I OK to take (Gold) multi-vitamins with the BP meds, - i.e. would there be any conflicts?

I made quite a long post this morning, shortly after renewing/extending my subscription, with information about my latest consultation, and some questions. the system saved it, and I thought sent it, but I don't see it in the "trail" of posts above. It followed on from the renewal. Is it within your system somewhere, and if so can you retrieve it, or have I lost it and have to type it all again?

The medical reports I sent about an hour or so later by separate email.

Regards
XXXX

Hello again Dr Benard,
This was the post that was meant to precede or accompany the medical reports & charts that I sent yesterday, after re-charging my medicare account. It seems to have got lost in transmission:
I saw the cardiologist in Udon Thani last Saturday. To minimise the effect of any white coat syndrome, I travelled there the preceding day and stayed overnight. So first thing on the morning of my Dr’s appointment my BP was: 132/78. Upon arrival at the hospital it was: 150/67.
They took a blood sample to check LIPID’s, which the Dr went through with me and told me that the levels were normal, (details & report copied to you yesterday).
I told the Dr (cardiologist) that I wanted to restart Xatral XL (Alfuzosin Hydrochloride 10mg), which I had previously been taking on and off for an enlarged prostate, frequency of urination and incomplete voiding. However I was concerned that taking the Xatral may cause problems or conflict with the BP meds (Tanzaril – Losartan Potassium 50mgs and Concor – bisoprolol half a tablet = 2.5mg. I had noted that Alfuzosin reduces BP. The Dr said no problems, as my dosage of BP meds is small. (later the urologist said similarly).
I also told the Dr that the BP meds were leaving me feeling tired, listless lacking in enthusiasm and that I was getting slight headaches, like a tight band around the head just above the forehead, and asked if I was able to reduce the dose of either of my BP meds. She said I could reduce the Beta blocker from half a tablet down to a quarter of a tablet (i.e. down to 1.25mgs), but that I shouldn’t reduce the Tanzaril.
I also asked about taking diuretics, and the Dr said two things: 1.) that they were difficult because it meant having to check & monitor electrolyte levels (often). And 2.) she said they were: “cheap, very cheap”. I’ll leave you to draw your own conclusion on the latter. It may be helpful if I point out here that I am not overweight, if anything, I am underweight. I weigh 62kgs and am 5’ 9”. As far as I am aware, being quite slim, I don’t think I retain fluids. I’m not sure about this, but guess the main purpose of taking diuretics may be to clear excess sodium from the kidneys. Should I seek out a local supply of diuretics from a local pharmacy and then see if I can get my electrolyte levels checked at a local hospital?
So subsequent to that consultation, I re-started taking Xatral, (and reduced the beta blocker to ¼ of a tablet). I then noticed that my BP fell quite significantly, to a range between: 87/54 to 130/67, though more usually around: 117/54. I was a bit worried that those levels were a bit too low and that the Xatral was reducing my BP more effectively than the BP meds had. So I stopped taking the two BP meds for a couple of days, to see how that affected the readings. The readings since then have been around: 127/67; though I noticed that my heartbeat (pulse) (previously in the 50 & 60’s range when I had been taking the beta blocker), then increased to a range around: 72- 96, more usually about: 79. I presume the heartbeat increased because I stopped the beta blocker.
My question here I guess is, should I take both BP meds and the Xatral, and if so at what dosage? Or should I hold off taking the BP meds until I discontinue the Xatral? I usually take Xatral for 2 -3 weeks at a time, and then stop for a couple of months.

I still feel tightness and discomfort across the upper chest, - along a horizontal band about 7” wide, across the upper ribs, about 2” or less below the collar bone. I tend to think (or convince myself) that that is skeletal/muscular related, perhaps due to increased expansion of the rib cage when breathing more deeply. Though I don’t know how I could check that?
I’ve just read your comments about dentistry. I’m not quite clear of the implications there. I do visit the dentist regularly. I have quite a few old fillings, including several amalgam fillings. Other teeth have had the amalgam fillings replaced, as and when the fillings needed attention, and any (re) fillings I have these days I opt for the white cosmetic stuff. I broke a tooth last year and had to have a root filling and crown late last year, (which because of constant discomfort afterwards was unsuccessful, and in the end I had the tooth extracted about 3 months ago. I do have 2 other (old) root filled & crowned teeth.
I look forward to your comments on the above.
Regards XXXX

Thanks for your comments and advise Dr Benard,
A couple of questions/points arising:

That sounds a good idea, - switching to half Xatral and half beta blocker. That will be the 1/4 tablet (1.25mg) beta blocker. Please note the Xatral XL is a prolonged release tablet and the leaflet says it must be swallowed hole, not crushed, chewed or ground into powder. It's hard tablet. Do you think it would be alright to cut if in half across the middle, though it looks like it might then break up. I'll try that from tomorrow, pending any reply from you.

What does the Tanzaril (Losartane) actually do then? Is something that relaxes the blood vessels/capillaries to aid reducing BP?

Regarding the upper chest pain, I still feel it's bone related. It's too high to be stomach and more of an ache or tightness (feels like in the rib bones) to be acidity (GERD) in the oesophagus. In fact I did have an upper endoscopy 2 years ago, because of stomach ache. At the time the stomach was a little red (pink) and the Dr prescribed me some proton inhibitors (3 week course) and told me to avoid spicy & acidic foods and citrus drinks. That seemed to clear up and I now avoid those foods.

My Mother suffered with back pain and both my children and myself similarly. My back an neck are very stiff and I can only bend with straight legs as far as the bottom of my knees. My daughter in the UK has been diagnosed with ankylosing spondylitis and my son suspected of having the same. (Adults in their early 30's). It has been suggested that she take Naproxen.

I'll make some enquiries with local pharmacies re a mild diuretic. I note (according to internet websites) in the UK they tend to favour Thiazides. I eat bananas for potassium.

I have been having the odd tinge from one of my upper filled teeth (molars) so will get that and my teeth checked out this next week.

Thanks

Regards
XXXX

I had been taking a 10mg Xatral in the morning and 1/4 of a Concor after the evening meal ( I haven’t yet found out if I can get Xatral in 5mg size. I’ll be doing that tomorrow).
First thing this morning my BP was: 139/68. I took no meds this morning (after last night's ¼ Concor and yesterday morning’s Xatral 10mg slow release tablet), and drove to Udon Thani to check out the chest "ache" situation. Upon arrival at the hospital my BP was 150/77.
I saw an orthoepedic surgeon followed by a gastro-enterologist. The orthopaedic surgeon, after discussion, checking & feeling my chest, ribs and throat area, and measuring my chest expansion, couldn't find anything wrong. He strongly doubted that it was associated with vertebrae problems or anglio-spondylitis, or the cartilage between ribs to sternum. I then saw the gastro-enterologist, who said based on the symptoms I described and another examination including the stomach and throat areas, that he didn’t think it was acid reflux GERD or anything like that and didn’t need another Endoscopy. They did a chest x-ray which showed nothing untoward. So I came away with no answers.
On the way home I visited the dentist, who did an X-ray and said he could see no cracks in the fillings of the teeth where I have been feeling sensitivity, (though that didn’t necessarily mean that there wasn’t a minute one somewhere), and that everything else looked AOK. I had a scale and polish whilst there.
Upon returning home my BP was 135/72. However after going back out and having a red grape (fruit) juice (no alcohol) and returning home & typing some emails before eating, my BP was reading: 152/80, and half an hour later: 162/79. So after eating I took a 10mg Xatral (the one in effect I hadn’t taken this morning), followed by a ¼ Concor (beta-blocker/6535?iL=true" >beta blocker). 3 hours later my BP was: 137/73, and 4 hours later: 122/71. (Pulse: 73), though the slight headache (which I didn’t have all day) has also returned! I am sat quietly at a computer.
It does seem to be the systolic figure that jumps high quickly. The diastolic seems to stay fairly stable.

I’ll see if I can find a 5mg Xatral (slow release) tomorrow, though Xatral certainly isn’t helping with the frequency of urination, although it does improve the flow rate. I am tempted to stop taking Xatral and revert to the ¼ beta-blocker and ½ a TanZaril per day and concentrate on stabilising that and the side effects. I will also look out for a diuretic as discussed.
Regards XXXXXXX