Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Medicines For Moderate BP Other Than Exforge And Amlodipine
Question: I am 66 and have been taking blood pressure medication for 40 years. I have been taking home BP reading for the last 30years. My BP management has in the opinion of my doctor been good. I am heavily involved in the management and selection of BP medications with my GP. My recent BP meds were Exforge HCT (25mg Hydrochlorothiazide 10mg Amlodipine 320mg Valsartan) plus 5mg Amlodipine and 25mg Spironolactone. My average BP's for the last three months have been 130/63.
My latest Echo has shown moderate pulmonary hypertension (PASP 53mm/Hg)
I am concerned that my diastolic and pulse is getting a bit low and have with my doctor been trying a new BP drug regime to get a better result.
Currents meds are Indapamide hemihydrate 1.5mg amlodipine 5mg and Telmisartan 80mg. Results after 10 days are systolic up to 175 during the day and down to 125 or so in the early AM rising to 160 by 8:00am, whilst diastolic is fairly constant at around 80.
Can you offer any advice on a meds change that I can discuss with my Doctor.
My latest Echo has shown moderate pulmonary hypertension (PASP 53mm/Hg)
I am concerned that my diastolic and pulse is getting a bit low and have with my doctor been trying a new BP drug regime to get a better result.
Currents meds are Indapamide hemihydrate 1.5mg amlodipine 5mg and Telmisartan 80mg. Results after 10 days are systolic up to 175 during the day and down to 125 or so in the early AM rising to 160 by 8:00am, whilst diastolic is fairly constant at around 80.
Can you offer any advice on a meds change that I can discuss with my Doctor.
Brief Answer:
please see below
Detailed Answer:
Dear Sir
1. If your blood pressure was good (130/63 ) why did you requested for a change? There is no theoretical set lower limit for pulse rate and diastolic BP, provided you have no symptoms.
2. Your reports show absence of LV hypertrophy, again suggesting good long term BP control. They show right sided chamber enlargement most likely due to anomalous pulmonary venous drainage. There is moderate pulmonary artery hypertension possible due to obstructive lung disease, old age, diastolic dysfunction and increased flow due to anomalous pulmonary venous drainage.
3. The major reason for rise in blood pressure seems to be reduction in amlodipine dose (from 15 to 5 mg). Rest of medication is nearly equal in efficacy. I normally do not combine spironolactone with telmisartan because of fear of hyperkalemia.
Hope this provides some insight.
Sincerely
Sukhvinder
please see below
Detailed Answer:
Dear Sir
1. If your blood pressure was good (130/63 ) why did you requested for a change? There is no theoretical set lower limit for pulse rate and diastolic BP, provided you have no symptoms.
2. Your reports show absence of LV hypertrophy, again suggesting good long term BP control. They show right sided chamber enlargement most likely due to anomalous pulmonary venous drainage. There is moderate pulmonary artery hypertension possible due to obstructive lung disease, old age, diastolic dysfunction and increased flow due to anomalous pulmonary venous drainage.
3. The major reason for rise in blood pressure seems to be reduction in amlodipine dose (from 15 to 5 mg). Rest of medication is nearly equal in efficacy. I normally do not combine spironolactone with telmisartan because of fear of hyperkalemia.
Hope this provides some insight.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thank you for your help, I will be suggesting amlodipine increase with my MD.
With regard to Pulmonary Artery Hypertension would you in my case advise further investigation by a Right Ventricular Catheterization procedure.
You might have noticed that from the period of my first Echo in August 2013 to the second in May 2014 Pulmonary Artery Hypertension has changed from mild to moderate. This does not look encouraging to me.
Would you be so kind as to comment on this change.
I am sorry I made an error in describing my BP meds when BP readings were oK.
I was taking only 10mg of amlodipine not 15mg. The other 5mg was Perindopril.
Does this regime still look OK
Many thanks
XXXXXXX
Thank you for your help, I will be suggesting amlodipine increase with my MD.
With regard to Pulmonary Artery Hypertension would you in my case advise further investigation by a Right Ventricular Catheterization procedure.
You might have noticed that from the period of my first Echo in August 2013 to the second in May 2014 Pulmonary Artery Hypertension has changed from mild to moderate. This does not look encouraging to me.
Would you be so kind as to comment on this change.
I am sorry I made an error in describing my BP meds when BP readings were oK.
I was taking only 10mg of amlodipine not 15mg. The other 5mg was Perindopril.
Does this regime still look OK
Many thanks
XXXXXXX
Brief Answer:
please see details.
Detailed Answer:
Dear Sir
1. Why perindopril was combined with valsartan? To the best of my knowledge and international guidelines, two should not be combined to achieve anti-hypertensive effect. Still, increasing the dose of amlodipine should do the trick, as you are still 5mg short of your previous regimen.
2. A right heart catheterization will not yield any good results if we do not have a provisional diagnosis in mind. Your physician can order this only if he thinks that the cause of this moderate PAH is not evident and may be made out on catheterization. High blood pressure may also be associated with transient rise in pulmonary artery pressure by producing LV diastolic dysfunction. Your obstructive lung disease may also be contributing to it. Control your BP, get a repeat ECHO after some weeks of good control, If still unexplained pulmonary hypertension (PAH), do consult a specialist.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Sir
1. Why perindopril was combined with valsartan? To the best of my knowledge and international guidelines, two should not be combined to achieve anti-hypertensive effect. Still, increasing the dose of amlodipine should do the trick, as you are still 5mg short of your previous regimen.
2. A right heart catheterization will not yield any good results if we do not have a provisional diagnosis in mind. Your physician can order this only if he thinks that the cause of this moderate PAH is not evident and may be made out on catheterization. High blood pressure may also be associated with transient rise in pulmonary artery pressure by producing LV diastolic dysfunction. Your obstructive lung disease may also be contributing to it. Control your BP, get a repeat ECHO after some weeks of good control, If still unexplained pulmonary hypertension (PAH), do consult a specialist.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
