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Suggest Remedies For Stage 2 Hypertension
Question: I have stage 2 hypertension, I take .3 clonidine ,160/12.5 valsartan,2.5 minoxidil morming and night, in the morning my systolic averages about 180, at night about 170,i have experimented wit each separately,i have taken .3 clonidine alone when it was 170 and it dropped my systolic 25 points in 2 hours,after 3 hours it starts increasing again,my dystolic never gets over 85 and my heart rate rarely gets over 65 my understanding is that clonidine lowers the heart rate,my question, what type time release medications would be of help for my problem I am 82 years old and still administrative work every day and otherwise I am in great shape and have been able to balance all of my hormones except thyroid and I am now making slight progress with that..........thanks I!m XXXXXXX XXXX
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello XXXX!
Welcome back on HCM!
I carefully passed through your question and would agree with you in the fact that clonidine lowers the heart rate and can cause bradycardia as a known adverse effect.
It has an anti hypertensive effect as well. I would also like to add that it should be given twice a day and not three times daily.
Anyway I would recommend switching to other antihypertensive drugs with slow release like: lisinopril, valsartan, irbesartan, lercanidipine, amlodipine but also other alternatives as well, such as olmesartan, telmisartan, felodipine, etc., which can be more effective in lowering your blood pressure, without lowering your heart rate.
Your blood pressure values are above the normal ranges and your actual medication does not seem to be very effective in the management of arterial hypertension.
The fact that your systolic blood pressure is much higher than your dyastolic blood pressure, indicates a high pulse pressure, which is quite normal for your age.
I would recommend you to discuss with your doctor on the possibility of gradually reduce the doses of clonidine.
You can switch to combination of an ACEI (Lisinopril 10-20 mg/day, or Ramipril 5-10 mg/day, etc.) or an ARB (Valsartan 80-160 mg/day, or Olmesartan 10-20 mg/day, or Irbesartan 150 mg/day, etc) with a calcium channel blocker (Amlodipine 5-10 mg/day, or Lercanidipine 5-10 mg/day, or felodipine 5-10 mg/day,etc.).
The above mentioned drugs are time release (sustained-release [SR], extended-release [ER, XR, XL].
Hope you will find this answer helpful!
Feel free to ask any other questions whenever you need!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello XXXX!
Welcome back on HCM!
I carefully passed through your question and would agree with you in the fact that clonidine lowers the heart rate and can cause bradycardia as a known adverse effect.
It has an anti hypertensive effect as well. I would also like to add that it should be given twice a day and not three times daily.
Anyway I would recommend switching to other antihypertensive drugs with slow release like: lisinopril, valsartan, irbesartan, lercanidipine, amlodipine but also other alternatives as well, such as olmesartan, telmisartan, felodipine, etc., which can be more effective in lowering your blood pressure, without lowering your heart rate.
Your blood pressure values are above the normal ranges and your actual medication does not seem to be very effective in the management of arterial hypertension.
The fact that your systolic blood pressure is much higher than your dyastolic blood pressure, indicates a high pulse pressure, which is quite normal for your age.
I would recommend you to discuss with your doctor on the possibility of gradually reduce the doses of clonidine.
You can switch to combination of an ACEI (Lisinopril 10-20 mg/day, or Ramipril 5-10 mg/day, etc.) or an ARB (Valsartan 80-160 mg/day, or Olmesartan 10-20 mg/day, or Irbesartan 150 mg/day, etc) with a calcium channel blocker (Amlodipine 5-10 mg/day, or Lercanidipine 5-10 mg/day, or felodipine 5-10 mg/day,etc.).
The above mentioned drugs are time release (sustained-release [SR], extended-release [ER, XR, XL].
Hope you will find this answer helpful!
Feel free to ask any other questions whenever you need!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you very much for your response, the valsartan I am now taking is 160/12.5,with the 12.5 being hydroclorothizide, if the valsartan I am using is time or extended release would it have one of the time release symbols mentioned in your earlier response? of everything you mentioned which ones that you mentioned have been most effective in your practice for someone similar to me ,realizing of course that each of us are somewhat different. and in your opinion for my circumstances would all three of my medications be time release, aso I!m sure that one of them should have at least 12.5 hydroclorozide, to date I have never had any type water retention problems. thank you very much for helping me continue my education, I was told that clonidine only come in .1 time release and valsartan did not come in time release. i!m XXXXXXX XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
I understand your concern and would explain that Hydroclorothyazide is not only a diuretic, but also a very effective anti-hypertensive medication.
The dose of Hydroclorothyazide that you are taking is really low. I would recommend increasing the dose to 25 mg (you can take it separately from Valsartan or add another 12.5 Hydrolorothyazide to your therapy), in order to help you lower your blood pressure.
Another option would be to add a calcium channel blocker like Amlodipine 5-10 mg/day, or Lercanidipine 5-10 mg/day, or felodipine 5-10 mg/day. They are all extended release and would be really helpful in achieving the desired blood pressure values.
Regarding Valsartan, it has a very long pharamacological half-life, which means that it is time released, as it remains in your body for a long time from the intake.
I would also advise discussing with your doctor on the possibility of gradually reducing the doses and even stopping Clonidine, as it does not seem to be effective in your situation.
Hope to have been helpful!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
I understand your concern and would explain that Hydroclorothyazide is not only a diuretic, but also a very effective anti-hypertensive medication.
The dose of Hydroclorothyazide that you are taking is really low. I would recommend increasing the dose to 25 mg (you can take it separately from Valsartan or add another 12.5 Hydrolorothyazide to your therapy), in order to help you lower your blood pressure.
Another option would be to add a calcium channel blocker like Amlodipine 5-10 mg/day, or Lercanidipine 5-10 mg/day, or felodipine 5-10 mg/day. They are all extended release and would be really helpful in achieving the desired blood pressure values.
Regarding Valsartan, it has a very long pharamacological half-life, which means that it is time released, as it remains in your body for a long time from the intake.
I would also advise discussing with your doctor on the possibility of gradually reducing the doses and even stopping Clonidine, as it does not seem to be effective in your situation.
Hope to have been helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you again for a great response ,to tell you a bit more about me, I have had hypertension for about 12 years,i for the first time about 15 years ago became a type 2 diabetic, as usual I started on metformin which I feel is a fantastic medication, however mine was so hard to control that it was necessary for me to take 70 units of insulin morning and night, sometimes my a1c would be as high as7.9 after 2 1/2 years I became hypertensive and at one time was taking 4 medications 3 every 8 hours, i started studying alternative medicine and was amazed at what i learned, i completely cured my diabetic condition, in the last 15 months my a1c has never been more than 4.8.all of my hormones are now balanced well above medical reference level including total and free testosterone, my question is, if possible ,knowing my condition, which 3 medications would you prescribe if it was for one of your patients as well as the milligrams at the beginning level, i thank u so much, heres to great health.... XXXXXXX XXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again dear XXXX!
Thank you for the additional information.
I would explain that all the above mentioned drugs are indicated in your clinical situation. They are safe to take with your medical history.
Only Hydroclorothyazide can cause a little raise in the blood sugar, but we usually prescribe it in diabetic persons, without any significant rise in blood sugar.
So I would recommend starting Amlodipine at the dose of 5 mg per day (usually on the afternoon) and raise the dose after 7 days to 7.5 mg per day and than after other 7 days to a daily dose of 10mg per day. This gradual raise is recommended in order to minimize possible adverse effects.
If after these changes to your therapy, your blood pressure is still high, you can add 12.5mg of Hydroclorothyazide or even double the dose of Valsartan 20/12.5 as a unic double dose in the morning (this would be recommended if your blood pressure is still very high).
Hope to have been helpful!
Greetings!
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again dear XXXX!
Thank you for the additional information.
I would explain that all the above mentioned drugs are indicated in your clinical situation. They are safe to take with your medical history.
Only Hydroclorothyazide can cause a little raise in the blood sugar, but we usually prescribe it in diabetic persons, without any significant rise in blood sugar.
So I would recommend starting Amlodipine at the dose of 5 mg per day (usually on the afternoon) and raise the dose after 7 days to 7.5 mg per day and than after other 7 days to a daily dose of 10mg per day. This gradual raise is recommended in order to minimize possible adverse effects.
If after these changes to your therapy, your blood pressure is still high, you can add 12.5mg of Hydroclorothyazide or even double the dose of Valsartan 20/12.5 as a unic double dose in the morning (this would be recommended if your blood pressure is still very high).
Hope to have been helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank u again, sorry to keep coming back, I have a couple more questions, in the event I need to increase the hyroclorothyazide would it be better to go 1 25 mg one time or would it be better to do it in 2 12.5 separate doses, morning and night ? I did not understand the valsartan 20/12.5 when I am now taking 160/12.5 morning and night and I am not familiar with the term unic double dose, also should we double the dose to 25 mg of hyroclorothyazide only after trying the recommended protocol for amlodipine. I really appreciate you guidance on this and I will discuss all of this with my primary care physician who has been hesitant in changing my meds, even tho from everything I have learned is that beta blockers are much less effective in seniors. again many thanks, I!m XXXXXXX XXXX
something I forgot to ask on my last message a few minutes ago, when I start the amlodipine, valsartan/ hydroclorothyazide or your final suggestion do I immediately stop all of the clonidine and minoxidil I am now taking or does it require phasing out? thanks.........I!m XXXXXXX XXXX
back again, if this keeps up I may just need to place u on my payroll as an expert. advise me assuming I drop the clonidine and minoxidil and start the amlodipine are you suggesting that i take 1 12.5 hydroclorothyazide morning and night or 25mg hydroclorothyazide 1 time per day or 25mg morning and night? in the event the amlodipine and the hydroclorthyazide and my pressures are not then in the normal range, what then is the next medication and the mg strength should I add. i apologize for being so thick headed, if we were talking about real estate developing it would be somewhat different, thank u again, I!m XXXXXXX XXXX.......
something I forgot to ask on my last message a few minutes ago, when I start the amlodipine, valsartan/ hydroclorothyazide or your final suggestion do I immediately stop all of the clonidine and minoxidil I am now taking or does it require phasing out? thanks.........I!m XXXXXXX XXXX
back again, if this keeps up I may just need to place u on my payroll as an expert. advise me assuming I drop the clonidine and minoxidil and start the amlodipine are you suggesting that i take 1 12.5 hydroclorothyazide morning and night or 25mg hydroclorothyazide 1 time per day or 25mg morning and night? in the event the amlodipine and the hydroclorthyazide and my pressures are not then in the normal range, what then is the next medication and the mg strength should I add. i apologize for being so thick headed, if we were talking about real estate developing it would be somewhat different, thank u again, I!m XXXXXXX XXXX.......
Brief Answer:
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
I understand your concern and would explain as follows:
1- I would recommend to gradually reduce the doses of clonidine until stopping it, as it does not seem to be effective.
2- Meanwhile, I would recommend starting Amlodipine in the above mentioned doses with gradual increase of the dose up to 10mg per day.
3- In the next step, if your blood pressure is still high, you can first try to double the dose of Hydroclothyazide. I would explain that Hydroclorothyazide is prescribed only in the morning. It can not be taken twice. So I would recommend adding first another 12.5mg of Hydroclorothyazide to your actual therapy (you can take valsartan 160mg separately and 1 tb Hydroclorothyazide both in the morning or ad to your actual valsartan 160/12.5, half tablet hydroclorothyazide 25mg).
3- If your blood pressure is still high, you can double the dose of Valsartan too. So you can take 2 tablets of Valsartan 160/12.5 both in the morning (this is what I called a unic double dose), because it is better taking hydroclorothyazide in the morning.
I am sorry for mis writing the dose of Valsartan. I meant taking 2 tablets of Valsartan 160/12.5mg in the morning.
Hope to have clarified all your uncertainties!
If you have any other questions, do not hesitate to ask me!
Greetings!
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
I understand your concern and would explain as follows:
1- I would recommend to gradually reduce the doses of clonidine until stopping it, as it does not seem to be effective.
2- Meanwhile, I would recommend starting Amlodipine in the above mentioned doses with gradual increase of the dose up to 10mg per day.
3- In the next step, if your blood pressure is still high, you can first try to double the dose of Hydroclothyazide. I would explain that Hydroclorothyazide is prescribed only in the morning. It can not be taken twice. So I would recommend adding first another 12.5mg of Hydroclorothyazide to your actual therapy (you can take valsartan 160mg separately and 1 tb Hydroclorothyazide both in the morning or ad to your actual valsartan 160/12.5, half tablet hydroclorothyazide 25mg).
3- If your blood pressure is still high, you can double the dose of Valsartan too. So you can take 2 tablets of Valsartan 160/12.5 both in the morning (this is what I called a unic double dose), because it is better taking hydroclorothyazide in the morning.
I am sorry for mis writing the dose of Valsartan. I meant taking 2 tablets of Valsartan 160/12.5mg in the morning.
Hope to have clarified all your uncertainties!
If you have any other questions, do not hesitate to ask me!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you so much, you have been so kind and helpful to a dumb guy like me,just trying to stay alive and good health as long as possible I have never for 82 years been in any hospital and I am just trying to keep it that way, I would like to send u a little gift of appreciation, please provide me with your address and wait for a small XXXXXXX ........................thanks, I!m XXXXXXX XXXX
Brief Answer:
You are welcome!
Detailed Answer:
Dear XXXXXXX
I am really glad to have been helpful!
Your appreciation for my advice is the most important gift for me! I do not think you are a dumb guy! I really appreciate your concern about your health, as it is a sign of respect towards life and life is beautiful! It is worth living decently.
You can ask me directly in case of any other uncertainties in the future in the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
Dear XXXXXXX
I am really glad to have been helpful!
Your appreciation for my advice is the most important gift for me! I do not think you are a dumb guy! I really appreciate your concern about your health, as it is a sign of respect towards life and life is beautiful! It is worth living decently.
You can ask me directly in case of any other uncertainties in the future in the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hello again, in reviewing all of our messaging I!m not clear if I should eliminate the minoxidil, I don!t see where we addressed that directly, if so should it be eliminated and phased out or could it be eliminated cold turkey? or should it be eliminated after a period of time into the new amlodipine protocol? with all of this information I will visit my primary care physician and maybe get my pressures under control, this morning a 6 A M my systolic was 206..........................thanks I!m XXXXXXX XXXX
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again XXXX!
I would recommend continuing Minoxidil until all these changes are made.
This medication is a vasodilator, which can be used in uncontrolled high blood pressure.
If your blood pressure values, are lowered with the changes I recommended (add amlodipine, double the dose of hydrolorothyazide and than double the dose of valsartan), you can discuss with your doctor on reducing the doses of minoxidil.
In such case, it would be necessary a gradually decrease of the dose ( to 2.5mg once daily for a week and then stopping it).
But, I would not recommend reducing Minoxidil doses before making the other changes to your therapy, because of possible raise in your blood pressure.
Your actual blood pressure values are really high. I recommend discussing as soon as possible with your attending physician on these possible changes to your actual therapy.
Hope to have fulfilled all your expentancies!
Best wishes,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again XXXX!
I would recommend continuing Minoxidil until all these changes are made.
This medication is a vasodilator, which can be used in uncontrolled high blood pressure.
If your blood pressure values, are lowered with the changes I recommended (add amlodipine, double the dose of hydrolorothyazide and than double the dose of valsartan), you can discuss with your doctor on reducing the doses of minoxidil.
In such case, it would be necessary a gradually decrease of the dose ( to 2.5mg once daily for a week and then stopping it).
But, I would not recommend reducing Minoxidil doses before making the other changes to your therapy, because of possible raise in your blood pressure.
Your actual blood pressure values are really high. I recommend discussing as soon as possible with your attending physician on these possible changes to your actual therapy.
Hope to have fulfilled all your expentancies!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
last evening I arrived at home at 7 pm, I decided to test the effectiveness of valsartan only so I measured my bp level for which the systolic was 160, I took 160/12.5 valsartan tablet waited 11/2 hours and measured my pressures again, my systolic pressure was then 176, I have been scratching my head ever since, at that time I took the clonidine and minoxidil, this morning my systolic was 165, can you tell me any other way or method to use to explain this. my diastolic is hardly over 70 and my heart rate is almost never over 65, help!!!!!!!!! thanks XXXXXXX XXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again XXXX!
As I already advised you, I would not recommend taking Hydroclorothyazide during the evening.
From the other hand you should know that all the changes to blood pressure therapy, achieve a stable effect on your blood pressure after some days, because it is necessary a certain period of time (up to a week) for them to make the real changes in your body.
If after this period of time, your blood pressure is still high, you can try further changes to the doses or add other antihypertensive drugs.
So, my advise is to be patient and make gradual changes to your therapy.
Regarding valsartan, I would recommend taking 2 tab in the morning (not divided morning and night). From the other hand you should know that this is the maximal daily dose of valsartan (320mg).
I would recommend adding amlodipine to your actual therapy, with the above recommended doses.
You should be patient and wait some days before concluding that these therapy changes are not effective.
Hope you will find this answer helpful!
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again XXXX!
As I already advised you, I would not recommend taking Hydroclorothyazide during the evening.
From the other hand you should know that all the changes to blood pressure therapy, achieve a stable effect on your blood pressure after some days, because it is necessary a certain period of time (up to a week) for them to make the real changes in your body.
If after this period of time, your blood pressure is still high, you can try further changes to the doses or add other antihypertensive drugs.
So, my advise is to be patient and make gradual changes to your therapy.
Regarding valsartan, I would recommend taking 2 tab in the morning (not divided morning and night). From the other hand you should know that this is the maximal daily dose of valsartan (320mg).
I would recommend adding amlodipine to your actual therapy, with the above recommended doses.
You should be patient and wait some days before concluding that these therapy changes are not effective.
Hope you will find this answer helpful!
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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