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What Do The BP Readings Indicate?
Question: Dr . Llir,
My granddad Is on 1/4 of Azilsartan medoxomil (Edarbi) for two weeks now , last night the blood pressure is only79-38 before bed time . Other times are ok 120-60. Is this too low ? Should I change medication again ?
I was on exforge (1/4) but it caused very low blood pressure at night before bed .so change to Azilsartan medoxomil (Edarbi).
My granddad Is on 1/4 of Azilsartan medoxomil (Edarbi) for two weeks now , last night the blood pressure is only79-38 before bed time . Other times are ok 120-60. Is this too low ? Should I change medication again ?
I was on exforge (1/4) but it caused very low blood pressure at night before bed .so change to Azilsartan medoxomil (Edarbi).
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome back and thank you for asking on HCM!
Regarding your concern, I would like to explain that as these low blood pressure values keep persisting time after time, it is important to immediately reduce the daily antihypertensive dose.
79/33 mmHg is extremely low and no antihypertensive therapy is indicated in such case.
I recommend stopping Azilsartan for awhile (a couple of days) and closely monitor your granddad's blood pressure (several times daily).
If his blood pressure values turn within acceptable ranges (not higher than TAs 135-140 mmHg) without treatment then he doesn't need treatment for a while (only frequent BP monitoring).
Otherwise, if BP values turn higher, then a prudent initial Azilsartan (1/8 tab/day) could be tried.
Just follow the above mentioned advices, and turn back for a review of registered blood pressure values.
You need also to inform his prescribing doctor on this exaggerated effect of the current therapy.
I will be at your disposal when you need my opinion again.
Hope to have been helpful to you!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome back and thank you for asking on HCM!
Regarding your concern, I would like to explain that as these low blood pressure values keep persisting time after time, it is important to immediately reduce the daily antihypertensive dose.
79/33 mmHg is extremely low and no antihypertensive therapy is indicated in such case.
I recommend stopping Azilsartan for awhile (a couple of days) and closely monitor your granddad's blood pressure (several times daily).
If his blood pressure values turn within acceptable ranges (not higher than TAs 135-140 mmHg) without treatment then he doesn't need treatment for a while (only frequent BP monitoring).
Otherwise, if BP values turn higher, then a prudent initial Azilsartan (1/8 tab/day) could be tried.
Just follow the above mentioned advices, and turn back for a review of registered blood pressure values.
You need also to inform his prescribing doctor on this exaggerated effect of the current therapy.
I will be at your disposal when you need my opinion again.
Hope to have been helpful to you!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you , Dr. Lliri ,
He has tried off medication for few days after (1/4 Exforge) showing low blood pressure only before bedtime . The BP was sometimes high reached 170-90, so he decided to try azilsartan(1/4), all other times are perfect except for just before bedtime . What do you think he tried 1/8 of azilsartan first or do you suggest to try one of the ingredients in Exforge ??
Thank you fof helping us !Dr. Lliri ,
Is this possible for someone has high blood pressure and get normal pressure without medication ?
He has tried off medication for few days after (1/4 Exforge) showing low blood pressure only before bedtime . The BP was sometimes high reached 170-90, so he decided to try azilsartan(1/4), all other times are perfect except for just before bedtime . What do you think he tried 1/8 of azilsartan first or do you suggest to try one of the ingredients in Exforge ??
Thank you fof helping us !Dr. Lliri ,
Is this possible for someone has high blood pressure and get normal pressure without medication ?
Brief Answer:
My opinion:
Detailed Answer:
Hi again,
As blood pressure is a dynamic parameter (and you granddad is a live evidence of BP fluctuations during the day), it is quite possible that a hypertensive patient show normal or even low BP readings and no therapy is necessary in that case.
I recommend to decrease Azilsartan daily dose (to a half the actual dose) and during those days of profound hypotension, no therapy should be administered.
Clinical symptomatology (extreme tiredness, dizziness, etc) are good markers for judging about a possible hypotension (even in the morning); and thus giving a rationale trigger for immediate BP measurement; consequently on day therapy reconsideration.
Regards,
Dr. Iliri
My opinion:
Detailed Answer:
Hi again,
As blood pressure is a dynamic parameter (and you granddad is a live evidence of BP fluctuations during the day), it is quite possible that a hypertensive patient show normal or even low BP readings and no therapy is necessary in that case.
I recommend to decrease Azilsartan daily dose (to a half the actual dose) and during those days of profound hypotension, no therapy should be administered.
Clinical symptomatology (extreme tiredness, dizziness, etc) are good markers for judging about a possible hypotension (even in the morning); and thus giving a rationale trigger for immediate BP measurement; consequently on day therapy reconsideration.
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much . I have suggested him to take 1/8 of azilsartan and measure BP every few hours and I will let you know . Thank you for the opinion . Have a good day
Brief Answer:
You are welcome!
Detailed Answer:
Hello again!
Let me know how things are going on.
Best wishes!
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again!
Let me know how things are going on.
Best wishes!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr. Lliri ,
Here is the update of BP of these two days with no medication at all .
17/nov Left arm. Right arm
00:54. 112/65. 120/69
05:00. 111/66. 118/65
08:36. 115/68. 116/70
13:52. 125/73. 127/64
18:13. 124/68. 119/65
21:29. 104/59. 114/58
18/ November. Left arm. Right arm
01:06. 112/64. 118/65
05:04. 116/71. 125/68
Please kindly advice your opinion !
Thank you for helping us
Here is the update of BP of these two days with no medication at all .
17/nov Left arm. Right arm
00:54. 112/65. 120/69
05:00. 111/66. 118/65
08:36. 115/68. 116/70
13:52. 125/73. 127/64
18:13. 124/68. 119/65
21:29. 104/59. 114/58
18/ November. Left arm. Right arm
01:06. 112/64. 118/65
05:04. 116/71. 125/68
Please kindly advice your opinion !
Thank you for helping us
Brief Answer:
BP readings seem to be OK.
Detailed Answer:
Hi again,
I reviewed your granddad's BP readings; they seem to be quite fine. So, I find the actual antihypertensive therapy dosage acceptable.
If your granddad denies any clinical symptomatology (dizziness, weakness, etc), then my opinion is to keep following such a reference daily dose.
Just continue to closely monitor BP values, so as to be sure that everything is going OK.
Kind regards,
Dr. Iliri
BP readings seem to be OK.
Detailed Answer:
Hi again,
I reviewed your granddad's BP readings; they seem to be quite fine. So, I find the actual antihypertensive therapy dosage acceptable.
If your granddad denies any clinical symptomatology (dizziness, weakness, etc), then my opinion is to keep following such a reference daily dose.
Just continue to closely monitor BP values, so as to be sure that everything is going OK.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dr . Lliri ,
After few days without any medication , the BP went back up to 150-169 sometimes even though the BP before bad was not that low anymore . But now he started 0.25 of Azilsartan medoxomil (Edarbi) again , the BP still stay up high . If we increase the dosage , worry about the extreme low BP before bed time . Would you suggest your idea ?? Should he go back to Exforge 1/4 tablet (he changed to Azilsartan medoxomil (Edarbi) because low BP before bed) but it looks even worse with Azilsartan medoxomil (Edarbi).
But if he has went back to Azilsartan medoxomil (Edarbi) fir two days already can he swap to exgorge ??
Thank you !! With your experience , what do you suggest ?? These days without medication , BP gradually went up each day .., so means he does need regular medication . Do you have something in mind that will fix his high BP while doesn't bring too low BP before bed ??
After few days without any medication , the BP went back up to 150-169 sometimes even though the BP before bad was not that low anymore . But now he started 0.25 of Azilsartan medoxomil (Edarbi) again , the BP still stay up high . If we increase the dosage , worry about the extreme low BP before bed time . Would you suggest your idea ?? Should he go back to Exforge 1/4 tablet (he changed to Azilsartan medoxomil (Edarbi) because low BP before bed) but it looks even worse with Azilsartan medoxomil (Edarbi).
But if he has went back to Azilsartan medoxomil (Edarbi) fir two days already can he swap to exgorge ??
Thank you !! With your experience , what do you suggest ?? These days without medication , BP gradually went up each day .., so means he does need regular medication . Do you have something in mind that will fix his high BP while doesn't bring too low BP before bed ??
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello,
A 150-169 mmHg are quite increased values, there is need for a maintenance antihypertensive therapy.
As the main drawback of using Azatril or Exforge is the low blood pressure values appearance during the evening, then alternative drugs with shorter pharmacological effect duration could be tried instead.
By using drugs like Enalapril or Captopril once daily (in he morning) we minimize a possible antihypertensive effect during the second half of the day, thus avoiding low blood pressure values before sleeping.
Starting with low doses like 2.5 mg Enalapril or 25 mg Captopril and increasing the dose carefully during the up-titration process (if necessary) would be the most rationale approach in the management of your granddad's BP issue.
You need to discuss with his attending cardiologist about the above suggested alternatives.
Wishing you a pleasant weekend,
Kind regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello,
A 150-169 mmHg are quite increased values, there is need for a maintenance antihypertensive therapy.
As the main drawback of using Azatril or Exforge is the low blood pressure values appearance during the evening, then alternative drugs with shorter pharmacological effect duration could be tried instead.
By using drugs like Enalapril or Captopril once daily (in he morning) we minimize a possible antihypertensive effect during the second half of the day, thus avoiding low blood pressure values before sleeping.
Starting with low doses like 2.5 mg Enalapril or 25 mg Captopril and increasing the dose carefully during the up-titration process (if necessary) would be the most rationale approach in the management of your granddad's BP issue.
You need to discuss with his attending cardiologist about the above suggested alternatives.
Wishing you a pleasant weekend,
Kind regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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