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Advice on the dosage of hypertension medication - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3632 Questions
User :   Hi
Doctor :   Hi
User :   Hello I have a high blood pressure problem
Doctor :   How can I help you ?
Doctor :   Ok.
User :   Well I was taken lisinopril and hydrochloritizede (I hope I spelled that ok)
Doctor :   Yeah it is fine.
User :   then i run out of hydrochlorotizide and stupidly I started taking another dose of lisinopril 40 mg
Doctor :   Ok.
User :   I did not seem to have any problems but one day i overworked a lot for two days
Doctor :   Ok.
User :   and two weeks ago on friday i ended up in the emergency room with unstable angina
User :   I live in denver colorado but i am traveling in mexico
Doctor :   Ok.
Doctor :   Ok.
User :   they stabilized me and let me go, but my blood pressure was still high
Doctor :   Ok.
User :   and told me to take 10 mg every 8 hrs of enalapril
Doctor :   How much is it now ?
Doctor :   Ok.
User :   i also take atenolol at night 50 mg
Doctor :   Ok.
User :   with the current medication the high blood pressure goes from 125 to 150
Doctor :   Ok.
Doctor :   And how about diastoly?
User :   it averages 90 to 100
Doctor :   Ok.
Doctor :   May I know your age please /
User :   the problem is that I am starting to have chest pains and the pain goes to my left arm and neck
User :   i am 42
Doctor :   May I know your height and weight ?
User :   i am 5'2 and weight around 175
User :   i ended up in the emergency room again because of the chest and arm pain
Doctor :   Ok.
User :   they let me go again with a pressure of 137/85 i still had the chest and left arm pain but they told me i was not a candidiate for surgery
Doctor :   I can understand the problem you are in .
Doctor :   Ok.
User :   i asked them to lower my blood pressure a little bit more
Doctor :   Ok.
User :   because i noticed around 110/80 or 75 works for me, I feel good, but they said 137/85 was normal (even when i told them about the pain)
Doctor :   Ok.
User :   I am at home now, and I do not know what to do, can I switch from the enalapril 3 times per day to my old prescription lisinopril 40 mg once per day?
Doctor :   Ok.
Doctor :   Now , May I ask you a few more questions to help you better ?
User :   yes please
Doctor :   May I know if your treating doctor was a Cardiologist or Internal medicine specialist ?
User :   I was visited buy a cardiologist at the er, but he said i was fine
User :   the other doctor was a general medicine doctor
Doctor :   May I know, if you have undregone an Angio ?
User :   they did blood tests and an x ray i think, they did not tell me much
Doctor :   x-ray is of absolutely no use at this stage, EKG and Angio report would be helpful to treat you better .
Doctor :   How were your Lipid Profiles ?
User :   They did an EKG and said my heart was fine
Doctor :   Ok.That is encouraging .
User :   I suppose those were fine too, all i know is that as soon as my blood pressure raises so does my chest pain and left arm pain, which is every day and know i had them for about a week
Doctor :   Ok.
User :   why would not they try to lower my blood pressure to stop the pains
User :   and what can i do about it
Doctor :   I shall advise you on the medication that you need an additional dose of antihypertensive drug to lower the blood pressure to 110/70 which is the recent American heart association protocol
Doctor :   You can discuss this freely with the cardiologist and ask him to prescribe an additional dose of lisisnopril.
Doctor :   Especially at 42, it is mandatory to keep it at 110/70.
User :   the problem is they do not want me to take lisinopril nor the hydrochlorotizide anymore, they have me on enalapril 10 mg three times per day and it is not working
Doctor :   Please do follow one more advise ;
User :   I took lisinopril and hydrochlorotizide for about five years and it worked just fine
Doctor :   Ok, I understand.But i cannot go against teh cardiologist advise as he has seen you physically but an extra dose of enalapril might do good.
Doctor :   1.Please do get an angio done and a Stress test done .
User :   I was thinking about going back to the usa to get those done,
Doctor :   It is very essential to get these tests done, if you have not done for atleast one year.
User :   I was thinking about flying back today
User :   but i do not know if it is safe to do so
User :   because of the pains
Doctor :   Yes please get these tests done as soon as possible.
User :   so maybe i can take enalapril 4 times per day every 6 hrs
Doctor :   Please do keep some emergency drugs like Nitroglycerine, and an atenolol tab,. and some lisinopril.
User :   for a total of 40 mgs per day of enalapril instead of 30 mgs
Doctor :   It might help you but, i cannot prescribe without seeing you as it is against medical ethics and i should not do that against the rules.
Doctor :   I am sorry and helpless about a prescription drug.
User :   what is the nitroglycerine for
Doctor :   For any anginal pain or pain in chest.
User :   when and how should i take it an in what quantitiy
Doctor :   It is only used in emergency and you have 5mg tabs. that can be used.
User :   so only when the pain is severe i should take it
Doctor :   You will have an emergency doctor at the airport who can help you out on this.
Doctor :   Yes.
User :   and the lisinopril how will i know when to take it, is it also when i get the severe pain
Doctor :   They carry these drugs at the airport and they shall advise you , please let them know that you are a patient and you need some help.
Doctor :   Lisinopril is an ordinary antihypertensive.
Doctor :   like enalapril and ateneolol , etc.
User :   but i should not take lisinopril and enalapril at the same time, should i
Doctor :   No, it might lower toomuch.
Doctor :   dont take them together.
Doctor :   it might cause more harm.
Doctor :   Thank you for ocnsulting me.
User :   can i switch from enalapril to lisinopril now
Doctor :   Do oyu have anything les to ask ?
Doctor :   No.
Doctor :   Take care, bye for now..
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