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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Are BP and pulse rate fluctuations due to the inefficiency of calcium channel blockers?

Answered by
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Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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Posted on Fri, 25 May 2018 in General Health
Question: Hello Doc Risu,

I continuation to my previous query about my mother. As I had narrated that she had been taking Stamlo 2.5 mg twice a day from past 6 days for her BP ,before this she had never taken any medication for Blood pressure .

As her BP was on the higher side from past 1 month doctor asked her to start BP tablet that is stamlo. But as her pulse rate is also on the higher side at time it had gone to 120 also, so doctor asked her to stop stamlo and take only angizem CD 90 that is CCB which will work for both BP and Pulse one a day .

From today she started Angizem CD 90 in the morning but her bp is not under control not the pulse its showing 95 pulse and BP as 145/85

From what I understand that taking CCB or any tablet at least the pulse and BP should have gone to normal at least on the lower side . Does this mean that the tablet is not working ?

Please advice .
doctor
Answered by Dr. Rishu Saxena 5 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi,
Thanks for auery,
Stamlo and Diltiazem both are calcium channel blockers and are not given together in clinical practice.
I have never seen any cardiologist combining amlodipine with diltiazem.
Better approach would be to ask you cardiologist to add Tablet ivabradine 5 mg once daily.Very effective drug to control heart rate in patient with tachycardia.
For blood pressure control B.P about 140/90 or less is our target blood pressure.So blood pressure and pulse as written by you are normal(almost) but approach is not correct.Diltiazem is not given with amlodipine.
Ivabradine is much safer then diltiazem in controlling patients with normal sinus tachycardia.

Right now the blood pressure and pulse of your mother are near normal.


Regards!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Rishu Saxena 14 minutes later
Hello doc

May be I have not arriculated well. I meant she was taking stamlo 2.5 mg twice a day for 5 days for blood pressure. But since she had high pulse rate soo doc asked to stop stamlo and take only angizem 90 cd once a day and he said it will be effective for both pulse and bp . And soo from
Today she has stopped stamlo and started angizem once a day.

My worry is even after taking the tablet her bp and pulse should be quite normal like 125/80 becoz when she was not taking the tablets the bo was in the below range

140/80
150/80

Soo there is no major difference post taking the medication

And about ivabrad i am a little concerned as u kmow my dad went through an angiplasty with actue MI he is taking that tablet soo when my mom doesnt have much problem like ypu went through the reports and u sugestes tht reports are quite normal then y ivabrade as its a beta blocker right and can it be taken by asthama patients who are on oral medication for asthama.

Please advice
doctor
Answered by Dr. Rishu Saxena 7 minutes later
Brief Answer:
Thanks for the info

Detailed Answer:
Hi,
Ivabrad is not a betablocker and is a new medicine which usually does not effect blood pressure of patient(unlike betablockers) hence they are used by doctors in more sensitive cases.
Mild variatiion of blood pressure in such situations (your father had a attack few weeks back hence your mom must be having lots of anxiety). This anxiety stimulates the nervous system causing mild to moderate shoot up in blood pressure.
Dilzem alone is ok as it would cover her fast heart rate with mildly elevated blood pressure.
However as she was having almost normal b.p few days back all we need to do is to add an anti anxiety medication for few week(Etizolam 0.5 mg-Non hanit forming) would be a good choice.

Category     -Blood Pressuremm Hg
Normal -SBP(upper bp) 90-119 and lower 60-79
Prehypertension(Normal range in above 40 people) 120-139 or DBP 80-89
Stage 1 HTN     SBP 140-159 or DBP 90-99
Stage 2 HTN     SBP ≥160 or DBP ≥100-109
Stage 3 HTN above 160/110

As you can see after dilzem your mother is in stage 1 range.Once an anti anxiety is added she wound return back to prehypertensive stage.

Thanks!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Rishu Saxena 20 minutes later
Thank you doctor. You have been guiding me through this journey very well

Yes it could be anxiety but her bp had been on a higher side from more than 2 months now before my dad's case. But since we wanted to see if it stablizes hence doc asked not to out her on bo medication but since pulse also got high and bp also hence he started with stamlo and now wirh angizem

Soo finally what u suggest is lets wait and watch for 2 to 3 days and see the effect of angizem tablet on bp and pulse both and then take a call??

Becoz she has stopped stamlo since yeaterday and frok today only she has started angizem

Also, as an anti anxiety she is taking mentat from
Himalaya from past 1 month not rrgulary but almost for 15 days shue wud have taken is that fine??
Please advice
doctor
Answered by Dr. Rishu Saxena 9 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hi, XXXXXXX
Good morning and thanks for appreciation,
Mentat is an ayuvedic tablet and i don’t think its anti anxiety.If you want to go for natural anti anxiety pilks at first then she could tske casein hydroxylate supplents for few months.Can google DESTRESS by biotic pharma.

Secondly any drug would take a minimum of 3-5 days to show its optimal effect in body.So it would be a good idea to wait and watch for a week atleast before making changes again.

Hope i was helpful.
Thanks!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Rishu Saxena 28 hours later
Hello Doc

Thanks for all your advice
I have two questions here
My mom is not getting sleep like she is up for the whole night almost soo will sleep study show proper results if she is awake?
Second she is having cough can we give her montair 10mg or mondeslor 10mg once a night which one should be goiven pls advice

Her current tablet which she is taking are as below kindly advice if this montair or monfeslor will interfere with the bwlow tablets
Angizem 90cd
Rozaval F 10
And budecort puff

Please advice
doctor
Answered by Dr. Rishu Saxena 7 hours later
Brief Answer:
follow up.

Detailed Answer:
Hi,
Thanks for folow up query,
Yes Montair LC is a safe anti histaminic and can be used safely in your monthsr case.
However an expectorant can also be added if cough is wet in nature.
Montair has no interaction with medications she is on.

Sleeping is very inportant during sleep study so if she was awake its definitely going to effect the results.Consult your respiratory doctors for the same.

Thanks!
Above answer was peer-reviewed by : Dr. Raju A.T
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