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Dr. Andrew Rynne

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Have hypertension, type 2 diabetes and joint arthritis. Suggest proper treatment

Answered by
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Dr. Das Arindam

General & Family Physician

Practicing since :2008

Answered : 1416 Questions

Question
for 55yr old female with hypertension, type2 diabetes and joint arthritis what is suitable antihypertensive?she is taking amtasE for last 5 years but joint pain is aggravating now
Sat, 8 Dec 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Das Arindam 25 minutes later
Hello,
Thank you for posting a query.

Firstly, hypertension and joint arthritis are two different disease not realated to each other’s. As you have told the blood pressure is 144 / 96, I think the diastolic is higher than normal for this age. For this, you have to consult with your treating doctor for changing the drug / dosing. Because, she needs more meticulous treatment. The higher diastolic blood pressure indicates a poor control of hypertension. Other antihypertensive agents which may be considered are losartan, telmisartan group of drugs. These newer antihypertensive agents are better. So, consult with your treating doctor about this. If the hypertension does not respond to this, then two antihypertensive agents should be considered and they should be given in two different times of day.

About her joint pain, in this age many disease can lead to this condition. The causative agent may be idiopathic or bone erosion due to osteoporosis, increased uric acid level.
In cases of osteoporosis newer treatment modalities are available to increase the bone mineral density which invariably leads to a good prognosis. For this, you have to consult with an orthopedic surgeon. You can consult with a physiotherapist for light exercise appropriate for her.

You have to do an uric acid level in blood to exclude increased uric acid level as a causative agent.

Now, in case of a patient with this type of joint pain the only antihypertensive that has to be avoided is hydrochlorothiazide. It increases the uric acid level and leads to increased pain.

So, you have to consult with your treating doctor / cardiologist for control of hypertension and orthopedic surgeon for joint pain.

Hope this information suffices. Let me know, if you have any more question.

Regards.
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Follow-up: Have hypertension, type 2 diabetes and joint arthritis. Suggest proper treatment 25 minutes later
she has osteoarthritis in knee joint,ankle.Diabetes is well controlled with Amaryl.Recently i come to know that amlodipine ingridient of AMTAS E is not good in arthritis as its side effect is joint pain.her uric acid level ,creatinine are within normal limit.what you would recommend as antihypertensive with dose?ECG normal with RVHypertrophy due to hypertension.ECHO wnl
 
 
Answered by Dr. Das Arindam 7 minutes later
Hello,
Thank you for writing back.

As I previously told you that telmisartan or losartan group of drugs are far better. As far as I know,amlodipine is a very safe drug that can be used in any disease. It does not have any side effects on arthritis.
You have to consult with your treating doctor for dosing and frequency of the above mentioned drugs.

Regards.
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