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Have Stent Placed. Taking Candesartan For High BP, High Potassium And Dizziness. Can I Change To Concor?

Posted on Sat, 14 Dec 2013

Question: Hi Doctor: I'm Male, 68, weight 78KG. Medical History: I have a Stent for the last 10 years with NO complains/issues. Recently, been through through a lot of tests including Blood, Sugar, Lipid profile, Thyroid, Urine, kidneys, Heart, ECG, Holter Monitoring (24Hrs), stress Test etc. Diagnosis revealed High Cholesterol & Thyroid, for that i'm taking Tab LIPITOR (10), Tab Aspirin (8mg), & Tab Thyroxine (5mg). No Blood Pressure at all. General Lifestyle: No Dairy or Meat products and only vegetable, fish and infrequently chicken. Lots of walk and limited water intake. Recent Problems: 1) Undiagnosed Blood Pressure: Started monitoring it for last 1 month when my BP dropped to 90/60-immediately took ELECTROLYTES after every 2 hours/glass until the BP reached around 125/75 in the next 6-8 Hrs. Monitored BP every 12 Hrs and then it started to show high readings till today in the range of 145-155/80-98. For 18 days taking Candesartan Cilexetil 8mg/day for High BP but the effect is minimal and BP starts to get HIGH from afternoon till late evening and i could feel the heat on my face and ears. Neck muscles get a little stiff too. Then at this time Captopril 25mg is taken and there is a lot of relief till the next day and also BP drops when this is taken in the rage of 100-110/65-70. 2) Potassium level: 5.44 3) Vitamin D: 11.7 2) Stress/Anxiety/depression/dizziness starts around afternoon Another opinion i'm now getting is to change my undiagnosed BP/situation medication to CONCOR® 2.5mg/day and leave (Candesartan Cilexetil 8mg & Captopril 25mg). Which i did take in the last 5 days and BP is much better now but PULSE dropped to 60s. I can provide numbers and reports of different tests if needed. Plz Advise many thanx

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer: Please refer to the suggestions below... Detailed Answer: Hi XXXXX I have read your medical history carefully, and I could say that you got high blood pressure due to thyroid problems and electrolite disbalance. Before going for a conclusion, I'd like to have the results of your lab and other examinations you did. Meanwhile, as you are saying, your blood pressure and hearth rhythm has been optimized with starting bisoprolol (Concor). So, I suggest to continue with such medication. You are saying to consume less water. That is not a good choice as less water would increase kalium which cause hypertension and heart rate arhythmia. So, I strongly suggest to consume more water. Looking forward to have the results as requested. Dr.Benard

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Benard Shehu (1 hour later)

Thank you Dr for the prompt reply. While taking CONCOR, my pulse rate has gone down to 65 from a regular 75 area..is that a concern? And BP now tends to be around 135/85area.... Any specific reprots that u would like results for? As sending all of them would take a while. Apart from the above, i have asked specific questions in my 1st writeup, can u plz specifically relate to them. Many thx XXXXX

Answered by Dr. Benard Shehu (2 hours later)

Brief Answer: Please refer to the suggestion below... Detailed Answer: Hi XXXXX, Thank you for writing back. With regards to your heart rate of 65 after taking concor it’s not a concern at all. I encourage to keep this way, because it’s within the excepted values. Your BP values are to be concerned because the desirable values are <130/80mmHg. To reach this goal talk with your doctor to see if the doses can be adjusted or another pill can be added. Regarding the reports, could you please send the ECG and Holtter 24 h rhythm monitoring. Thank you. 1. There are many factors contributing in increasing your blood pressure: thyroid problems, electrolytes, dehydration (little water intake); low calciferol (vit D), problems with high cholesterol, anxiety/stress. 2. Your potassium level seems to be slightly elevated. However, different laboratories have different reference ranges. So, in general the upper limit would be up to 5.2; so, yours is slightly elevated. Can you consult your cardiologist to start diuretics in order to lower potassium levels together with increasing the water intake. 3. You have slightly low levels of vitamin D, which is considered as a potential risk for developing Hypertension especially in dark color skin. You should take vitamin D supplements and to expose more to sun. The recommended dose for your age is 600 U.I per day, however talk with your doctor for the exact doses. With regards to the afternoon dizziness, it might be related to oscillations in the blood sugar, thyroid problems and/or stress after a overloaded day. Hope it answered to your inquiries! Looking forward to have your requested results in for further assistance. Dr.Benard

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Benard Shehu (58 minutes later)

Thank you for the detailed reply. Have you had a look at 10 reports that I have attached including Holter moniter summary? Also, do u think I should be referred to another area specialist? Regards

Answered by Dr. Benard Shehu (2 hours later)

Brief Answer: Please refer to the following answer... Detailed Answer: Hi XXXXX, Thank you for sending in the test results you ran. Now, I was gone through them and there is no serious problem noted. Your bio-chemical balance is ok. However, I strongly suggest to keep in touch with your cardiologist and endocrinologist. With regards to the Holter monitoring summary, I noticed only fourteen supraventricular ectopic arrhythmia (seven in single and seven in couple), but this findings are within the normal parameters. Beta blockers (concor) are the first choice in this cases. I have noticed that your creatinine levels were slightly elevated. I suggest to consult a nephrologist to check for probable kidney disease. Also, consult urologist for possible prostate hypertrophy, which is normal at your age and can cause kidney problems too. Hope it answered to your questions! Wish you health! Dr.Benard

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Benard Shehu (2 hours later)

So, Dr what is the Diagnosis and Conclusion with any specific problem areas and your recommendations? Any more Specific Tests that i should go through? Also, does anything confirms that i have a permanent High BP problem or is it temporary? Y should i continue to use Concord, to correct heart rythems or for BP My Creatinine levels have been the same for me for the last 10years. Many thanks?

Answered by Dr. Benard Shehu (11 hours later)

Brief Answer: Please refer to the following suggestion... Detailed Answer: Hi XXXXX, Thank you for writing back. To my judgement, your diagnosis is Hypertension, st.I-II; most probably due to adrenergyc hyper-stimulation. That's why you should continue using Concor. By passing of time, based on the improvements you will have, it will be decided if your hypertension is temporary or permanently. As mentioned earlier; your creatinine level is at the border range. If remained the same, I hope you won't have further problems. However, I recommend regular check ups with nephrologist to catch kidney problems in time. Hope it answered to your inquiries! Wish you health! Dr.Benard

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Benard Shehu (35 minutes later)

Many thanks for the reply. Its been 7 days now that i have been using Concor and situation is improved 50%. Before the morning dose, the BP remains around 135/90 but once the medication is taken it improves to 120/82. The does is minimal at this time that is 2.5mg. Do u think does needs to be adjusted on the upper side..if yes, how much, else i will continue with this. Hope to hear your early reply. Regards XXXXX

Answered by Dr. Benard Shehu (56 minutes later)

Brief Answer: Please follow the answer below... Detailed Answer: Hi XXXXX, It is great that your BP is improving together with heart rates. It is true that you are using a minimal dose of Concor. It's dose can be raised to 5 or 10 mg, depending on your BP and heart rate to avoid bradychardia from medications. For this (to raise the doses) you should talk with your cardiologist and should be done under strict medical surveillance. As long as your heart rate and/or BP is low, you should keep on with 2.5 mg of Concor until your cardiologist would judge what else he can do. All the best! Dr.Benard

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Benard Shehu (4 hours later)

hello Dr I can confirm now that Concor (2.5) continues to keep my pulse rate at 60 beat/min. If i need to change Concor with any other, would this be done instantly or do i need to leave Concor slowly and gradually? If gradually, then how much time and what would be the frequency then? Can you suggest other best alternates for Concor, keeping in view my situation? (This would be strictly for my information as i would be visiting a Cardiologist before switching) many thanks

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer: Please follow the answer below... Detailed Answer: Hi XXXXX, Once again, thank you for writing back. If you want to change Concor with any other, you can do instantly withing 1-2 days. You do not need to leave Concor slowly as the dose you are taking is the minimal. If you stop Concor in your case you should begin another antihipertensive pill. In your case i recommend diuretic that could also help reduce potassium levels too. If you want to stop Concor and take another drug within this group (beta-blockers), I'd suggest metoprolol, starting with 25 mg dose then, gradually increasing to 50 and 100 mg/day, if the BP and heart rate aren't stabilized. Wish you health! Dr.Benard

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

Follow up: Dr. Benard Shehu (19 hours later)

Hello Doctor Wanted to update u on my status. Pulse is now stable at 60 by using Concor 2.5 and the BP stays within the normal range of 130/80 however it has started to get high by evening with a reading of 140/90. What should i do? Concor Dosage increase may take the pulse below 60...is this understanding right? What possible solution do u have in mind to keep BP stable throughout the day and night? Many thx

Answered by Dr. Benard Shehu (39 minutes later)

Brief Answer: Please refer to the following answer... Detailed Answer: Hi XXXXX, Thank you for sending your health updates in. At this point, I strongly suggest to start a diuretic together with Concor 2.5 mg. I do not think it is time to increase Concor, but to start only diuretic. The increase of Concor doses will cause bradicardy (low heart rate) even if you change beta-blocker the expectancy will be the same. You should also keep on lifestyle and diet changes too. Hope it answered to your inquiries! Dr.Benard

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Benard Shehu (16 hours later)

Hi Dr Using Concor before breakfast now. Do you think there would be any positive effect in my case if Concor is spilt in morning and afternoon/evening out of the same 2.5 mg dose. Thanks

Answered by Dr. Benard Shehu (4 hours later)

Brief Answer: Please refer to the following answer... Detailed Answer: Hi XXXXX, Once again, thank you for writing back. I don't think that there will be any positive effect if Concor is taken two times a day because the effect of Concor last 24 hours (so no need to take the pill two times a day). In most of the cases the best time to take Concor is in the morning, however I recommend to take the pill at afternoon (around 02-04 p.m), because the problem is happening from afternoon till evening. Hope it answered to your inquiries! Dr.Benard

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Above answer was peer-reviewed by : Dr. Yogesh D