Question: Hi Doctor,

My father is 51 years old, he previously had certain episodes of high blood pressure but was only during stress, he used to take diazepam to calm down and lower bp.
He went to Hospital on 2012 for a routine check up everything was normal however urine analysis showed few red blood cells and protein traces. the Doctor suggested to do abdominal ultrasound which showed normal kidneys, and prostate, as well as normal bladder, there was a little fatty liver seen however the doctor said it's hard to diagnose anything since the ALT/AST and other liver function tests showed to be in normal range. as for the RBC in urine and protein traces he thought it's nothing to worry about as long as abdominal ultrasound didn't show any mass lesions or other alarming signs

About 2 weeks ago he went for a routine health check up again and his blood pressure was high even though he doesn't recall being in stress, his BP upon check up was 150/90. The doctor suggested him to take Micardis 80mg once in the morning and to come back another day to do CBC, urine analysis Liver function tests and renal function tests.

after 4 days of taking Micardis it didn't show any benefit as the blood pressure was always about 150/90 --> 155/98 etc. He went back to the hospital and the doctor suggested to add amlodipine 5mg once per night, so now he takes two medicines Micardis 80mg in the morning and amlodipine 5mg at night. his blood pressure is now back to normal at about 120/80.
as for the laboratory results everything showed in normal range apart from High triglycerides which the doctor prescribed Statix 10 once at night. and the urine analysis again showed some RBC (about 3-4 RBC) traces but this time no protein was traced.

My questions.

1.After the second visited the Doctor gave him Micardis 80mg morning, at night he takes Norvasc (amlodipine 5mg) together with Statix 10. Is there any drug interaction between Norvasc 5mg and statix 10? i read somewhere that there is high interaction between amlodipine and atorvastatin and it's not recommended to take together... what do you suggest? can we say the dosage is low so we shouldn't be alarmed about it ?

2.What's it all about this fatty liver? given that my father is not obese his BMI is about 22. is there further tests we should do to figure out what's going on ? or it's normal finding ?

3.The doctor didn't suggest to do anything about RBC in urine given that laboratory tests plus ultrasound showed normal results ? do you suggest to do further tests ? should we do PSA test to rule out possibility of early prostate cancer ? or there is no need for that as long as ultrasound was normal?

4-can i change his current micardis 80mg morning and amlodipine 5mg at night to exforge 5/80 so he can take it only once in the morning?


I'm medical student by the way :)

Thanks in advance doctor

Hi Dr, thanks for your quick reply and your advice, appreciate it.

As for your questions for the follow-up regarding the possible cause of fatty liver.

My father is not alcoholic, never had alcohol as per Muslim belief
The Doctor did fasting glucose test which showed about 112mg/dl and the h1bc was about 5.5, the doctor said he is at prediabetes state and needs to avoid sugar or reduce it but no medicine is required at the moment.

1-How about if we redo abdominal ultrasound to rule out possibility of misdiagnoses from the previous ultrasound ?

2.Another question that popped up to me now is that, when my father was collecting his urine for the laboratory test he told me he was fasting the night before so when he did the blood test and went to urine test he had to drink alot of water to be able to pass urine.. Would that change results on the urine analysis? he was asking me that because in 2012 he had protein traces and rbc but this time they didn't see protein traces so he thinks it could be diluted by the amount of water he drunk ... possible to have wrong urine analysis reading if one drinks alot of water before collecting urine?


Thanks again doctor