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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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My father has bifascicular block. On 30/1/2019 he has blood

Answered by
Dr.
Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1799 Questions

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Posted on Sun, 24 Mar 2019 in Hypertension and Heart Disease
Question: My father has bifascicular block. On 30/1/2019 he has blood pressure 160. Also slight spinning in head and presure. He was prescribed Telvast 20 for 10 days.. But maximum pressure did not reduced below 148-152. So he took Ditor plus 5 ---which reduced pressure to 146.
On 15th February 15/2/19 we visited Doctor at XXXXXXX under whom My Father takes medicines doctor Arup Dasbiswas. But After taking Ditor plus 5 pulse rate is reducing even coming to 65. Another doctor at XXXXXXX said to take Dilizem 30 twice as Dilizem does not reduce heart rate instead of Calaptin 40 thrice . Is it right?? Will he take TElvast 20 instead of ditor?? Some doctors are saying do not use Ditor.
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Follow up: Dr. Sagar Makode 0 minute later
My father has bifascicular block. On 30/1/2019 he has blood pressure 160. Also slight spinning in head and presure. He was prescribed Telvast 20 for 10 days.. But maximum pressure did not reduced below 148-152. So he took Ditor plus 5 ---which reduced pressure to 146.
On 15th February 15/2/19 we visited Doctor at XXXXXXX under whom My Father takes medicines doctor Arup Dasbiswas. But After taking Ditor plus 5 pulse rate is reducing even coming to 65. Another doctor at XXXXXXX said to take Dilizem 30 twice as Dilizem does not reduce heart rate instead of Calaptin 40 thrice . Is it right?? Will he take TElvast 20 instead of ditor?? Some doctors are saying do not use Ditor.
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Follow up: Dr. Sagar Makode 2 minutes later
I want to upload Echo report and EcG but cannot upload more than 3 .
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Follow up: Dr. Sagar Makode 0 minute later
I want to upload Echo report and EcG but cannot upload more than 3 .
doctor
Answered by Dr. Sagar Makode 24 minutes later
Brief Answer:
Telvas is preferable

Detailed Answer:
Hello,
I have gone through his report. His blood work is fine, and echo and ecg shows the changes which are likely related to hypertension only. However, it's better to undergo further test like stress thallium or treadmill test if he is able walk fast or even CT coronary angiography to rule out possibility of blockages in heart.
Regarding hypertension, first choice is of telvas which should be continued and gradually dose is escalated to 40 mg and if necessary to 80 mg. If not controlled on 80 mg then other medicines may be added like Amlodipine and later Dytor plus/calaptin/Diltiazem. However, if bp is well controlled on current medicines then may continue same.
Calaptin and diltiazem belong to same class and can reduce heart rate. However, heart rate more than 55-60 at rest is fine to have and not worrisome.
So, overall, if his bp is well controlled on current medicine with heart rate 65, he may continue with same medicines. However, you should discuss and request your local doctor to shift to telvas only and increase it's dose gradually which is a first drug of choice, before adding other second line medicines.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Sagar Makode 0 minute later
Brief Answer:
Telvas is preferable

Detailed Answer:
Hello,
I have gone through his report. His blood work is fine, and echo and ecg shows the changes which are likely related to hypertension only. However, it's better to undergo further test like stress thallium or treadmill test if he is able walk fast or even CT coronary angiography to rule out possibility of blockages in heart.
Regarding hypertension, first choice is of telvas which should be continued and gradually dose is escalated to 40 mg and if necessary to 80 mg. If not controlled on 80 mg then other medicines may be added like Amlodipine and later Dytor plus/calaptin/Diltiazem. However, if bp is well controlled on current medicines then may continue same.
Calaptin and diltiazem belong to same class and can reduce heart rate. However, heart rate more than 55-60 at rest is fine to have and not worrisome.
So, overall, if his bp is well controlled on current medicine with heart rate 65, he may continue with same medicines. However, you should discuss and request your local doctor to shift to telvas only and increase it's dose gradually which is a first drug of choice, before adding other second line medicines.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sagar Makode 3 hours later
My father is hart-patient for nearly 25-30 years and he is taking calaptin for nearly 20-22 years. So I want to know is it good to change Calaptin to Dilizem?? 17 years before my father stopped Calaptin for 10 days in advice of local doctor and he had mild stroke.
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Follow up: Dr. Sagar Makode 0 minute later
My father is hart-patient for nearly 25-30 years and he is taking calaptin for nearly 20-22 years. So I want to know is it good to change Calaptin to Dilizem?? 17 years before my father stopped Calaptin for 10 days in advice of local doctor and he had mild stroke.
doctor
Answered by Dr. Sagar Makode 8 hours later
Brief Answer:
There is no need to change to diltiazem..

Detailed Answer:
As I mentioned both are similar drugs so changing to diltiazem will be of no help. So, there is no point in changing medicines.
And stopping calaptin will not cause stroke, it may just increase bp or heart rate. Anyway, he may continue with Calaptin.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Sagar Makode 0 minute later
Brief Answer:
There is no need to change to diltiazem..

Detailed Answer:
As I mentioned both are similar drugs so changing to diltiazem will be of no help. So, there is no point in changing medicines.
And stopping calaptin will not cause stroke, it may just increase bp or heart rate. Anyway, he may continue with Calaptin.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sagar Makode 9 days later
My father was taking Telvast 20 twicw /once a day , stopping on pressure below 120/80.
He has stopped taking Telvast 20 for 72 hrs and at today morning 9:0 am pressure rises to 151 ---- 151/73, pulse 87. Again he took Telvast 20 and pressure reduced to 126/71 pulse 83 , now at 9:00 pm it is 131/72, pulse 82. But his diastolic pressure remaing almost same, The water which he drinks has TDS 550---- is that making any trouble?
Is the pressure normal? Any special medicine, Is water TDS reduction necessary?
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Follow up: Dr. Sagar Makode 0 minute later
My father was taking Telvast 20 twicw /once a day , stopping on pressure below 120/80.
He has stopped taking Telvast 20 for 72 hrs and at today morning 9:0 am pressure rises to 151 ---- 151/73, pulse 87. Again he took Telvast 20 and pressure reduced to 126/71 pulse 83 , now at 9:00 pm it is 131/72, pulse 82. But his diastolic pressure remaing almost same, The water which he drinks has TDS 550---- is that making any trouble?
Is the pressure normal? Any special medicine, Is water TDS reduction necessary?
doctor
Answered by Dr. Sagar Makode 1 hour later
Brief Answer:
Not related to water TDS

Detailed Answer:
Hello,
It's not related to water tds. He should regularly be on medications in order to keep it controlled. For reducing tds, may use water filters.
His readings are fine. Diastolic is already controlled, so not expected to go down further. Readings less than 140/90 are fine and his are well controlled.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Sagar Makode 0 minute later
Brief Answer:
Not related to water TDS

Detailed Answer:
Hello,
It's not related to water tds. He should regularly be on medications in order to keep it controlled. For reducing tds, may use water filters.
His readings are fine. Diastolic is already controlled, so not expected to go down further. Readings less than 140/90 are fine and his are well controlled.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sagar Makode 37 minutes later
But in some internet pages I read that too much reduction of diastolic pressure with increased systolic pressure is not good.??? Is it?? Should he stop telvast below 115 /70 pressure
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Follow up: Dr. Sagar Makode 0 minute later
But in some internet pages I read that too much reduction of diastolic pressure with increased systolic pressure is not good.??? Is it?? Should he stop telvast below 115 /70 pressure
doctor
Answered by Dr. Sagar Makode 8 hours later
Brief Answer:
No, it's not like that

Detailed Answer:
His diastolic bp is not low, it's normal. Also, diastolic bp may remain on lower side due to age factor. There is no definitive evidence that it is detrimental.
He should avoid the dose if bp is less than 110 systolic or having any symptoms like uneasiness dizziness with low bp.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Sagar Makode 0 minute later
Brief Answer:
No, it's not like that

Detailed Answer:
His diastolic bp is not low, it's normal. Also, diastolic bp may remain on lower side due to age factor. There is no definitive evidence that it is detrimental.
He should avoid the dose if bp is less than 110 systolic or having any symptoms like uneasiness dizziness with low bp.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Sagar Makode 11 hours later
Today he has not taken telvast till. Now at 8:00pm pressure is 120/66, pulse 73. In morning it was 137/73 , pulse 77. Is it ok. is it required to take tevas.




Yesterday on 1/3/19 before taking telvast it was 151/73, pulse 73.
After telvast it was- 126/71, pulse 78
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Follow up: Dr. Sagar Makode 0 minute later
Today he has not taken telvast till. Now at 8:00pm pressure is 120/66, pulse 73. In morning it was 137/73 , pulse 77. Is it ok. is it required to take tevas.




Yesterday on 1/3/19 before taking telvast it was 151/73, pulse 73.
After telvast it was- 126/71, pulse 78
doctor
Answered by Dr. Sagar Makode 2 hours later
Brief Answer:
It's better to have it

Detailed Answer:
Hello,

It's better to have because once the medicine is stopped BP will start rising. So, it's better to continue with medicine.

Otherwise, these readings are not detrimental immediately, but readings more than 140/90mmhg will be detrimental in the long term. So, medicine should be continued despite normal readings.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Sagar Makode 0 minute later
Brief Answer:
It's better to have it

Detailed Answer:
Hello,

It's better to have because once the medicine is stopped BP will start rising. So, it's better to continue with medicine.

Otherwise, these readings are not detrimental immediately, but readings more than 140/90mmhg will be detrimental in the long term. So, medicine should be continued despite normal readings.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sagar Makode 44 hours later
When blood pressure is being checked by DIGITAL bp monitor 3 times- three readings on systolic side showing e.g. 145, 123, 132 whereas as diastolic showing around 75/77.
Previous year 2018 this was e.g 147, 144, 150.

why the fluctuations increased??
Is it normal ?? anything to be cautious
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Follow up: Dr. Sagar Makode 0 minute later
When blood pressure is being checked by DIGITAL bp monitor 3 times- three readings on systolic side showing e.g. 145, 123, 132 whereas as diastolic showing around 75/77.
Previous year 2018 this was e.g 147, 144, 150.

why the fluctuations increased??
Is it normal ?? anything to be cautious
doctor
Answered by Dr. Sagar Makode 15 minutes later
Brief Answer:
It's fine

Detailed Answer:
Hello,
Firstly, whenever readings are being taken on electronic bp apparatus, then arm should be supported on table and it should be relaxed. Average of three readings should be taken. So, in this case, his true bp must be around 130 systolic and diastolic is around 75. 5 to 10 mmhg difference is acceptable.
So, his readings are fine. Bp less than 140 systolic is fine, but less than 130 and more than 110 should be the target ideally.
And for diastolic, less than 85 should be the target.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Sagar Makode 0 minute later
Brief Answer:
It's fine

Detailed Answer:
Hello,
Firstly, whenever readings are being taken on electronic bp apparatus, then arm should be supported on table and it should be relaxed. Average of three readings should be taken. So, in this case, his true bp must be around 130 systolic and diastolic is around 75. 5 to 10 mmhg difference is acceptable.
So, his readings are fine. Bp less than 140 systolic is fine, but less than 130 and more than 110 should be the target ideally.
And for diastolic, less than 85 should be the target.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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