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Suggest dosage for Hydrochlorothiazide

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Posted on Wed, 15 Feb 2017
Question: I'm seeking second opinion on my treatment for high blood pressure and type two diabetes. I've had my current doctor for 11 years. Over the past 6 years he has prescribed hydrochlorothiazide to control my blood pressure. The dosage started out at 10 mg for the first 5 years, and in Summer of 2015 he increased the dosage to 25 mg. At the 10 mg dosage I seemed to tolerate the medication and it lowered my blood pressure with no side effects. When he increased the dosage to 25 mg, the blood pressure was decreased only slightly, but I started to have negative side effects, like erectile dysfunction. I discussed this with him in November of 2015 and he reduced the dosage to 10 mg, but the erectile dysfunction continued. I saw him again in November of 2016 and told him that I was still have the problem and that my blood pressure was not being controlled under the new dosage (blood pressure was 188/102. This is the level that he got in the office as well). I told him that I was considering going to an endocrinologist for treatment. He asked me to allow him to try one other medication, chlorothalidone at 12.5 mg for one month and if that didn't work he would recommend an endocrinologist. After one month I returned and the new medication promoted fluid reduction, but did nothing to control my blood pressure. He then suggested that I do a urine test to see if I had high levels of cortisol, which may suggest Cushing's disease. The test came back with normal levels of cortisol and no Cushing's disease. After 11 years of care, my blood sugar (I'm currently taking Glipizide 25 mg) and my blood pressure have not been controlled. I get the idea that my doctor does not know how to treat me. What should I do?
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Answered by Dr. Mirjeta Guni (1 hour later)
Brief Answer:
About Diabetes and blood pressure treatment;

Detailed Answer:
Hello,
For the blood pressure i would recommend to discuss with your treating physician about using Enalapril (if your renal function is not alterated).
It is the best choice for a patient with Diabetes because it lowers the blood pressure and protects the kidneys from Diabetes damages.
It may cause a dry cough and in these cases is discontinued.
Of course physical activity and a low salt diet should have been suggested by your physician.
Your actual weight and height ( or BMI) and HbA1c (the mean glucose levels of the last three months) would be the main indicators of Diabetes control.
If you are overweight and HbA1c is high with the actual treatment, metformine would be a good alternative ( of course if there are no contraindications such as; renal or liver function impairment).
So i would recommend to check:
-HbA1c, BUN and Creatinine, AST, ALT.
I would be happy to review your performed tests for another professional opinion.

I am always at your disposal for any other questions whenever you need!

Wishing all the best,
Dr.Mirjeta

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

Endocrinologist

Practicing since :2006

Answered : 2411 Questions

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Suggest dosage for Hydrochlorothiazide

Brief Answer: About Diabetes and blood pressure treatment; Detailed Answer: Hello, For the blood pressure i would recommend to discuss with your treating physician about using Enalapril (if your renal function is not alterated). It is the best choice for a patient with Diabetes because it lowers the blood pressure and protects the kidneys from Diabetes damages. It may cause a dry cough and in these cases is discontinued. Of course physical activity and a low salt diet should have been suggested by your physician. Your actual weight and height ( or BMI) and HbA1c (the mean glucose levels of the last three months) would be the main indicators of Diabetes control. If you are overweight and HbA1c is high with the actual treatment, metformine would be a good alternative ( of course if there are no contraindications such as; renal or liver function impairment). So i would recommend to check: -HbA1c, BUN and Creatinine, AST, ALT. I would be happy to review your performed tests for another professional opinion. I am always at your disposal for any other questions whenever you need! Wishing all the best, Dr.Mirjeta