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Suggest hypertensive medication for a diabetic

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Posted on Fri, 2 Jan 2015
Question: CARDIOLOGY
Dear Doctor, kindly go through this patiently.
I have had IHD(Twave inversion) in the year 1977 and mild hypertension in 1981. The doctor who has attended on me prescribed Aten. Since then I have been using Aten in form or other like Aten 50/Atenlol/Stamlobeta. 37 long years have passed with out any problem with either of these two. My BP is quite normal 120/80 and some times 110/70 and some times on very few occassions 140/80 or 90.I had Type two diabetes in the year 2010.I have been taking Glycomet 250 mg twice a day. Right from the begining my fasting level is more than normal and oscillates between 110 to 120 and on very few occassions 125.My pp levels are quite normal below 140.I have recently undergone bloodtest and my fbs is 125 and pp 140 and hba1c 6.9 and my bp on the day of visiting the doctor is140/80.The attending physician has prescribed Cresar 40 mg (Telmisartan) and asked me to stop taking stamlobeta 50 mg which i am taking from 2006 and further said since i am using this Amlodipine combined atenlol ,its better to change the medicine which will also take care of the diabetes and kidneys and heart (IHD) Is it so?. Please do not get the impression that i have noconfidence in my physician.But i have a tendency to go for second opinion on new drugs before starting a new one. I do not blindly or in hasty manner take any new medicine.Hence i require expert advise.Can i stop Stamlobeta 50 mg and start taking Cresar 40 mg one a day in the morning.As Stamlo and Atenlol are ace inhibitors and beta blockers and Telmisartan is an angiotensin ii (arrb).shifting from the stamlobeta to telmisartan does it cause any harm or is it quite safe. Does the heart acclamatise to the old drug?My lipid profile is very normal. cholestrol is 123 ,tryglecerides 141, hdl 46, ldl 53 and vldl 23.TSH 0.5.KIndly ask me if any clarification.
doctor
Answered by Dr. Divakara (1 hour later)
Brief Answer:
Your Physician is right.

Detailed Answer:
HI

Greeting from Dr. Divakara.P
First of all thanks for choosing Healthcaremagic for posting your query.


Your Physician is absolutely right. The hypertensive medication of choice in diabetic is either ACE Inhibitor or ARB. (Here I would like to correct you that neither Stamlo nor atenolol are ACE inhibitors) Also ACE Inhibitor or ARB have some protection on the kidneys and heart too. So I advise you to start Telmisartan.

But stopping Stamlobeta which contains Beta blocker all of a sudden is not a good practise. I advise you to take half tablet of Stamlobeta and half tablet of Telmisartan for 2 weeks and then stop Stamlobeta and take full tablet of Telmisartan. Discuss about this with your doctor.

Hope this information was useful to you.
Any clarifications feel free to ask.

Regards


Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Divakara (16 minutes later)
Dear doctor
I thank you very much for your kind and prompt advice. I shall follow your advise and after consulting my physician i shall start taking telmisartan.thank you sir.



doctor
Answered by Dr. Divakara (7 minutes later)
Brief Answer:
Get these tests also.

Detailed Answer:
HI

I would also advise you to ask your doctor to do Serum Creatinine test and Serum Potassium test to be conducted on you as Telmisartan can be started only if Serum Creatinine and Serum Potassium are in normal range.

Take care of yourself.

Good Day.



Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Divakara (35 minutes later)
Dear doctor
my s creatinine is 0.7 and serum urea is 22. How ever i have not undergone test for s potassium. I shall follwo your advise.
thank you sir.
doctor
Answered by Dr. Divakara (27 minutes later)
Brief Answer:
Welcome

Detailed Answer:
HI

You are Welcome. If your Potassium is high then Telmisartan should not be started till Potassium levels are normalized.

Good Day.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Divakara

Internal Medicine Specialist

Practicing since :2006

Answered : 2358 Questions

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Suggest hypertensive medication for a diabetic

Brief Answer: Your Physician is right. Detailed Answer: HI Greeting from Dr. Divakara.P First of all thanks for choosing Healthcaremagic for posting your query. Your Physician is absolutely right. The hypertensive medication of choice in diabetic is either ACE Inhibitor or ARB. (Here I would like to correct you that neither Stamlo nor atenolol are ACE inhibitors) Also ACE Inhibitor or ARB have some protection on the kidneys and heart too. So I advise you to start Telmisartan. But stopping Stamlobeta which contains Beta blocker all of a sudden is not a good practise. I advise you to take half tablet of Stamlobeta and half tablet of Telmisartan for 2 weeks and then stop Stamlobeta and take full tablet of Telmisartan. Discuss about this with your doctor. Hope this information was useful to you. Any clarifications feel free to ask. Regards