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Dr. Andrew Rynne

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Suggest treatment for high BP and fatty liver

Answered by
Dr.
Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 910 Questions

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Posted on Mon, 26 Oct 2015 in Hypertension and Heart Disease
Question: Hi , This is XXXXXXX XXXXXXX age 40 yrs, suffering from BP and on the following medications :

Medical History
Fatty Liver : due to the anti viral medication given during Chicken pox about 3 yrs ago
High BP + Headaches in the evening Diagnostics reports attached

1st round diagnostics done on 30th August and another round of diagnostics done today . kindly suggest what is going on ?? what should be the next steps....
Current Medications
Taking Bloop Pressure medication :
stamlo 2.5 mg
Levocet
doctor
Answered by Dr. Priyank Mody 1 hour later
Brief Answer:
Resolve liver issues, tab coversyl 2mg instead if amlodipine

Detailed Answer:
Hello I am Dr Mody and I would be addressing your concern,
Went through all your reports attached.
My observations
1) even if you have blood pressure, it's just early as your 2.5 mg amlodipine is a very small dose, and if controlled with it, we should be good to go
2) your echo and kidney and cholesterol and other reports are good enough and need no further evaluation
3) instead of Amlodipine I would suggest a ace inhibitors / arb, .
Eg. Perindopril 2mg at night, as the protection offered to heart and brain from blood pressure is more than amlodipine, and that should be our primary aim considering your age, also amlodipine may theoretically decrease platelets which for you is low. The only side effect of coversyl (perindopril) is cough, because you are on levocet which is anti histamine (for allergic cough) do consider the same
4) my most important concern is your live enzymes and with low platelets which points towards an active liver pathology.
If you take alcohol, plz plz do stop as your body isn't made for it, if you don't take alcohol strongly consider a condition called XXXXXXX (non alcoholic steatohepatitis) particularly if you are obese,
Also I would recommend you get the viral markers fone again, as chicken pox 3 years before should not result into the same
5) a gastroenterology St consult may be taken.
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Priyank Mody 2 hours later
Thanks Dr. XXXXXXX

The BP medication has been started recently and without medication for 4- 5 days the BP is around 90/130, however on some days there is a severe headache which doesn't go away with Asprin or Disprin etc

during the chicken pox, i was given an anti viral shot to avoid the adverse impact of Chicken pox post which the liver was diagnosed as fatty liver and the doctors stated it as a side effect of the anti viral shot for Chicken pox and were advised that it will reverse over the years.

Kindly suggest the liver markers you are recommending for diagnosis.

if there any other safer medication for BP ? considering minimal side effects


doctor
Answered by Dr. Priyank Mody 18 hours later
Brief Answer:
Amlodipine has minimal side effects but not the best for a young person

Detailed Answer:
Hello, XXXXXXX
As I said a very mild dose of perindopril, brand name coversyl 2mg or any other from same group anytime day is the alternative I suggest. The only side effect is dry cough which is seen in 0.2% of patients, though rare as you will not be following up with me I tho I should tell you, otherwise it's a Dar better drug than , as it protects your heart, kidney. And brain from long term side effects of hypertension apart from. Just bringing your blood pressure down.

Now though I am not the best person to advice on liver part, but I have too done my MD Medicine before cardiology, hence I am not convinced with the fact that your liver enzymes be raised 3 years post a vaccine shot. Raised enzymes means active inflammation is still going on in your liver, though fatty liver may occur but not raised enzymes.
Common hepatic virus b and c, alcohol and as I thought XXXXXXX will comprise 90 of XXXXXXX population who may have long term archive inflammation. I would suggest you do visit an gastroenterologist maybe to discuss this further, because once damaged it's not completely reversible and so I believe in prevention is always better. Hopefully I could help,
So rate for others reference
Regards Dr Priyank Mody.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Priyank Mody 40 hours later
follow up question pertaining to the Hematology report :

why is the platelet count low?
Platelet Count -(EDTA Blood/Automated Blood cell Counter)- 1.14
Total Leukocyte Count (TC)-(EDTA Blood/Automated Blood cell Counter)= 3900
Neutrophils 31 %
Lymphocytes 63 %

what does this mean ?

we repeated this test two days back and the reports are on the similar range

Platelet Count -(EDTA Blood/Automated Blood cell Counter)- 1.12
Total Leukocyte Count (TC)-(EDTA Blood/Automated Blood cell Counter)= 4000
Neutrophils 31 %
Lymphocytes 63 %


we repeated this test two days back and the reports are on the similar range

Platelet Count -(EDTA Blood/Automated Blood cell Counter)- 1.12
Total Leukocyte Count (TC)-(EDTA Blood/Automated Blood cell Counter)= 4000
Neutrophils 24 %
Lymphocytes 70 %
doctor
Answered by Dr. Priyank Mody 12 hours later
Brief Answer:
Low platelets and increased liver enzymes do point towards liver pathology

Detailed Answer:
Hello,
The total count is just borderline low so I would not be worried about it, also the neutropil and lymphocytes differntial ratio is normal.
WBC are our protective cells, something which protects our body against any infection or stress, neutrophils are the cells which take care of acute infection, which is near normal in your reports.
Now increased liver enzymes and decrease platelets point towards chronic liver disease, the reason why I told you to visit a gastroenterologist .
However I would reassure you that nothing grossly wrong as your sonography of abdomen doesn't point towards anything significantly wrong with your liver except the fatty liver.
Also if you have active fever such hemogram is characteristically seen in dengue and thypoid fever, which also in you is ruled out in your case.
A re-evaluation for low platelets is needed in my view.
Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Priyank Mody 9 hours later
see the attached peripheral Smear report and suggest the next steps.
doctor
Answered by Dr. Priyank Mody 14 hours later
Brief Answer:
Di go through the detailed answer.

Detailed Answer:
P/s smear shows low platelets the reason I think might be related to lover itself or some infection which is decreasing the platelets and increasing the enzymes. The increase in monocyte s and lymphocytes suggest some chronic infection.
Further action is to allow a physician to examine you and guide you for further investigation

I am a cardiologist and I may not be the best person who would be helpful you with the general aspects .

Regards Dr Priyank Mody
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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