Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For High BP Despite Taking Lisinopril-hydrochlorothiazide
Question: Lisinopril/HCTZ 20/25 worked for 15+ years. Last year it stopped working so my md added an additional 20mg lisinopril and 5mg amlodipine. After 2 weeks my BP was still not back to normal. My question, is there another ACE inhibitor generic or name brand that is good to try? I've tried ARBs Losartan/HCTZ 100/25 and am on Valsartan/HCTZ 300/25 mg for over a week now and my bp is still high 142/100.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your concern and would like to explain that first of all, as there are no predefined superior anti-hypertensive schemes, it is necessary to optimize your current therapy (by modulating the actual daily doses and possibly adding other components).
- Valsartan/HCTZ 320/25 mg seems to be at the top of the upper recommended daily dose,
- Amlodipine 5 mg could be increased to 10 mg daily dose,
- Bystolic (Nebivolol) may be increased 5 to 10 mg daily every two weeks (daily dose should not exceed 40 mg/day), so you need to give enough time to this drug in order to yield beneficial effects.
Only after trying this modified scheme, a new change should be tried.
Coming to this point, several anti-hypertenive drugs could be used as alternatives:
- Instead of Bystolic (Nebivolol), Carvedilol could be a rationale option. It is a beta-blocker with blood vessels dilating properties and thus a helpful medication in high blood pressure treatment.
- Several ACEIs may be used as alternatives (Ramipril, Zofenopril, Perindopril, etc.). They should be used after excluding any potential contraindications and on an escalating up-titration dose regimen (under doctor supervision).
Meanwhile, I recommend discussing with your attending doctor on the possibility of checking some lab tests, just to exclude any secondary causes responsible for persistent high blood pressure values:
- complete blood count (for possible anemia),
- thyroid hormone levels (possible thyroid dysfunction),
- renal function tests (renal dysfunction),
- blood electrolytes level and arterial blood gas analysis (possible adrenal glands dysfunction)
Once a secondary responsible cause is identified and properly treated, treatment of high blood pressure will be more effective.
You need to discuss with your doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Wishing you a Merry Christmas!
Kind regard,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your concern and would like to explain that first of all, as there are no predefined superior anti-hypertensive schemes, it is necessary to optimize your current therapy (by modulating the actual daily doses and possibly adding other components).
- Valsartan/HCTZ 320/25 mg seems to be at the top of the upper recommended daily dose,
- Amlodipine 5 mg could be increased to 10 mg daily dose,
- Bystolic (Nebivolol) may be increased 5 to 10 mg daily every two weeks (daily dose should not exceed 40 mg/day), so you need to give enough time to this drug in order to yield beneficial effects.
Only after trying this modified scheme, a new change should be tried.
Coming to this point, several anti-hypertenive drugs could be used as alternatives:
- Instead of Bystolic (Nebivolol), Carvedilol could be a rationale option. It is a beta-blocker with blood vessels dilating properties and thus a helpful medication in high blood pressure treatment.
- Several ACEIs may be used as alternatives (Ramipril, Zofenopril, Perindopril, etc.). They should be used after excluding any potential contraindications and on an escalating up-titration dose regimen (under doctor supervision).
Meanwhile, I recommend discussing with your attending doctor on the possibility of checking some lab tests, just to exclude any secondary causes responsible for persistent high blood pressure values:
- complete blood count (for possible anemia),
- thyroid hormone levels (possible thyroid dysfunction),
- renal function tests (renal dysfunction),
- blood electrolytes level and arterial blood gas analysis (possible adrenal glands dysfunction)
Once a secondary responsible cause is identified and properly treated, treatment of high blood pressure will be more effective.
You need to discuss with your doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Wishing you a Merry Christmas!
Kind regard,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Dr. Iliri,
I'm currently taking the Valsartan and Bystolic 5mg together in the mornings. I take the Amlodipine 5mg in the evening. Should I give the Valsartan with Bystolic a try for another 5 to 6 days to determine if there's a decrease in BP readings? If my BP is still high after 6 days, should I add Amlodipine to the morning as well?
I'm currently taking the Valsartan and Bystolic 5mg together in the mornings. I take the Amlodipine 5mg in the evening. Should I give the Valsartan with Bystolic a try for another 5 to 6 days to determine if there's a decrease in BP readings? If my BP is still high after 6 days, should I add Amlodipine to the morning as well?
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
I agree with the alternative to give Bystolic a chance for 1-2 weeks and after that to decide performing the above mentioned modification.
If after taking Bystolic 5 mg in the morning, your average BP values do not get under 140/90 mmHg, then it is necessary to increase Amlodipine daily dose to 10 mg and if this is not sufficient, after around a week to increase Bystolic daily dose to 10 mg.
You should know that you don't need to take Bystolic and Amlodipine twice daily, as they have a prolonged half-life and are suitable to be used once daily.
So, you may take Bystolic in the morning as you actually do and Amlodipine 10 mg once daily in the evening.
Remember that you need to keep monitoring closely your BP values meanwhile (several times daily for a couple of days) and write them down in order to consult the effectiveness of therapy with the doctor.
Please, let me know how things are going with your blood pressure in the upcoming days.
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
I agree with the alternative to give Bystolic a chance for 1-2 weeks and after that to decide performing the above mentioned modification.
If after taking Bystolic 5 mg in the morning, your average BP values do not get under 140/90 mmHg, then it is necessary to increase Amlodipine daily dose to 10 mg and if this is not sufficient, after around a week to increase Bystolic daily dose to 10 mg.
You should know that you don't need to take Bystolic and Amlodipine twice daily, as they have a prolonged half-life and are suitable to be used once daily.
So, you may take Bystolic in the morning as you actually do and Amlodipine 10 mg once daily in the evening.
Remember that you need to keep monitoring closely your BP values meanwhile (several times daily for a couple of days) and write them down in order to consult the effectiveness of therapy with the doctor.
Please, let me know how things are going with your blood pressure in the upcoming days.
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
