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    Suggest treatment for hypertension and anxiety

Posted on Thu, 29 Jun 2017 in Hypertension and Heart Disease
Question: Hi doctor I m. Suffering from hypertension... Ecg normal tmt negative echo report says mild concentric lvh and diastolic dysfunction. I want to control my BP morning which usually is high compared to through out the day.. It is 130to 140/ 90 to 100 plz help me out what dose adjustments needed to control my early morning BP... Currently on azilsartan and cilnidipine morning evening ..want to have steady uniform 24 hr BP..... Suggest me good medicine....
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:
Please refer to the detailed answer below

Detailed Answer:
Hello Dear

After going carefully through the medical details provided by you first of all I would like to suggest you to relax don't take stress as Stress and anxiety significantly contribute to increase blood pressure.

Now talking about your Bp readings which you have mentioned, for you information the normal recommended range of blood pressure for an adult is less than 140 / 90 mmhg and your systolic is staying well within that range (130 -140 mmHg) which is good. Only your diastolic bp is going a bit high which is around 100 mmHg.

Now the good thing is that these types of slight bp variations can very well be controlled with just good lifestyle modifications.

So instead of focusing on medicines alone, In my opinion you should adapt strict healthy lifestyle habits as you are quite young .

These includes:
1. Daily morning walks 45 mins a day for 5 days a week
2. Stop smoking completely if you do
3. Include good amount of fresh fruits and vegetables in daily diet
4. Avoid junk food and caffeine drinks
5. Avoid excessive salt diet
6. Drink plenty of water

Follow these strictly for 3 months and you probably won't need any more meds to control bp.

I hope this information will be helpful. Feel free to ask if you have any more doubts.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Bhanu Partap 1 hour later
Thanx... What's your take on medicines? Is new generation beta blocker nebivolol required for diastolic high BP?or ismo?
What is your preferred choice of Medicines for mild lvh and diastolic dysfunction?
What can be done for high morning BP? How to manage dose... At what time medicine should be taken for morning high BP?

Answered by Dr. Bhanu Partap 20 minutes later
Brief Answer:
Hello Again

Detailed Answer:
In my opinion I would like to suggest you to focus more on lifestyle modifications instead of medicines because of your young age.

For medicine change advice it's important for me to know your average blood pressure reading of a week.

Beta blockers like nebivolol and ACE inhibitors like ramipril or ARB'S like telmisartan or azilsartan are good for LVH and diastolic dysfunction and diastolic bp.

Regarding dose adjustments it depends on your average bp and should always be done under personal medical supervision by your treating doctor preferably a cardiologist.

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Bhanu Partap 21 hours later
My avg BP is 140/90 and morning 140 to sometimes 150/100 almost... Please being a cardiologist help me out in dose and medicine.... Currently on azilsartan 40 mg after dinner and cilnidipine..... Please suggest a dose or any medicine which benefits lower morning BP.... For morning BP isn't it better to take at bedtime or at early morning like 5am or so....
Help me out... Suggest potent powerful drug for 24 hour control not only day time... Thanx a lot... (u have seen my ecg echo tmt)
Answered by Dr. Bhanu Partap 1 hour later
Brief Answer:
Hello Again

Detailed Answer:
You have not uploaded any reports just mentioned that they were normal.

In my opinion you should do the following things

1. Strictly no smoking ( if you do)
2. Low salt diet
3. Start Telmisartan 40 mg in the morning
And Telmisartan 20 mg at bedtime
4. Azilsartan and cilnidipine to be stopped
5. You have to monitor your Bp daily in the morning and keep a record for 7 days after you switch to the medicines prescribed by me. After 7 days you have to show me these readings so that I can adjust the meds as required.

If you want to be in my follow up then you can directly ask me your health query by posting it in my profile.

Follow these things strictly and we will follow up after 1 week. One more thing I want to know is have you done your renal artery doppler? ?

Kind regards
Dr Bhanu partap
Above answer was peer-reviewed by : Dr. Raju A.T
Answered by
Dr. Bhanu Partap


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