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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest ways to control hypertension in a person with a heart condition

Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 7016 Questions

Posted on Thu, 25 Aug 2016 in Hypertension and Heart Disease
Question: my BP right now is 160/120 or that was the best reading of three. the worst owas 167/12. I am a 46 year old black male 6'2 215. I have hypertension and typicall BP medications resolve BP Problems...Carvedilol 12.5 times 2..Lisinopril 20-12.5 daily....the last week though, the meds have not been working, and each day the BP has become worse. It's not going down anymore, or seems not to be responding to the meds.

I have had MI times two 2006 and 2009., 3rd degree heart block that resolved with a pacemaker in 2010. and Cardiac arrest while in the ER in 2012, which i fully recovered from. I have two stents, placed after each MI.

There is no known heart disease in my family. My LAD grows through my heart muscle however. It has never been fully explained to me why each event occurred. Right now I feel really bad, which is not normally the case when BP is elevated. I have no chest pain, no shortness of breath or anything....although I have been having chest pain (unusual the past few days.

I hate going to the ER but I want to be cautious...the worst BP should read 167/127 and the pacemaker was temporary and removed before my release from the hospitial
Answered by Dr. Ilir Sharka 32 minutes later
Brief Answer:
I would explain as follows;

Detailed Answer:

Welcome on HCM!

I passed carefully through your medical history and would like to explain that, as you have suffered 2 MIs, a successfully treated cardiac arrest, you need to be very careful at controlling all the potentially present coronary artery risk factors.

The most obvious in your case is uncontrolled hypertension.

Hypertension also aggravates potential cardiac ischemia, by increasing extravascular tension over your intamuscular LAD portion (that is called muscular bridge).

Coming to this point, I would recommend anti-hypertensive therapy optimization and body weight control.

Regarding you actual therapy, I would explain that drug dosages are relatively low facing your body weight.

I recommend increasing your Lisinopril/HCTZ daily dose (doubling the dose) to 40/25 mg/once daily (in the morning).

Also, if your blood pressure is not properly controlled (under 130/75 mmHg) after a couple of day, I would advise to start a calcium channel blocker drug (such as Amlodipine, Lercanidipine, etc) on your therapy (5-10 mg starting dose).

After adjusting that way your actual therapy, I am sure that your blood pressure values will be better controlled and you will feel more relieved, too.

In addition, regarding your body weight control, I would explian that it is necessary to start a physical training program under an expert supervisor in order to low you weight with an average of 10 kg.

You should know elevated body weight maintain resistant hypertension.

Other coronary risk factors should be considered, such as avoiding close smoking contacts; following a healthy diet (with poor fatty and spicy foods content) to decrease potential adverse effects of dyslipidemia; checking your blood glucose level to prevent possible glucose metabolism disorders.

You need to discuss with your attending doctor on the above mentiomed issues.

Hope t ohave been helpful to you.

In case of any other uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ilir Sharka 4 hours later
Thanks for the excellent advise. However, I am on my way to the ER as chest pain has increased with temporary relief with nitro sublingual at .4 times 3 at 5 minute interv. Afterward, the chest pain, center chest, returns.

Answered by Dr. Ilir Sharka 6 minutes later
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

I agree with your decision of going to the ER.

In this situation a resting ECG and cardiac enzymes are necessary to exclude another possible acute coronary event.

Let me know about everything!

Best wishes,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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