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What Causes High BP Despite Being On Enalapril And Amlodipine?
Question: Why did my blood pressure shoot up to crisis 220 over 120 12 days ago and despite taking aniodipino 5mg night and enalapril 20mg day it keeps on shooting up to the same high so changed the day one to losartan 25mg day and dont think that is working either but only been a day of taking it but my head still feels bad. Never been like this before. How long to feel anything like 'normal' again..and what else can I do?????
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern and would explain that your blood pressure values are really high. It seems that your actual anti-hypertensive therapy is not very effective in the management of your blood pressure.
From the other hand, I would recommend performing some tests to investigate for secondary causes of high blood pressure:
- a resting ECG
- a chest X ray study
- some blood lab tests (complete blood count, PCR, sedimentation rate, thyroid hormone levels, fasting glucose, kidney and liver function tests).
Meanwhile, I would recommend raising the dose of losartan up to 50mg twice daily (increase by 25 mg every 2 days) and also increase the dose of amlodipine to 10mg daily (in a single dose).
You should know that 25mg of Losartan is really a low dose and non therapeutic one. So no changes in your blood pressure are expected with this dose.
From the other hand, I would also advise to be patient, before making other changes to your therapy (besides the above recommended), because every change in blood pressure therapy needs some days (up to a week), to show its real effect and achieve a new balance in blood pressure.
You should discuss with your doctor on the above issues.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern and would explain that your blood pressure values are really high. It seems that your actual anti-hypertensive therapy is not very effective in the management of your blood pressure.
From the other hand, I would recommend performing some tests to investigate for secondary causes of high blood pressure:
- a resting ECG
- a chest X ray study
- some blood lab tests (complete blood count, PCR, sedimentation rate, thyroid hormone levels, fasting glucose, kidney and liver function tests).
Meanwhile, I would recommend raising the dose of losartan up to 50mg twice daily (increase by 25 mg every 2 days) and also increase the dose of amlodipine to 10mg daily (in a single dose).
You should know that 25mg of Losartan is really a low dose and non therapeutic one. So no changes in your blood pressure are expected with this dose.
From the other hand, I would also advise to be patient, before making other changes to your therapy (besides the above recommended), because every change in blood pressure therapy needs some days (up to a week), to show its real effect and achieve a new balance in blood pressure.
You should discuss with your doctor on the above issues.
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doctor would like tests you suggested but not scheduled for another 3 weeks. She seems to have no great sense of urgency. Had ecg fairly normal. But no other exam or test. Is 3 weeks soon enough I wonder. I have ringing buzzing in ears and have had low back pain now not much need to urinate. Taking magnesium drink to stop severe leg cramps each day now. Dont smoke,drink, not overweight.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
I understand your situation. The buzzing in your ears is related to uncontrolled high blood pressure.
While the lower back pain could be related to different disorders:
- backbone chronic degenerations
- a kidney disorder. Although you do not have any signs of possible kidney disorder.
A backbone X ray study, kidney function tests and an abdominal ultrasound would help finding the possible cause of your back pain.
Meanwhile, I would recommend you to follow my advises on the changes to your actual anti-hypertensive therapy:
1- gradually raise the dose of losartan to 50mg twice daily
2- raise the dose of amlodipine to 10mg daily (one dose).
You should wait for some days and closely monitor your blood pressure frequently during the day.
If your blood pressure is still high, you should discuss with your doctor on further changes to your therapy (add new drugs) in order to manage your blood pressure better.
I would also advise some lifestyle modifications which can help in lowering your blood pressure:
- diet modifications (avoid salt and caffeine intake)
- a lot of physical activity (walking, aerobics). I would not recommend straining physical activity, because it can raise your blood pressure.
Hope to have been helpful!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
I understand your situation. The buzzing in your ears is related to uncontrolled high blood pressure.
While the lower back pain could be related to different disorders:
- backbone chronic degenerations
- a kidney disorder. Although you do not have any signs of possible kidney disorder.
A backbone X ray study, kidney function tests and an abdominal ultrasound would help finding the possible cause of your back pain.
Meanwhile, I would recommend you to follow my advises on the changes to your actual anti-hypertensive therapy:
1- gradually raise the dose of losartan to 50mg twice daily
2- raise the dose of amlodipine to 10mg daily (one dose).
You should wait for some days and closely monitor your blood pressure frequently during the day.
If your blood pressure is still high, you should discuss with your doctor on further changes to your therapy (add new drugs) in order to manage your blood pressure better.
I would also advise some lifestyle modifications which can help in lowering your blood pressure:
- diet modifications (avoid salt and caffeine intake)
- a lot of physical activity (walking, aerobics). I would not recommend straining physical activity, because it can raise your blood pressure.
Hope to have been helpful!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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