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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Can Elevated Blood Pressure Be Treated?

I am trying to find a blood pressure medicine I can tolerate. I can not take a beta blocker because of a bee sting allergy and need for an epi pen. I have been taking Benazapril for about 15 years. I am 58. For three years I took 5mg amlodipine and 20 mg Benazapril. Had a side effect of puffy gums so asked to switch off amlodipine. My doc tried 40 mg Benazapril only, but didn t lower enough. Recently I tried hydralazine with the benazapril, but got migraines, then took triamterene with the Benazapril for about 2 months, but got bad gas pains (I have a hiatal hernia) and chest pains and had heart tests done. Everything ok there. However, I only took half a 25 mg triamterene due to very low pressure with a full dose. My doc sent me to a cardiologist to prescribe something else. Cardiologist prescribed 320 mg valsartan/25mg hydroclorothiazide in one tablet. I am afraid to take this because I saw it is the highest dose and am afraid of the possible side effects. My cardiologist went out of the country after prescribing this so I am taking the benazapril 40mg only because I got severe swelling of my gums. Would like to keep the Benazapril because I know I tolerate it and wonder what else you d suggest I take with it.
Mon, 23 Apr 2018
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General & Family Physician,  's  Response
Hello and Welcome to ‘Ask A Doctor’ service.
I have reviewed your query and here is my advice.

There are stepwise treatment approach to a patient with hypertension.

1. If a patient is below 50, you start him on ACE inhibitors which is valsartan. If above 50, we start with calcium channel blockers that is amlodipine.
2. If above fails, we give the patient ACE inhibitor or calcium channel blocker depending on what he/she was taking before.
3. Third step is to add the diuretic which is hydrocholrothiazide.
4. Fourth step is either aldosterone antagonist or newer antihypertensive agents depending on your pottasium level.

So based on these guidelines, I think your cardiologist is doing the right thing and you should stick by it as your hypertension is not under control.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Muhammad Adnan Iqbal
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How Can Elevated Blood Pressure Be Treated?

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. There are stepwise treatment approach to a patient with hypertension. 1. If a patient is below 50, you start him on ACE inhibitors which is valsartan. If above 50, we start with calcium channel blockers that is amlodipine. 2. If above fails, we give the patient ACE inhibitor or calcium channel blocker depending on what he/she was taking before. 3. Third step is to add the diuretic which is hydrocholrothiazide. 4. Fourth step is either aldosterone antagonist or newer antihypertensive agents depending on your pottasium level. So based on these guidelines, I think your cardiologist is doing the right thing and you should stick by it as your hypertension is not under control. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Muhammad Adnan Iqbal