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Isolated systolic hypertension, 170-180/60-75, amlodipine, Change in drug dosage

My mother is 73 with history of Barrett s esophagus , chronic vertigo , (?) IBS . No other cardiac or medical history. She is suffering from Isolated Systolic Hypertension . 7 am readings are 170-180/60-75. Presently on 2.5 mg of amlodipine bid doses. The morning does is taken at 7:30 am post breakfast and evening dose is taken at around 7:30 pm post dinner. Despite this, her pulse pressure is always remaining 100. Could you please help whether a change of drug is required or if the current dose needs adjustment so that the systolic can be maintained around 140 and diastolic doesnt fall below 70? In her case...we are not able to achieve this....if the dose is increased higher...of amlodipine...she has a drop of diastolics into the 50s... please help.
Asked On : Sun, 13 May 2012
Answers:  2 Views:  418
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General & Family Physician 's  Response
In case of your mother the systolic pressure remaining in the 60-80 range is a good sign because most complications of hypertension are caused by an increased diastolic pressure rather than an increase in the systolic pressure.As such your mother may not need any modification in the dose.If you still want a reduction in your mothers systolic pressure you can give her T Apresol (hydralazine)25mg 1/2 daily in the should watch over her and support her on the first week that she is taking the medicine.Have her BP measured one hour after she takes the medicine to look for any sudden fall in BP.Usually there is no such problem but it does not hurt to be vigilant
Answered: Sun, 13 May 2012
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General & Family Physician Dr. Pavan Kumar Gupta's  Response
Isolated systolic hypertension is characterized by a widened pulse pressure. It has been recognized as an important entity, which requires consistent treatment. Apart from the well‐known advices for life‐style modification, drug treatment is required in the majority of patients with ISH.

The data so far available indicate that low‐dose thiazide diuretics and slow/long‐acting calcium antagonists are the drugs of first choice. A slow reduction of systolic pressure in the mostly elderly patients is mandatory. A target level of SBP around 140 mmHg seems desirable. Drugs which can be used are
 Spironolactone, an aldosterone antagonist, is not only a (rather weak) natriuretic agent. It also inhibits the synthesis of collagen and myocardial and vascular fibrosis provoked by aldosterone. For this reason spironolactone may counteract the arterial stiffness which underlies the pathogenesis of ISH. Studies  have indeed documented favourable effects of spironolactone in ISH patients.

(ii) Eplerenone is a newer aldosterone antagonist with much weaker endocrine activities than spironolactone, so that one would expect fewer endocrine side‐effects such as gynaecomastia;

(iii)  Nitrates, as NO generators, may also be considered as a potential new approach in the treatment of ISH. Isosorbide dinitrate has been shown to selectively lower systolic blood pressure without changing diastolic pressure in elderly patients with isolated systolic hypertension. It took 8 weeks of treatment before the effect on systolic blood pressure became manifest.
Consult your doctor for their use.
Answered: Sun, 13 May 2012
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