Have High BP. On Lisinopril Added Metoprolol And This Has Done Nothing. Suggest Medicine?

Posted on Mon, 8 Jul 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 8 Jul 2013 Answered on

Sat, 3 Aug 2013 Last reviewed on

Question : Hi. My question is what antihypertensive med is best for me. I am currently on Lisinopril 20mg qd and for three yrs have not had best results. 5 days ago added Metoprolol 25mg and this has done nothing. Running 170 - 180 / 102 -108. I work out, am thin, in good health otherwise. Heart rate is about 50. Age: 57. No other medical issues.

Answered by Dr. Dr. Michelle Gibson (41 minutes later)

Hi, thanks for using healthcare magic

Blood pressure is related to the volume of blood or fluid in the body and the resistance of the blood flow through the blood vessels.
Resistant blood pressure is often related to excess fluid volume. This is the reason that the addition of a diuretic anti hypertensive is often effective.

Lisinopril would act to decrease the resistance of the blood vessels, it can also have an effect on blood volume.
The metoprolol would relax the blood vessel and slow the heart so it does not have to work as hard.

If a diuretic can be added it may be helpful in reducing your readings.The most common diuretics are hydrochlorothiazide, lasix, amiloride, spironolactone.

You can speak to your doctor about this possibility.

I hope this helps, feel free to ask any other questions

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

Follow up: Dr. Dr. Michelle Gibson (22 minutes later)

I was on HCTZ initially a few years ago and it caused UTI's. What are some other options?

Answered by Dr. Dr. Michelle Gibson (11 minutes later)

Hi

There are other diuretics that can be used such as lasix, amiloride or spironolactone, chloroth.
Alternatively there are other anti hypertensives such as ARB inhibitors (atacand, micardis, diovan) that have been shown to be effective.
These would have to be substituted for the lisinopril since these two families of medications are not used together.

Alot of persons require at least 3 medications for control.

Please feel free to ask any additional questions

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

Follow up: Dr. Dr. Michelle Gibson (48 minutes later)

Thank you. Well I cant say that I'm happy with 3meds. But the diuretic caused a bit of the prune effect and brought on the UTIs. What are some good combo's with least side effects. I don't think beta blockers are right for me since I work out every day and normally run a heart rate of 50. (that's what it is right now and I did take meds this am) A nurse friend thought that Norvasc was a good choice. Can you give me some options and why they are good. My family doc is a doll but I'm afraid I often have to teach him. I am 5'9" 140lbs. Had a check up recently and had pretty good numbers. The triglicerides were slightly elevated and I have started a supplement called prelipid, recommended by another Doc friend. It would help me a great deal if you could recommend some options on meds for hypertension and the different ways they work. Sorry if that is a lot of trouble.

Answered by Dr. Dr. Michelle Gibson (6 hours later)

Hi

There are different categories of antihypertensive medications.

ACE inhibitors such as lisinopril and ARB ( micardis, atacand and diovan mentioned previously)- these help relax blood vessels and may help reduce blood volume

Diuretics- these help reduce blood volume which is one of the most common reasons for uncontrolled blood pressure

BEtablockers- these reduce heart rate and may also relax the blood vessels

Norvasc is the trade name for amlodipine which is a ca channel antagonist- this relaxes blood vessels

vasodilators such as hydrallazine-- relax blood vessels

If your heart rate is normally low then you are correct in stating that a beta blocker may not be the best option.

Your doctor may consider using one of the ARBs with the norvasc and a diuretic that you can tolerate.
There are combination tablets of ARBs with diuretics so they are often used together for a combined effect.

Please feel free to ask any other questions

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

Follow up: Dr. Dr. Michelle Gibson (14 minutes later)

Ok Great thank you very much. Is there a website to look up drugs to read more about them that you can recommend?

Thanks,
Elaine

Answered by Dr. Dr. Michelle Gibson (33 minutes later)

Hi

There are quite a few medical information web sites available such as : WWW.WWWW.WW medicinenet.com, emedicinehealth.com, drugs.com, medline plus.

Please feel that you can ask any additional questions

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

Follow up: Dr. Dr. Michelle Gibson (27 minutes later)

that was excellent. I wont close our conversation as of yet. I have no further questions for now. I may see my doc in the morning or as soon as possible. Thanks again.

Answered by Dr. Dr. Michelle Gibson (29 minutes later)

Ok, you can contact with any additional queries

Note: For further follow up on related General & Family Physician Click here.

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