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Suggest Treatment For Fluctuating BP Readings Despite Medication

Posted on Sat, 12 Sep 2015

Question: hi im 33/ male ht 177, wt 105kg
diagnosed with stage 2 hypertension before 1 year
all the test (kidney, heart liver lipid profile) was normal
bp was controlled on telmah 40/12.5 in the morning and cilacar 10mg in the night
before 1 month bp was raised somewhere between 145/90
so my doctor added minipress 10mg but still my bp fluctuates between 130/84 - 140/92
daily exercise like
walking 30minutes
swimming 1 hr
low sodium diet
am I on right track of treatment?
why bp is not comimg down?

Answered by Dr. Priyank Mody (14 hours later)

Brief Answer:
Try finding the reason, and uptitrate medication rather than adding 4th

Detailed Answer:
Hello, I am Dr. Mody and I would be addressing your concern,
Considering your age at 33 years, I do consider that all work up and investigation to rule out Secondary and reversible cause of hypertension.
As per the start telmisartan plus hydrochlorthiazide was a good combination for you as the first drug and clinidipine adds the regime.
So after good control what went wrong,
We should address that before.
Was it your life style, salt intake, are you obese, some other meds you are taking, stress on your life.
Also i would prefer you getting s creatinine and e electrolytes to be done.
Now for your increased pressure rather than adding the fourth drug I will prefer optimisation of the already drugs you are on.
Because telmisartan with clinidipine combination is nit available.
Take telma h in morning and tab telma Am (40+5) at night or alternatively different tablet for telmisartan and clinidipine.
Minipress is not the best drug in present era because safer alternative are available and should be used only when not controlled by other drugs.
Now the pressure variations you have mentioned is pretty normal as blood pressure is a vital features of the body and changes every second according to body needs , so the upper is withen normal range it's just the diastolic or lower we need to bring below 85 at most.
I think the fine change should work and protect your heart and other organs from long time hypertension in future.
Do upload all your reports so I can help you better, also would be happy to address any of your doubts.
Regards Dr Priyank Mody , XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Priyank Mody (54 minutes later)

Currently i don have the report but we chked kidney ultrasound doppler, ech showed lvh but echo was normal, blood test like urea creatinine esr lft cbc uric acid electrolytes all were normal (not even higher end normal)
Im obese height 178 cm weight 105kg
My father had hypertension in his early age ... All his brothers are known for hypertension
XXX

Answered by Dr. Priyank Mody (11 hours later)

Brief Answer:
Weight loss would be the key.

Detailed Answer:
Thank you for the reports.
Being over weight is the most important reason why you have not been able to control the blood pressure, I would recommend a weight loss of min 15 to 20 kilos, if possible. Go on a stringent diet and exercise protocol, you are young don't let diseases accumulate.
Also if you snore and have short neck , one test I would suggest is sleep study, to rule out obstructive sleep apnoea, a reason why the blood pressure reading are on the higher side.
Lastly I would recommend the anti hypertensive regime as I had discussed in the previous answer.
Any further clarification do let me know.
Regards Dr Priyank Mody

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Priyank Mody (8 hours later)

So what medicine i can take
Telma h in the morning
Telma am in the night?
How about cilacar and minipress?

Answered by Dr. Priyank Mody (17 hours later)

Brief Answer:
Telma H in morning and cilacar T and night

Detailed Answer:
Hello,
I recommended the above drug based on third long term protective effect of heart, kidneys and brain, rather than just decreasing blood pressure. Also minipress commonly cause orthostatic hypotension, that is decrease in blood pressure when you change position ie. When you suddenly stand from sitting or sleeping position leading to fluctuations in BP and sometimes dizziness, so for me and most cardiologist it is a second like drug for hypertension used only If other drug don't control BP. It is still used widely for XXXXXXX physician, however as new we r and safer medication are available I would refrain from it.
Now amlodipine that is part of telma Am, is same as clinidipine, I had said because no preparation of telma with clinidipine is commercially available.
However as you are taking cilacar already I would suggest the following.
In morning take telma H (which contains 40 mg telmisartan and 12.5 my hydrochlorthiazide)
At night Cilacar T(which contains 10 mg.
clinidipine and 40mg telmisartan).
The above regime may not be as powerful as minipress addition and may take some days to control the pressure, however it is better in long term and if still not controlled we may titrate the dose further.
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX
For further assistance you may contact me @Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Do rate the conversation for other ppl reference.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Priyank Mody (14 hours later)

Thank u so much doctor ill start taking the medication as u prescribed and will get back to u after 15 days

Answered by Dr. Priyank Mody (10 hours later)

Brief Answer:
All the best

Detailed Answer:
Happy I could help, however cutting salt in the dirt, more fruits and reducing weight is the key. Looking forward to hear from you. God bless

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar