Suggest Treatment For Hypertension

Posted on Sun, 5 Apr 2015

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

Sun, 5 Apr 2015 Answered on

Mon, 27 Apr 2015 Last reviewed on

Question : Hi
I am 48, male and am suffering from hypertension (just diagnosed last month) - my reading taken last month was 169/105. I am a vegetarian, non smoker but drink about 150 ml of alcohol or 3 pints 5 days a week. I had a previous episode of gout which was treated with Allopurinol and i continue to take 200 mg daily with about 4 litres of fluids consumed everyday. (so i have a bit of water retention)
I am 5 ft 10 inches tall and weigh 73 kgs - so not fat or obese.
My father died at an age of 50 with a heart attack - though he was a teetotaler and non smoking vegetarian.
I have had a couple of headaches since the diagnosis and am now worried about a stroke and want to get on medication.
I am fully insured and can go to a private hospital anytime but want to know some basics about different types of medication before i go there :

1 What is the preferred type of medication for my case - Ace Inhibitors, Beta blockers, Calcium channel blockers or diuretics - and if a combo, what would be a preferred combo. Pls remember that i take allopurinol
2 Alcohol - how much should i reduce consumption to be relatively safe
3 Apple cidar vinegar with Baking soda - recommended in addition to medication - or Baking soda is not good for me

Any other questions i should ask the doctor when I visit

Thanks

Answered by Dr. Prof. Kunal Saha (1 hour later)

Brief Answer:
Alcohol would be harmful. Salt restricted diet and lifestyle changes needed

Detailed Answer:
Thanks for asking on HealthcareMagic.

Your intake of alcohol would be detrimental with respect to your family history of heart disease, recently detected hypertension as well as hyperuricemia or gout. So, I would strongly advocate cutting down on the same, if not eliminating it altogether. Unless you do that, the situation is supposed to eventually worsen. In your case, no quantity would be considered safe.

There are a number of determinants based on which a doctor decides on the antihypertensives. Beta blockers would be the first preference followed by ACE inhibitors. A combination might be preferable as compared to a single drug. But I would suggest you to depend on the judgement of your treating physician for the same.

I am not aware of the significance of taking Apple cidar vinegar with Baking soda.

You should ask about the lifestyle changes that need to be brought about for a healthy life. I cannot think of any other specific queries unless you have one.

Hope that helps.

Regards
Dr. Kunal Saha

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

Follow up: Dr. Prof. Kunal Saha (44 minutes later)

Since i take allopurinol and drink a lot of fluids and have a bit of water retention (shows on one ankle) would diuretics be an option along with beta blockers and ace inhibitors - why, why not?

For Ace inhibitors as well as Beta blockers, what is the recommended dosage for someone who is significantly hypertensive - by how much can each of the three drug categories bring down the blood pressure

Also when i was given calcium channel blockers for a week in terms of treatment last month, i saw a significant effort to urinate (as if my urethra was constricted) and a drop in libido (mild erectile dysfunction) - is this normal?

Finally, in terms of rough measures - how much blood pressure can be reduced by

Moderate Exercise :
Reduction in Salt :
Ace inhibitors :
Beta blockers :
Calcium channel blockers :
Diuretics :

Thanks

Answered by Dr. Prof. Kunal Saha (2 hours later)

Brief Answer:
Leave the choice of drugs on your treating physician.

Detailed Answer:
Thanks again for writing back.

There seems to be some discrepancy in what you understand. All the categories of antihypertensives can be prescribed to you. Even other than the difference in categories, there are differences in the features of the individual drugs within the category. For suggesting what medicines are appropriate for you, a number of things need to be kept in consideration. Besides, these are prescription medicines and you should get them prescribed by your treating physician and depend on his judgement.

It is beyond the scope of this question to try to explain you the pros and cons of each medicine of each category and the specific scenarios where they are used. Besides, unless you have the background understanding it would be hard for you to understand it in proper essence.

There is some problem in your understanding expressed by your asking about the dose of ACE inhibitors and beta blockers. The dose of metoprolol would be different from bisoprolol or atenolol, all of which are beta blockers. Similarly, there are differences between amlodipine and diltiazem both of which are calcium channel blockers. The dose of diltiazem can be varied between 90 mg to 180 mg per day depending on what we are trying to achieve. So, it would be better to leave it upon your clinician's judgement.

Erectile dysfunction is unlikely with calcium channel blockers but if you have felt a difference, discuss it with your treating physician and ask him to prescribe an alternative.

Moderate exercise along with the medicines and lifestyle modifications can keep the blood pressure in control. But the effect cannot be equated between somebody having systolic BP 140 vs someone else with SBP 180. In some cases, a 10 mm difference makes a significant difference whereas in other cases a 50 mm difference may be well tolerated.

You should go for a prolonged discussion with your doctor to clear your basic concepts before you step in for advanced concepts. A doctor needs a decade to get a grasp of these. Please do not expect me to be able to give them all within the scope of this answer. Please pardon me for the same.

Regards
Dr. Kunal Saha

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