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Suggest Treatment For Panic Attack And High BP
Question: Hi,
I am 64 year old male (5 11 and wt 170 lbs). I am a very active physically (play tennis). I take Diavan 180 (with 12mg water pill added to it) in the morning and I take Tropol 50mg in the evening. I take small dose of pottasium supplement. I take 10mg simbastatin. I have general anxiety disorder. I take xanax 0.25 to 0.5 mg as needed. In doctors office, my bp runs between 165 to 170 over 85 to 90. Most of home readings: vary from 145 to 160 over 80 to 85; Pulse vary from 70 to 80. (This is my consistent medical history for last 20 years) My cardiac (those graphs) normal. No irregular conditions. I was in ER with panic attack. Chest x-ray normal. Colonoscopy done three times in the last 10 years --normal except one small polyp removed. Cholesterol below 170 and trigycerol normal. Fasting sugar varies 120 to 125. I have not done hemoglobin a1c. My kidney and liver functions; psa all seem to be ok. I have only one kidney.
I am told this situation is called ISH --I hate to add more medicine to lower my upper number. In the first place, which medicine (good one) will bring down my systolic. Is it worth taking another calcium channel blocker? Or just leave my bp level as it is. My doc wants to bring it down to 135 level --can slow breathing techniques bring it down? Thanks for your time
How bad is my current bp situation in terms of risk for heart attack or stroke. No family history of such incidents at below 75 age in my family.
I am 64 year old male (5 11 and wt 170 lbs). I am a very active physically (play tennis). I take Diavan 180 (with 12mg water pill added to it) in the morning and I take Tropol 50mg in the evening. I take small dose of pottasium supplement. I take 10mg simbastatin. I have general anxiety disorder. I take xanax 0.25 to 0.5 mg as needed. In doctors office, my bp runs between 165 to 170 over 85 to 90. Most of home readings: vary from 145 to 160 over 80 to 85; Pulse vary from 70 to 80. (This is my consistent medical history for last 20 years) My cardiac (those graphs) normal. No irregular conditions. I was in ER with panic attack. Chest x-ray normal. Colonoscopy done three times in the last 10 years --normal except one small polyp removed. Cholesterol below 170 and trigycerol normal. Fasting sugar varies 120 to 125. I have not done hemoglobin a1c. My kidney and liver functions; psa all seem to be ok. I have only one kidney.
I am told this situation is called ISH --I hate to add more medicine to lower my upper number. In the first place, which medicine (good one) will bring down my systolic. Is it worth taking another calcium channel blocker? Or just leave my bp level as it is. My doc wants to bring it down to 135 level --can slow breathing techniques bring it down? Thanks for your time
How bad is my current bp situation in terms of risk for heart attack or stroke. No family history of such incidents at below 75 age in my family.
Brief Answer:
I agree that blood pressure needs to be lower
Detailed Answer:
Hello and thank you for your question.
From reading your note It sounds like you are taking Diovan/HCT at 180 mg daily and Toprol XL 50 mg daily for your hypertension.
Normal blood pressure is below 120/80 and it definitely needs to be below 140/90. The higher the blood pressure the greater the risk for stroke, heart attack and kidney failure which is particularly important since you only have one kidney.
The risks for cardiovascular disease that you have are hypertension, hyperlipidemia (I assume that is controlled with the simvastatin), being male and being over 50. The more risks you have that are not controlled the greater your risk. I am assuming you do not smoke or drink excessive alcohol.
The reality is that your risk is fairly low if you are exercising and your weight is in the normal range. However there is still risk and it would help decrease that risk by getting your blood pressure in normal range.
You are not currently on a calcium channel blocker, the diovan is an angiotensin receptor blocker and the toprol is a beta blocker. The dose of either of those could be increased or a calcium channel blocker could be added.
Other things that may help lower your blood pressure are relaxation exercises, very low salt diet, getting weight in normal range if it is not, daily exercise (perhaps walking on days you do not play tennis) and getting rid of all alcohol, caffeine and nicotine (all those can raise blood pressure).
Good luck to you and let me know if you have further questions.
Dr. Robinson
I agree that blood pressure needs to be lower
Detailed Answer:
Hello and thank you for your question.
From reading your note It sounds like you are taking Diovan/HCT at 180 mg daily and Toprol XL 50 mg daily for your hypertension.
Normal blood pressure is below 120/80 and it definitely needs to be below 140/90. The higher the blood pressure the greater the risk for stroke, heart attack and kidney failure which is particularly important since you only have one kidney.
The risks for cardiovascular disease that you have are hypertension, hyperlipidemia (I assume that is controlled with the simvastatin), being male and being over 50. The more risks you have that are not controlled the greater your risk. I am assuming you do not smoke or drink excessive alcohol.
The reality is that your risk is fairly low if you are exercising and your weight is in the normal range. However there is still risk and it would help decrease that risk by getting your blood pressure in normal range.
You are not currently on a calcium channel blocker, the diovan is an angiotensin receptor blocker and the toprol is a beta blocker. The dose of either of those could be increased or a calcium channel blocker could be added.
Other things that may help lower your blood pressure are relaxation exercises, very low salt diet, getting weight in normal range if it is not, daily exercise (perhaps walking on days you do not play tennis) and getting rid of all alcohol, caffeine and nicotine (all those can raise blood pressure).
Good luck to you and let me know if you have further questions.
Dr. Robinson
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My weight is 170 give or take 5 lbs--consistently for the last 20 years or more. I am going to cut down salt. But I do drink one glass of red wine a day (for heart healthy). I am told that is beneficial to me. What is the chance systolic will come down with all the BOCKERS? What if it stays in the same range? I am thinking of do slow bicycling. Without adding calcium blocker, can anti-anxiety medicines any effect on BP?
Suppose my bp remains the same, can my life expectancy be above 70 given that I am 64 now? Thanks for your time
Suppose my bp remains the same, can my life expectancy be above 70 given that I am 64 now? Thanks for your time
Brief Answer:
hard to predict life expectancy
Detailed Answer:
Hello,
It is true that drinking a glass of red wine daily may be beneficial but I think it is worth cutting it out and cutting out all salt and processed foods for a few weeks and see if your blood pressure comes down.
From what I have heard about your health you probably have a good life expectancy but the elevated risk from the increased blood pressure is very real. It may help you to go up on the diovan if you are concerned about problems with the calcium channel blockers and beta blockers.
If you can get the pressure down without adding medications that of course would be the best situation.
The xanax may bring down the blood pressure temporarily but unfortunately it may bounce up as the medication gets out of your system
Regards,
Dr. Robinson
hard to predict life expectancy
Detailed Answer:
Hello,
It is true that drinking a glass of red wine daily may be beneficial but I think it is worth cutting it out and cutting out all salt and processed foods for a few weeks and see if your blood pressure comes down.
From what I have heard about your health you probably have a good life expectancy but the elevated risk from the increased blood pressure is very real. It may help you to go up on the diovan if you are concerned about problems with the calcium channel blockers and beta blockers.
If you can get the pressure down without adding medications that of course would be the best situation.
The xanax may bring down the blood pressure temporarily but unfortunately it may bounce up as the medication gets out of your system
Regards,
Dr. Robinson
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doc,
Thanks. Here is something I did not mention in my earlier thread. If I am not eligible to receive your answer, it is Ok.
My BP history started in the early 1990s. I started with 25 mg tropol. Then they increased to 50 mg. Then they added 80 mg diavan in 2005 and then they added 160 mg diavan with HTDC(water pill 12.5 mg). Pottasium was low and gave 10 mg pottasium supplement. Throughout this course of my medical history, systolic fluctuates between 140 and 160--when calm between 145 and 150; otherwise between 150 and 160; Docs office above 160 (white coat syndrome.
1)I am thinking this way. I feel that systolic is impossible to control. Am I right?
2) reduce diavan to 80 and add norvax. Cut down alcohol completely or cut it in half. I am observing salt. I do at least 2 hours of some walking or physical activity per day. Play tennis about once a week (2 hours). Is this right strategy. I have only one Kidney. I dont know 360 diavan good or bad for my Kidney. Kidney functions normal now--GFR about 68
3) Do you any evidence about garlic,ginger,lemon,honey,vinegar (called miracle medicine in India) on BP?
Thanks. Here is something I did not mention in my earlier thread. If I am not eligible to receive your answer, it is Ok.
My BP history started in the early 1990s. I started with 25 mg tropol. Then they increased to 50 mg. Then they added 80 mg diavan in 2005 and then they added 160 mg diavan with HTDC(water pill 12.5 mg). Pottasium was low and gave 10 mg pottasium supplement. Throughout this course of my medical history, systolic fluctuates between 140 and 160--when calm between 145 and 150; otherwise between 150 and 160; Docs office above 160 (white coat syndrome.
1)I am thinking this way. I feel that systolic is impossible to control. Am I right?
2) reduce diavan to 80 and add norvax. Cut down alcohol completely or cut it in half. I am observing salt. I do at least 2 hours of some walking or physical activity per day. Play tennis about once a week (2 hours). Is this right strategy. I have only one Kidney. I dont know 360 diavan good or bad for my Kidney. Kidney functions normal now--GFR about 68
3) Do you any evidence about garlic,ginger,lemon,honey,vinegar (called miracle medicine in India) on BP?
Brief Answer:
does not sound like a good plan
Detailed Answer:
Hello and thanks for the follow up,
It is not true that the systolic blood pressure is impossible to control. The diovan and medications like it actually protect the kidney, though doses may need to be reduced if there is kidney compromise.
I would either increase the diovan or add amlodipine, first at 5mg then to 10 if BP is not controlled.
There is no evidence based medicine data about the supplements like garlic and ginger, but you could try them, they may work for some people
Best regards,
Dr. Robinson
does not sound like a good plan
Detailed Answer:
Hello and thanks for the follow up,
It is not true that the systolic blood pressure is impossible to control. The diovan and medications like it actually protect the kidney, though doses may need to be reduced if there is kidney compromise.
I would either increase the diovan or add amlodipine, first at 5mg then to 10 if BP is not controlled.
There is no evidence based medicine data about the supplements like garlic and ginger, but you could try them, they may work for some people
Best regards,
Dr. Robinson
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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