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What Causes High BP Despite Taking Telmisartan?
Question: HiDoctor
I am aT2DM patient for the last 15 yrs.I am taking Tablets Zoryl 1mg 1.5-0-1,galvas50. 0-1-0,telma40. 0-0-1,cilacar 10mg. 1-0-0,rosuvas 10. 0-0-1,rejunex + 0-0-1,coq100. 0-1-0,urimax
0.4. 0-0-1,multivit. 1-0-0.My age is 71yrs, weight 77kg, no habits, doing excercise 1 hr, walking 4 kms.I have no issues with bg control or medicines.My syst BP
ALWAYS 170 at doc, s office, diast 80. And at home omron meter , syst 145 to 150,, diast between 55 to 70. I consulted a cardio here and he gave me natrilix and my sugar started going up, and stopped that.He incresed telma to
80 mg and cilacar 10 mg but no change in bp.My potassium started going up.I consulted another cardio and he has asked me to stop Telma and instead take Olmesartan 40mg. And T Concor 5mg, a betablocker.I am totally confused and worried whether my sugar , kidney function will go out of control with betablocker and whether there is an
y diff between Telma and Olmesartan. To reduce my syst bp only.Both cardiologiss say it is Isolated syst BP prob and all heart parameters are fine in ECg and screening done at their office.I dontknow whether it will adversly affect my bl sugar, creatinine 1.4 now, sr urea, potassium etc etc and wat should I do for my syst bp. Because my diabetologist
are not in fvr of diuretics, betablockers and I have been taking telma for the last 5/6years. I request you to help me out and guide me to clear doubts in my mind.
Thanking you
XXXXX
I am aT2DM patient for the last 15 yrs.I am taking Tablets Zoryl 1mg 1.5-0-1,galvas50. 0-1-0,telma40. 0-0-1,cilacar 10mg. 1-0-0,rosuvas 10. 0-0-1,rejunex + 0-0-1,coq100. 0-1-0,urimax
0.4. 0-0-1,multivit. 1-0-0.My age is 71yrs, weight 77kg, no habits, doing excercise 1 hr, walking 4 kms.I have no issues with bg control or medicines.My syst BP
ALWAYS 170 at doc, s office, diast 80. And at home omron meter , syst 145 to 150,, diast between 55 to 70. I consulted a cardio here and he gave me natrilix and my sugar started going up, and stopped that.He incresed telma to
80 mg and cilacar 10 mg but no change in bp.My potassium started going up.I consulted another cardio and he has asked me to stop Telma and instead take Olmesartan 40mg. And T Concor 5mg, a betablocker.I am totally confused and worried whether my sugar , kidney function will go out of control with betablocker and whether there is an
y diff between Telma and Olmesartan. To reduce my syst bp only.Both cardiologiss say it is Isolated syst BP prob and all heart parameters are fine in ECg and screening done at their office.I dontknow whether it will adversly affect my bl sugar, creatinine 1.4 now, sr urea, potassium etc etc and wat should I do for my syst bp. Because my diabetologist
are not in fvr of diuretics, betablockers and I have been taking telma for the last 5/6years. I request you to help me out and guide me to clear doubts in my mind.
Thanking you
XXXXX
Brief Answer:
My suggestions/explanation
Detailed Answer:
Hi,
I am Dr Mittal.
I have read your message, and I think I can help you.
I think you need to understand basically what is happening.
If you know that, then there will be no confusion.
First, your BP was high, while the BP on the home monitor was lower, yet not normal. This is indicative of 2 things- either a white collar hypertension- that is basically high blood pressures on meeting a doctor; or simply your home machine may need recalibration. Since your BP has been persistently high with doctors, I think that the letter is the problem. I would suggest calling the service number of the company of the bp machine and get it recalibrated.
Now on finding the first BP to be high, your doctor gave you natrilix- your blood sugar went up- so he changed to a higher dose of Telmisartan (Telma). Due to this your potassium was up. So it was changed by the new doctor to Olmesartan. This is the same group as Telmisartan, but a stronger version. So the idea is justified.
Now, diabetics usually have compromised kidneys, so any drug change will need to be adjusted to the kidney functions. So we will need to monitor the kidney function test while the dose is adjusted.
Now your diabeticians are not happy because olmesartan and telmisartan are known to affect the kidney functions- however, you have been on telmisartan already, so i don't see much problem in changing to olmesartan. And the beta blockers are known to raise the sugars mildly- but not that much with concor.
But considering the high blood pressure, I would recommend that the BP is to be controlled first. The sugar medicines will need to be readjusted. You may discuss the change of medicine from concor to cilacar with your cardiologist. If there is no cardiac dysfunction as they suggest, then the step may be taken.
As of the information given, you are not on diuretics- so I will not get into that. But it is usually best avoided unless highly indicated in people who have deranged renal functions- it damages the kidneys further.
I would suggest testing lipid profile and reducing the dose of rosuvas also- it is a statin group of medicines, and they are known to raise blood sugars also.
I hope that the information helps. Feel free to contact me for any further clarifications.
Best of luck, Dr Mittal
My suggestions/explanation
Detailed Answer:
Hi,
I am Dr Mittal.
I have read your message, and I think I can help you.
I think you need to understand basically what is happening.
If you know that, then there will be no confusion.
First, your BP was high, while the BP on the home monitor was lower, yet not normal. This is indicative of 2 things- either a white collar hypertension- that is basically high blood pressures on meeting a doctor; or simply your home machine may need recalibration. Since your BP has been persistently high with doctors, I think that the letter is the problem. I would suggest calling the service number of the company of the bp machine and get it recalibrated.
Now on finding the first BP to be high, your doctor gave you natrilix- your blood sugar went up- so he changed to a higher dose of Telmisartan (Telma). Due to this your potassium was up. So it was changed by the new doctor to Olmesartan. This is the same group as Telmisartan, but a stronger version. So the idea is justified.
Now, diabetics usually have compromised kidneys, so any drug change will need to be adjusted to the kidney functions. So we will need to monitor the kidney function test while the dose is adjusted.
Now your diabeticians are not happy because olmesartan and telmisartan are known to affect the kidney functions- however, you have been on telmisartan already, so i don't see much problem in changing to olmesartan. And the beta blockers are known to raise the sugars mildly- but not that much with concor.
But considering the high blood pressure, I would recommend that the BP is to be controlled first. The sugar medicines will need to be readjusted. You may discuss the change of medicine from concor to cilacar with your cardiologist. If there is no cardiac dysfunction as they suggest, then the step may be taken.
As of the information given, you are not on diuretics- so I will not get into that. But it is usually best avoided unless highly indicated in people who have deranged renal functions- it damages the kidneys further.
I would suggest testing lipid profile and reducing the dose of rosuvas also- it is a statin group of medicines, and they are known to raise blood sugars also.
I hope that the information helps. Feel free to contact me for any further clarifications.
Best of luck, Dr Mittal
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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