Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would like to explain that as there are no predefined antihypertensive schemes, when choosing the most appropriate antihypertensive drugs, we are always guided by two main issues:

1-Medication effectiveness. As you are saying that your previous therapy couldn't manage your high blood pressure (186/90 mmHg) and your actual therapy (Norvasc, Acebutolol, Hydroclorthyazide) has led to a more stable blood pressure, it seems that your actual therapy is more effective in addressing high blood pressure.

Coming to this point, I would like to know: which are your actual blood pressure values?

Is your blood pressure under 140/90 mmHg?

Have you experienced recently low blood pressure (<110/70 mmHg)?

Which is your actual average heart rate?

2-Medication tolerance. Almost all antihypertensive drugs may exert potential unwanted (adverse) effects.

Coming to this point, I would like to explain that both your new drugs (Norvasc and Acebutolol) has been shown in certain patients to manifest potential muscular cramps and myalgia.

Which are your back pain characteristics (cramps, squeeze, compression, tightening, etc.)?

To ascertain whether drug-related muscular injury is responsible for your clinical symptomatology (back pain), it is necessary a careful physical examination and some laboratory tests (muscular enzymes and inflammation markers).

I would recommend you to test:

- CPK
- AST and ALT
- LDH
- PCR
- Complete blood count
- Chest X ray study
- Backbone X ray study

Only if muscular involvement is excluded by the above mentioned tests, any medication implication (adverse effects) would be surely excluded.

If Norvasc or Acebutolol adverse effects are confirmed, then you can switch to your previous Altace, but meanwhile it is necessary to increase Hydrochlorthiazide daily dose to 25mg and consider the possibility of adding another safer antihypertensive drug, to better manage your high blood pressure.
You need to discuss with your prescribing doctor on the above mentioned issues.

Hope to have been helpful!

If you have any other uncertainties, please do not hesitate to ask me!

Kind regards,

Dr. Iliri

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Brief Answer:
Opinion as follows:

Detailed Answer:
Hi again, dear XXXXXXX

Your actual blood pressure values seem to be perfectly controlled.

If no current complaints would be present (back pain), I would prefer to maintain this antihypertensive scheme.

But, as some unpleasant feelings are obvious, after performing the above recommended tests and concluding for a possible medication adverse effect, the newly started drugs dosage should be reduce, stopped and possible substituted.

Regarding beta-blocker (Acebutolol), if strong evidence results for its implication on your back pain, its withdrawal should be done gradually (by decreasing its daily dose through an escalating fashion).

An immediate interruption of Acebutolol (as other beta-blockers) would risk a rebound phenomenon (disturbing tachycardia).

Regarding other antihypetensive alternatives, there in not any ideal rule in choosing them.

My personal opinion is that besides using Altace 10-20 mg daily (or other ACEI or ARB drugs) to increase Hydrochlorothiazide to 25 mg daily, decrease Norvasc to 5 mg daily, and Acebutolol to 50 mg twice daily for a couple of days and see the effects.

If back pain persists, then decrease further Acebutolol to 25 mg twice after a couple of days and then stop. If back pain persists again stop Norvasc.

BUT, remember that all the above steps should be followed only if the above recommended tests give strong evidence of adverse drugs effects implication.

Wishing you a pleasant weekend,

Regards,

Dr. Iliri

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