My Mother Is Known Hypertensive For Last 15 Years. She

Posted on Tue, 10 Dec 2019

Question: My mother is known Hypertensive for last 15 years. She is having Congenital LBBB with EF of 40%. She is taking Dytor plus 10mg half tablet two times a day and Cardivas 3.125 mg two times a day. She frequently have chest pain on extertion with last CAG normal done on August 2016. Recently she put on lots of weight. Her TSH was found to be 7units with T3 and T4 normal. She has started Thyronorm 50mcg for last 6 months but did not loose any weight. She also gets breathlessness on exertion and gets tired on walking. Her Blood pressure is not under control. She has to get up in night frequently to pass urine, it is disturbing her sleep. She develops Brown spots with clopivas. We did her last body check up whci shows following 1. CAG - Nad, EF - 35%, TSH 7.8 , BP - 150/100 rest nad
Please guide on following

1. What anti-hypertensive medicines should be advised to her so that she does not have to get up in night and her BP gets controlled?

2. Should we continue her Thyroid medicines?

3.Should she stop Clopivas as she develops brown spots with medicines

Answered by Dr. Sagar Makode (1 hour later)

Brief Answer:
She ll need Vymada or telmisartan

Detailed Answer:
Hello,
Firstly, since she has a heart problem, all her medications should be changed only after consultating cardiologist in person because we can miss certain things online. Here we can provide you general advice.
Firstly, with low heart function, she should consume less salt and fluid restrictions like less water, tea, coffee etc as low as possible. Also, Dytor plus instead of taking half twice, it's better to go full tablet once daily in the morning so this will reduce frequency of urination at night.
With CAG, chest pain is not related to heart so should not be worried about it. Also, with normal CAG, clopivas is not necessary.
Attempt should be made to increase her heart function. Now, there is option of new medicine Vymada which helps in heart function improvement in most of the patients, but it's costly. Alternatively, if you don't afford, she may have telmisartan. Both these medicines reduce bp and also improve heart function. And she should continue cardivas as well which also helps in heart function improvement or slowing decline. So, both problems will be solved. so visit nearby cardiologist for the medicines.
Also, being on thyroxine of 50 ug, tsh is elevated. So, you should get dose of thyroxine increased.
Hope this helps you and get back if you have any doubts.

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Above answer was peer-reviewed by : Dr. Prasad