
Suggest Remedies For Morning Headache In A Stage 2 Hypertension

I would explain as follows:
Detailed Answer:
Hello!
Welcome back on HCM!
Your morning headaches could be related to high blood pressure (170mmHg indicates uncontrolled high blood pressure and could be the cause of headache) or adverse effects related to amlodipine or hydroclorthyazide.
You should know that amlodipine (as other calcium channel blockers), is known to cause headache as an adverse effect encountered up to 8% of the patients.
I carefully passed through your question and I would like to know more precisely the doses of your morning medicine and in the afternoon. I must admit that I do not understand entirely your doses. Do you take amlodipine only in the morning or twice daily?
From the other hand Hydroclorothyazide is another drug which can cause headache as an adverse effect in up to 5% of the patients. Do you take it only in the morning or in twice daily? Have you made any change to hydroclorothyazide doses lately?
What are your blood pressure values during headache episodes? How long does this headache last? Have you monitored your blood pressure during these hours and after them?
This is really important to determine if your headaches are caused by uncontrolled high blood pressure or are an adverse effect related to your actual therapy.
If your headaches are not connected to episodes of high blood pressure, than further changes to your therapy should be done, because it would indicate possible intolerance related to adverse effects of your actual antihypertensive drugs.
Hope to have been helpful!
I am at your disposal for further questions whenever you need!
Kind regards,
Dr. Iliri


My answer as follows:
Detailed Answer:
Hello again!
I would like to explain that on this site it is not usually allowed to communicate by email.
There is not a limitation of the characters that you can write.
You can ask your secretary to write your information on a Word document and than copy-paste by clicking inside this case. It is quite simple!
I would be happy to review all your tests and medical information.
Regards,
Dr. Iliri


My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
It seems that lisinopril is the cause of your headache, based on the fact that switching to valsartan has eliminated your headache.
I would recommend continuing valsartan intake, as it seems that you tolerate it well.
I would also recommend some lifestyle modifications in order to help you manage your blood pressure better:
-avoid salt and caffeine intake
- perform a lot of physical activity
- reduce your weight if you are overweight.
Regarding hydroclorothyazide, I would recommend increasing the dose to 25mg, as it is a normal dose.
You can try to take 2 tab of valsartan in the morning, in order to have a better control of your blood pressure, and achieved the desired blood pressure values.
Hope to have been helpful!
Regards,
Dr. Iliri


I would explain as follows:
Detailed Answer:
Dear XXXXXXX
I understand your concern and would explain that valsartan/hydroclorothyazide is a slow release medication as it has a long half life (the time that our body needs to metabolize the drug). It will certainly help reduce your blood pressure values throughout the day.
Regarding clonidine, I would recommend reducing gradually the doses until stopping it, as it doesn't seem to be very effective in your clinical situation.
Doubling the dose of valsartan/hydroclorothyazide will help maintain normal blood pressure during clonidine withdrawal.
I would not recommend reducing the doses of minoxidil for the moment. It is important to make gradual therapy changes (one drug at a time), in order to avoid possible exacerbations of high blood pressure.
Hope to have been helpful!
Best wishes,
Dr. Iliri


I would recommend as follows:
Detailed Answer:
Dear XXXXXXX
I understand that valsartan is helpful in managing your blood pressure, but I would not recommend making other changes to your actual therapy. These changes are a little confusing if made all at the same time. As I explained before, increasing the doses of medications taken in the evening can help reduce morning blood pressure values.
I would recommend taking valsartan 160mg twice daily, Hydroclorothyazide 25mg in the morning and amlodipine 10mg twice daily, besides clonidine and minoxidil as before.
I recommend continuing with this schema of medication for at least 3-4 days and closely monitor your blood pressure. You should write down your blood pressure values.
Let me know about your situation.
Hope to have been helpful!
Kind regards,
Dr. Iliri


My answer as follows:
Detailed Answer:
Hello again XXXXXXX
Yes, you are right: Amlodipine can be given up to a XXXXXXX dose of 10mg per day. I would recommend taking it in the evening (10mg), in order to help you reduce your morning blood pressure values. ( I am sorry to have confounded you before, just a mistake while writing)
I understand that your blood pressure is not stable, but as I already explained it is better be patient and wait until making the next changes to your therapy.
We should do one change at a time and wait for some days, in order to see the real changes in your blood pressure (it takes some days up to a week in order to achieve a new balance of blood pressure after every change to the anti-hypertensive therapy).
I am always here to help you make the proper therapy adjustments.
Greetings!
Dr. Iliri

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