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Suggest Remedy For Idiopathic Hypertension In A Chain Cigarette Smoker
Question: Dear doctor,
I am 40year oldmale(height 5feet10inches and weight 110kgs).
Recently, one month before i got diagnosied with High BP 180/100 or 190/100. all my other reports like ECG,2D ECHO,Renal exam,blood sugar are normal...all are in normal size. Doctor suggested STAMLO-D,MinipressXL,Olmesar.
my BP dropped down to 130/90 after 25days and further dropping to 114/75 or 105/68 and 100/65 (i tested using Digital BP monitor).
I have few doubts as given below.
1. Doctor suggested to use tabs at 8AM(stamloD and Olmesar) and 8PM(minipress). but my timings are different. i work in night time. so i am taking tabs as follows: i sleep at 5AM so before sleep cycle starts i am having food and taking minipressXL. then i wakeup by 1PM and thenonwards my day starts. i eat my Brunch at 6PM and taking stamloD and Olmesar. is it OK?
2. Docotr suggested me to reduce salt. i take only 2meals per day in limited quantities. in my brunch(6PM),i eat 5chapatis,1cup curry,1 cup mixture,2 sweets.
in my dinner(5AM) i eat 1cuprice,1/2cup curry,1/2cup mixture,1/2cup curd.i drink few cups of tea in daytime before brunch. i thought there is too less salt n potassium in my meal so i added mirchi bajji(homemade) and 2bananas in my brunch recently.
3. i smoke around 10 cigarrates a day
4. i am continuiously monitoring my BP. u can c the attachments. if u observe BP is around 105/65 to 115/75. but my pulse rate is high ....100 while resting.....115 while working.
Am i taking BP medicine morethan requirement? do i need to increase my salt intake? do i need to drink ORS liquid if i feel tired bcoz of loss of electrolytes? Are my timings of taking medicine are OK?What i am supposed to do to rise BP when i feel it is too low like 100/60? please kindly answer my questions?
I am 40year oldmale(height 5feet10inches and weight 110kgs).
Recently, one month before i got diagnosied with High BP 180/100 or 190/100. all my other reports like ECG,2D ECHO,Renal exam,blood sugar are normal...all are in normal size. Doctor suggested STAMLO-D,MinipressXL,Olmesar.
my BP dropped down to 130/90 after 25days and further dropping to 114/75 or 105/68 and 100/65 (i tested using Digital BP monitor).
I have few doubts as given below.
1. Doctor suggested to use tabs at 8AM(stamloD and Olmesar) and 8PM(minipress). but my timings are different. i work in night time. so i am taking tabs as follows: i sleep at 5AM so before sleep cycle starts i am having food and taking minipressXL. then i wakeup by 1PM and thenonwards my day starts. i eat my Brunch at 6PM and taking stamloD and Olmesar. is it OK?
2. Docotr suggested me to reduce salt. i take only 2meals per day in limited quantities. in my brunch(6PM),i eat 5chapatis,1cup curry,1 cup mixture,2 sweets.
in my dinner(5AM) i eat 1cuprice,1/2cup curry,1/2cup mixture,1/2cup curd.i drink few cups of tea in daytime before brunch. i thought there is too less salt n potassium in my meal so i added mirchi bajji(homemade) and 2bananas in my brunch recently.
3. i smoke around 10 cigarrates a day
4. i am continuiously monitoring my BP. u can c the attachments. if u observe BP is around 105/65 to 115/75. but my pulse rate is high ....100 while resting.....115 while working.
Am i taking BP medicine morethan requirement? do i need to increase my salt intake? do i need to drink ORS liquid if i feel tired bcoz of loss of electrolytes? Are my timings of taking medicine are OK?What i am supposed to do to rise BP when i feel it is too low like 100/60? please kindly answer my questions?
Brief Answer:
Do go through the detailed answer
Detailed Answer:
Hello,
I am Dr Mody and I would be addressing your concern.
As all work up had been done I would say that you have a diagnosis :idiopathic hypertension
Now some important notes
1) you have to cut down on the smoking anyhow. You are young and can do it presently, later it will be impossible
2)your diet is fine enough, I would not Really change much into it. Add fruit serving in your diet
3)your lifestyle is surely a precipitating cause of hypertension and the fluctuations, however as it's an obligation to your job I wouldn't comment much on it
5) medication timing are OK
6) yes you may take ORS when you feel Weak, though important to note you are not on any medication which will decrease the salt from your body, so the only way salt is less it Your intake is less . To be XXXXXXX best is to take less salt, so I wouldn't suggest you to increase the intake.
7) You should loose weight, as you are more than 30 kgs overweight
8) I am in a strong opinion that your meds are too powerful for the hypertension you have considering your age. Also the decrease in pressure may result in reflex increase in heart rate. Two components min press and amlodipine D will increase your pulse rate.
Most importantly I would suggest You decrease the dose of minipress to 2.5 mg from 5 mg, as it's not the best and safest drug At your age and may have been started considering resistant hypertension.
I would still like to make some fine titration about medication , so do let me know the pressure after decreasing the minipress after a week.
Regards Dr Priyank Mody
Do go through the detailed answer
Detailed Answer:
Hello,
I am Dr Mody and I would be addressing your concern.
As all work up had been done I would say that you have a diagnosis :idiopathic hypertension
Now some important notes
1) you have to cut down on the smoking anyhow. You are young and can do it presently, later it will be impossible
2)your diet is fine enough, I would not Really change much into it. Add fruit serving in your diet
3)your lifestyle is surely a precipitating cause of hypertension and the fluctuations, however as it's an obligation to your job I wouldn't comment much on it
5) medication timing are OK
6) yes you may take ORS when you feel Weak, though important to note you are not on any medication which will decrease the salt from your body, so the only way salt is less it Your intake is less . To be XXXXXXX best is to take less salt, so I wouldn't suggest you to increase the intake.
7) You should loose weight, as you are more than 30 kgs overweight
8) I am in a strong opinion that your meds are too powerful for the hypertension you have considering your age. Also the decrease in pressure may result in reflex increase in heart rate. Two components min press and amlodipine D will increase your pulse rate.
Most importantly I would suggest You decrease the dose of minipress to 2.5 mg from 5 mg, as it's not the best and safest drug At your age and may have been started considering resistant hypertension.
I would still like to make some fine titration about medication , so do let me know the pressure after decreasing the minipress after a week.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Prasad
Dear doctor,
Thank you verymuch for answering.
yesterday while having my brunch i ate 1/2spoon miriyum powder(pepper powder) for taste with dosa and mirchi bajjis(more in number than regular)....
that started burning in my stomach and in the night when i checked bp with digital meter it raised to 157/110 or 145/100.today i had normal meal and BP is normal back to 110/70.
1)just by eating more in one meal will raise BP like that????why so much fluctuations?? is it like all pepper powder n salt mixed into my blood and raising the pressure and then dropped down since it got passed out???
2) what i am supposed to do when my BP is high(150/100)???
3)what i am supposed to do when my BP is toolow(100/65)???
4)Is it ok to have bp like 110/70 or 105/65. how much is too low and when i am supposed to be concerned???
5)what indications i vl experience(bodywise) for Toohigh BP and Toolow BP??
6)Do i need to continue medication like this forever even if my BP maintains at 110/70??
7) Doctor told me to do exercise and walking. How can you expect me to do exercise when i am havingBP dropped down to 110/70???
8)what kind of food you advice to me???
9)Digital monitoring BP machine gives accurate results???
10)I want to purchase "24hour BP monitor". which one you will advice(any company kindof)for accurate measurement??? I want to use it regularly in day time such that i can find the readings automatically without my invovment.
I am really greatful to interact with a highly qualified doctor like you sir.
Thank you.
Thank you verymuch for answering.
yesterday while having my brunch i ate 1/2spoon miriyum powder(pepper powder) for taste with dosa and mirchi bajjis(more in number than regular)....
that started burning in my stomach and in the night when i checked bp with digital meter it raised to 157/110 or 145/100.today i had normal meal and BP is normal back to 110/70.
1)just by eating more in one meal will raise BP like that????why so much fluctuations?? is it like all pepper powder n salt mixed into my blood and raising the pressure and then dropped down since it got passed out???
2) what i am supposed to do when my BP is high(150/100)???
3)what i am supposed to do when my BP is toolow(100/65)???
4)Is it ok to have bp like 110/70 or 105/65. how much is too low and when i am supposed to be concerned???
5)what indications i vl experience(bodywise) for Toohigh BP and Toolow BP??
6)Do i need to continue medication like this forever even if my BP maintains at 110/70??
7) Doctor told me to do exercise and walking. How can you expect me to do exercise when i am havingBP dropped down to 110/70???
8)what kind of food you advice to me???
9)Digital monitoring BP machine gives accurate results???
10)I want to purchase "24hour BP monitor". which one you will advice(any company kindof)for accurate measurement??? I want to use it regularly in day time such that i can find the readings automatically without my invovment.
I am really greatful to interact with a highly qualified doctor like you sir.
Thank you.
Brief Answer:
Do read the detailed reply
Detailed Answer:
Good morning as I start let me impress upon some facts.
Blood pressure is a vital of our body, it means it will change with needs of body, so when you sitting and watching television it will be low, when there is a horror scene it will go up proportionally, similarly when you are exerting it has to increase otherwise you will faint. All said and done if there are no fluctuations in the blood pressure it means that your heart is not well compensated to take care of the body needs.
If you take blood pressure just after a smoke it will be 10mm higher than your routine.
So It's NORMAL to have fluctuations.
110/70 is normal blood pressure and you can exercise with that pressure for as long as you want.
Low lower than that we may decrease your antihypertensive medication, but at the same time it peaks with smallest provocation.
That was the reason I wanted to decrease your minipress, as it a medication which is effective for 6-8 hours, so pressure fluctuations in between the dose is pretty high.
I would like to mentioned to take an antacid for 3 weeks minimum as because I do believe you having a weak stomach considering smoking, overweight and lifestyle.
Take tab neksium 40 mg as you start the day 15 mins before each meal.
Do not keep on checking your blood so many times, you should do only if you have symptoms as it will add to unnecessary anxiety as the variation in even the best digital machine is 10-15 mm upper and 5-10 mm lower reading, while
24 hour machine is for diagnosis in borderline cases and to adjust dose of medication. It's not available on routine basis and even not needed for you.
Do not take so much stress about the whole thing.
All will settle in sometime. You need to lose weight.
Lastly if you snore during sleep, consider getting sleep study done for obstructive sleep apnea, as that might be the reason of your increased blood pressure.
If your pressure is well maintained one can consider slowly decreasing the medication, however not for you at present.
I would have liked to change your medication and titer it for you but this forum is difficult to coordinate, so you may continue follow up with your physician.
Olmesar (take at 8pm) and stamlo d(8 am when you wake up) along with minipress xl 2.5mg when you wake up are good enough.
Consider beta blocker concor 5 mg once a day and decrease minipress , on your next visit, do discuss it with your doctor . It will take care of pulse fluctuations as well.
Regards Dr Priyank Mody.
Do read the detailed reply
Detailed Answer:
Good morning as I start let me impress upon some facts.
Blood pressure is a vital of our body, it means it will change with needs of body, so when you sitting and watching television it will be low, when there is a horror scene it will go up proportionally, similarly when you are exerting it has to increase otherwise you will faint. All said and done if there are no fluctuations in the blood pressure it means that your heart is not well compensated to take care of the body needs.
If you take blood pressure just after a smoke it will be 10mm higher than your routine.
So It's NORMAL to have fluctuations.
110/70 is normal blood pressure and you can exercise with that pressure for as long as you want.
Low lower than that we may decrease your antihypertensive medication, but at the same time it peaks with smallest provocation.
That was the reason I wanted to decrease your minipress, as it a medication which is effective for 6-8 hours, so pressure fluctuations in between the dose is pretty high.
I would like to mentioned to take an antacid for 3 weeks minimum as because I do believe you having a weak stomach considering smoking, overweight and lifestyle.
Take tab neksium 40 mg as you start the day 15 mins before each meal.
Do not keep on checking your blood so many times, you should do only if you have symptoms as it will add to unnecessary anxiety as the variation in even the best digital machine is 10-15 mm upper and 5-10 mm lower reading, while
24 hour machine is for diagnosis in borderline cases and to adjust dose of medication. It's not available on routine basis and even not needed for you.
Do not take so much stress about the whole thing.
All will settle in sometime. You need to lose weight.
Lastly if you snore during sleep, consider getting sleep study done for obstructive sleep apnea, as that might be the reason of your increased blood pressure.
If your pressure is well maintained one can consider slowly decreasing the medication, however not for you at present.
I would have liked to change your medication and titer it for you but this forum is difficult to coordinate, so you may continue follow up with your physician.
Olmesar (take at 8pm) and stamlo d(8 am when you wake up) along with minipress xl 2.5mg when you wake up are good enough.
Consider beta blocker concor 5 mg once a day and decrease minipress , on your next visit, do discuss it with your doctor . It will take care of pulse fluctuations as well.
Regards Dr Priyank Mody.
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Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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