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Suggest Treatment For Atherosclerosis With Orthostatic Hypotension
Question: What can I do about frequent brief episodes of presyncopy assoc. with blood pressure readings 66-78 systolic and pulse pressures around 20-30, mostly post prandial and/or postural. I have suspected dysautonomia but no help from my local physicians who blame it on my age of 91 years. Other times, on the same day my blood pressure may be180+/72+ an read at 210 in the Doctor's office. We don't dare to use anti-hypertensives. I'm a retired physician, licensed in Michigan. the only medication I take is Nexium 20mg daily which I can't seem to tolerably do without.
I'm slim, trim, exercise mildly daily, eat healthily and I believe I'm mentally sound even though I am finding I don't learn as quickly as I used to in the college courses I audit free locally, especially Spanish.
I'm slim, trim, exercise mildly daily, eat healthily and I believe I'm mentally sound even though I am finding I don't learn as quickly as I used to in the college courses I audit free locally, especially Spanish.
Brief Answer:
Your problem is due to atherosclerosis along with autonomic dysfunction,
Detailed Answer:
Hi sir, welcome to Health care magic,
First of all congratulations on your health.
Your problem is due to atherosclerosis along with autonomic dysfunction, both due to age, and possibly hyponatremia.
The first two we cannot do much about at this age except supervised exercises which again I would not recommend. There are many trials with new drugs for orthostatic hypotension and interestingly Domperidone is one. I see no harm in trying out a combination Domperidone with Nexium that you are taking--once or twice a day for a week.
You have not told me your thyroid status, latest blood glucose and serum electrolyte levels, and any other medication you may be on.
Low sodium is more dangerous as you know at your age than a slightly high blood pressure.
Since you felt better on a salt diet, I would put you on that and simultaneously a mild anti hypertensive like low dose metoprolol extended release (12.5-25mg ) as needed.
Do try Domperidone and my salt, anti hypertensive recommendation.
Please revert back.
Warm regards.
Your problem is due to atherosclerosis along with autonomic dysfunction,
Detailed Answer:
Hi sir, welcome to Health care magic,
First of all congratulations on your health.
Your problem is due to atherosclerosis along with autonomic dysfunction, both due to age, and possibly hyponatremia.
The first two we cannot do much about at this age except supervised exercises which again I would not recommend. There are many trials with new drugs for orthostatic hypotension and interestingly Domperidone is one. I see no harm in trying out a combination Domperidone with Nexium that you are taking--once or twice a day for a week.
You have not told me your thyroid status, latest blood glucose and serum electrolyte levels, and any other medication you may be on.
Low sodium is more dangerous as you know at your age than a slightly high blood pressure.
Since you felt better on a salt diet, I would put you on that and simultaneously a mild anti hypertensive like low dose metoprolol extended release (12.5-25mg ) as needed.
Do try Domperidone and my salt, anti hypertensive recommendation.
Please revert back.
Warm regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
My thyroid function and my comprehensive lab profile have been normal for decades including a few months ago, three years after the onset of my current problem. Could you please give me references to any publications re. this off-label use of Domperidone? There doesn't seem to be any evaluation in the elderly.
My serum lipids have been excellent on my low sat. fat diet without statins.
It is the profound hypotensive episodes that are most disturbing. The postural plunge every time I teed up the ball caused me to give up golf.
What do you think about me trying fludrocortisone again in a very low dose? It worked so well, for a while, 8-12 mo. ago before my bp went alarmingly high. I suspected it was related to its long biological half-life and that I was better off without it.
My serum lipids have been excellent on my low sat. fat diet without statins.
It is the profound hypotensive episodes that are most disturbing. The postural plunge every time I teed up the ball caused me to give up golf.
What do you think about me trying fludrocortisone again in a very low dose? It worked so well, for a while, 8-12 mo. ago before my bp went alarmingly high. I suspected it was related to its long biological half-life and that I was better off without it.
Brief Answer:
I would be more comfortable using domperidone and anti hypertensive
Detailed Answer:
Hi here is a reference article---
Domperidone for Drug-Induced Orthostatic Hypotension-A Review
jdc XXXXXXX edu/cgi/viewcontent.cgi?article=1303&context=jeffjpsychiatry
I would be personally more comfortable using domperidone and anti hypertensive if needed.
Long term Fludricortisone at your age even in low dose will precipitate Diabetes which will be difficult to manage.
However, after receiving these inputs from me, you can discuss with your doctor and mutually arrive at an optimal management.
Wishing you the best.
Regards
I would be more comfortable using domperidone and anti hypertensive
Detailed Answer:
Hi here is a reference article---
Domperidone for Drug-Induced Orthostatic Hypotension-A Review
jdc XXXXXXX edu/cgi/viewcontent.cgi?article=1303&context=jeffjpsychiatry
I would be personally more comfortable using domperidone and anti hypertensive if needed.
Long term Fludricortisone at your age even in low dose will precipitate Diabetes which will be difficult to manage.
However, after receiving these inputs from me, you can discuss with your doctor and mutually arrive at an optimal management.
Wishing you the best.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Hi DR. XXXXXXX
Thank you for the ref. article. My blood pressure problem has not been "drug induced" since I have never taken any antihypertensives and except for Nexium 20mg. daily [and as a precaution a B12m tablet and 200mg of magnesium because the proton pump inhibitors may slow their absorption] I avoid unnecessary medication. Fludrocortisone has been in use for at least 45 years with the same recommendations for postural hypotension. Though I probably didn't prescribe it to more than six patients, the only adverse effects, that I recognized, were due to fluid retention.
Thank you for your suggestions. If you have other ideas or new information re. my unusually wide fluctuations in systolic bp with little change in heart rate or rhythm, I would appreciate your contacting me. XXXXXXX Peets, M. D.
Thank you for the ref. article. My blood pressure problem has not been "drug induced" since I have never taken any antihypertensives and except for Nexium 20mg. daily [and as a precaution a B12m tablet and 200mg of magnesium because the proton pump inhibitors may slow their absorption] I avoid unnecessary medication. Fludrocortisone has been in use for at least 45 years with the same recommendations for postural hypotension. Though I probably didn't prescribe it to more than six patients, the only adverse effects, that I recognized, were due to fluid retention.
Thank you for your suggestions. If you have other ideas or new information re. my unusually wide fluctuations in systolic bp with little change in heart rate or rhythm, I would appreciate your contacting me. XXXXXXX Peets, M. D.
Brief Answer:
The article I cited mentions 'drug induced' but I am sure it may help you
Detailed Answer:
Hello sir, I respect your experience, but I do have cases where Diabetes has been precipitated with long term corticosteroid use.
Choice of whether to use or not to use domperidone solely rests with you. The article I cited mentions 'drug induced' but I am sure it may help in your case too.
I will definitely revert back to you with any further information on this topic I can collect.
Warm regards.
The article I cited mentions 'drug induced' but I am sure it may help you
Detailed Answer:
Hello sir, I respect your experience, but I do have cases where Diabetes has been precipitated with long term corticosteroid use.
Choice of whether to use or not to use domperidone solely rests with you. The article I cited mentions 'drug induced' but I am sure it may help in your case too.
I will definitely revert back to you with any further information on this topic I can collect.
Warm regards.
Above answer was peer-reviewed by :
Dr. Kampana
Dear Dr. Sudar,
Thank you for that courtesy. I too have a healthy respect for corticosteroids and think they are greatly over used, especially by dermatologists, and even in diabetics and often long term or refillable Rxs in the elderly, which I deplore. My high risk for stroke with my present bp problem encourages me to try another course of the mineral corticoid, fludrocortisone, in very low dosage and judge it chiefly by symptom response.
I will watch for other confirmatory studies on that use of Domperidone before I risk its side effects.
Again, I thank you. You have my best wishes for your health and your career.
Sincerely,
XXXXXXX Peets
Thank you for that courtesy. I too have a healthy respect for corticosteroids and think they are greatly over used, especially by dermatologists, and even in diabetics and often long term or refillable Rxs in the elderly, which I deplore. My high risk for stroke with my present bp problem encourages me to try another course of the mineral corticoid, fludrocortisone, in very low dosage and judge it chiefly by symptom response.
I will watch for other confirmatory studies on that use of Domperidone before I risk its side effects.
Again, I thank you. You have my best wishes for your health and your career.
Sincerely,
XXXXXXX Peets
Brief Answer:
Thank you sir!
Detailed Answer:
Thank you sir!
Warm regards
Thank you sir!
Detailed Answer:
Thank you sir!
Warm regards
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Above answer was peer-reviewed by :
Dr. Yogesh D
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