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Question: I am 86 years old, had a heart attack in 2003, another one last September, have Diabetes-2, CLL and neither Bisoprolol 3.75mg nor Losartan 25mg taken on their own twice daily has prevented occasional stable Angina chest pains, increasing their mg not being 100% successful, the Losartan not stopping the heart beats speeding up. The Bisoprolol doing it is not helping my already bad blood circulation with Diabetes-2 ! Can combining them do a better job, I am going to test starting today !
Brief Answer:
I would recommend the following options:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern, and would like to explain to you that first of all you need to properly manage your actual risk factors;
Diabetes therapy (facing your prior heart attacks, and other co-morbidity) should be switched on insulin treatment.
A better management of high BP is necessary: you need to modulate your anti-hypertensive therapy after consulting with your doctor, the repeated measured BP values. Regarding this issue Bisoprolol and Losartan are helpful, but a dose adjustments and possibly new additional drugs could be necessary.
If no contraindications from your present comorbidity (such as CLL, possible gastric disturbances, etc) exist for anti-thrombotics, I would recommend to start at least Aspirin 50-80 mg /day and any PPI (such as Pantoprasol), and isosorbide mononitrate 1- to 40 mg/day (as tolerated).
An antilipemiant is necessary to be present on maintenance therapy, such as any statins (atorvastatin, etc).
All the above treatment advices should be discussed first with the attending physician to better evaluate medicine needs (facing concrete clinical scenario and prior medical history).
If after all the above therapy modulations do not resolve angina issues, then you need to perform coronary angiography coupled with eventual angioplasty and stenting (if no contraindications from CLL).
Hope to have been helpful to you. Greetings! Dr. Iliri
I would recommend the following options:
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern, and would like to explain to you that first of all you need to properly manage your actual risk factors;
Diabetes therapy (facing your prior heart attacks, and other co-morbidity) should be switched on insulin treatment.
A better management of high BP is necessary: you need to modulate your anti-hypertensive therapy after consulting with your doctor, the repeated measured BP values. Regarding this issue Bisoprolol and Losartan are helpful, but a dose adjustments and possibly new additional drugs could be necessary.
If no contraindications from your present comorbidity (such as CLL, possible gastric disturbances, etc) exist for anti-thrombotics, I would recommend to start at least Aspirin 50-80 mg /day and any PPI (such as Pantoprasol), and isosorbide mononitrate 1- to 40 mg/day (as tolerated).
An antilipemiant is necessary to be present on maintenance therapy, such as any statins (atorvastatin, etc).
All the above treatment advices should be discussed first with the attending physician to better evaluate medicine needs (facing concrete clinical scenario and prior medical history).
If after all the above therapy modulations do not resolve angina issues, then you need to perform coronary angiography coupled with eventual angioplasty and stenting (if no contraindications from CLL).
Hope to have been helpful to you. Greetings! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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