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Suggest Treatment For Elevated Diastolic Blood Pressure

Posted on Thu, 27 Jul 2017

Question: I had a general physical about a week ago.My lower blood pressure number{diastolic?} number has been elevated the past few days(4) about 10 points from about roughly 138/88 to 138/99. I already am on Lotrel 5/20, Toprol 50 ml. hydrachlorothiazide 12.5 ml. for years.Also, synthroid .15 milligrams.
I am stressing about packing for a trip to Hawaii with the entire family. This elevated lower number has not occurred since I was teaching in school about 5- 6 years ago when I checked it regularly with the school nurse..I am semi-retired now but am on school break.Also, it may or may not be relevant to this issue, I have a foot pain in the heel of my right foot and doctor says it is a nerve that runs the entire body when I visited him week ago.He did not think this foot issue was related to blood pressure or any cardiac issue. What should I do about the elevated pressure ? I am leaving to Hawaii on Saturday with boy scouts.I see this doctor again on Friday before I leave Saturday. There may not be time for any major cardiac tests except maybe an ekg. He mentioned high pressure last time and he said he might adjust meds. Thanks XXXXXXX XXXX

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would recommend as follows:

Detailed Answer:
Dear XXXXXXX

Thank you for asking on HCM!

I passed carefully through your question and would explain that your elevated diastolic blood pressure values could be related to the pain in the foot or painkillers. A thyroid hormone imbalance or an electrolyte imbalance can not be excluded either.

Are you taking any painkillers lately for the foot pain? You should know that all painkillers can elevate blood pressure values.

Coming to this point, I would recommend consulting with your attending physician for a physical exam and some tests to investigate for the possible causes:

- a complete blood count for anemia
- PCR and ESR for inflammation
- thyroid hormone levels
- blood electrolytes for possible imbalance
- kidney and liver function tests
- fasting glucose.

You may need to regulate synthroid dose in case of abnormal thyroid levels.

If all the above tests result normal, you should discuss with your doctor on the possibility of making some changes to your actual anti-hypertensive therapy (increase the dose of hydrochlorothiazide to 25mg or the dose of Lotrel).

You should discuss with your doctor on the above issues.

Anyway, these diastolic blood pressure values are not concerning. So, the situation is not so emergent.

Hope to have been helpful!

Wishing good health,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (10 hours later)

I am not on any painkillers.I will ask about the hydroclorothiazide or Lotrel dosage adjustment although doctor previously has said watch pottasium levels with hydrochlorothiazide.

Answered by Dr. Ilir Sharka (7 hours later)

Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Regarding your concern, I would explain that Hydrochlorothiazide does not make any change to potassium plasma levels.

But Lotrel contains benazepril, which is an ACEI drug, which are known to raise potassium plasma levels. That is why potassium plasma levels need to be monitored while taking Lotrel.

For this reason, I recommend to raise the dose of Hydrochlorothiazide, considering also the fact that the dose that you are taking actually is a really low dose.

Hope to have clarified some of your uncertainties!

Regards,

Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar