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Suggest Treatment For High BP While On Telmisartan And Atenolol
Question: I am 43. Average built. 64 Kgs. I take Tab Telmisartan 40 mg and Tab Atenolol 50 mg. My Bp still remains 145/85, Pulse 55 bpm average.
Brief Answer:
Some lifestyle change and fine titration of medication will do the magic
Detailed Answer:
Hello sir, I am Dr. Priyank Mody and I will be addressing your concern.
Some important aspect I will like to know. How long are you hypertensive and since when are you on these medication and investigation done till now.
Now you are on 2 medication yet your blood pressure is on higher side, though I would reassure you it's just borderline and may not need any medication change if you change your lifestyle for good. Take reading at different times of day over a week to make sure all reading are on higher scale
My recommendation :
Cut salt in the diet to less than 3gm a day
Aerobic exercise atleast 30 mins a day for atleast 5 days a week.
Compliance : you should not miss any dose and be regular
Atenolol is not the best antihypertensive, even in guidelines XXXXXXX /European it is given as second line drug.
I would prefer amlodipine 5mg with telmisartan 40 mg and a small dose of diuretic like chlorthalidone to start with..
If you are on atenolol from a long time, changing to similar group but a newer antihypertensive like bisoprolol 5mg or nevibulol 5mg which has better control of hypertension
Do discuss the same with your doctor .
Regards
Some lifestyle change and fine titration of medication will do the magic
Detailed Answer:
Hello sir, I am Dr. Priyank Mody and I will be addressing your concern.
Some important aspect I will like to know. How long are you hypertensive and since when are you on these medication and investigation done till now.
Now you are on 2 medication yet your blood pressure is on higher side, though I would reassure you it's just borderline and may not need any medication change if you change your lifestyle for good. Take reading at different times of day over a week to make sure all reading are on higher scale
My recommendation :
Cut salt in the diet to less than 3gm a day
Aerobic exercise atleast 30 mins a day for atleast 5 days a week.
Compliance : you should not miss any dose and be regular
Atenolol is not the best antihypertensive, even in guidelines XXXXXXX /European it is given as second line drug.
I would prefer amlodipine 5mg with telmisartan 40 mg and a small dose of diuretic like chlorthalidone to start with..
If you are on atenolol from a long time, changing to similar group but a newer antihypertensive like bisoprolol 5mg or nevibulol 5mg which has better control of hypertension
Do discuss the same with your doctor .
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
I stopped consuming alcohol for a month when i asked you the question. on 19 Jul 15 i went on a tour with my friends to a beach-side town. I again consumed liquor and slept much less than normal. I returned on 22 Jul 15. My bp shooted up to 155/95. took my daily dose of tab telmisartan 40 and tab atenolol 50mg. I also found that I was extremely dehydrated. I started taking plenty of water. But i was still not feeling comfortable. Checked bp again..... 175/100 and took another tab telmesartan 40 mg. At two oclock i remembered that i did not urinate since hours. I tried but passed very little of urin with very dark color. I took a litre of ro water with ORS. no urine as yet. I sipped in some more water. but eventually vomitted out all liquids. After sometime I started cloudy/smokey vission and it was increasing by time. By 3 oclock i got myself admitted to a nursing home. By 6 oclock they gave me some medicine (probably vertin) and iv saline. by 10 oclock in the night i felt comfortable. I got discharged on 24 Jul morning. I was feeling comfortable. They treated me with multivitamins....saline...zofer md 4, as i remember. the have done many kinds of blood test, x ray of chest and neck, ct scan of brain. Most parameters are wnl except TLC 14600, ESR 60, Total bilirubin 1.3 and Serum alkaline phosphatase 130. Otherwise random sugar 117...Creatinine 1.4.....globulin, albumin , potassium, sodium, LFT all ok. CT scan WNL. on 24 Jul, the day i got discharged...in the evening i checked my bp(i took telmesartan and atenolol at 11 AM) which was 165/95. I took another telmesartan and a alprazolam 0.5 mg and slept by 11 PM. Did not have a sound sleep. In the morning I found my bp 160/95. i took normal dose again but at 1130am it was 176/101... itook one more telmesartan... still was not at all feeling comfortable . At 1230 bp was 186/106. i took one more telmesartan and a alprazolam 0.5 mg. I slept. Woke at 1430 hrs ... had lunch.... now bp is 155/90. but all the time pulse rate was 53 to 72. now pr is 51. Plz advise Sir
Brief Answer:
Be reassured, all reports are normal,
Detailed Answer:
Hello, so addressing your concern point on.
1) as said alcohol is a powerful diuretic, which you have caused so much of dehydration
2) You were right when you took water post the binge, however when you took Orsett that must have stimulated the vomiting center leading to the vomiting episode.
3) all your reports were normal, alp raised mostly due to alcohol, will return to normal in sometime. Also kidney report is borderline raised , so giving Iv fluids just at right time was advisable to prevent any kidney injury,
4) all the meds you describe are for symptomatic relief only and should he stopped as soon as you are all right
5) now coming to you blood pressure recording
1) if always controlled and for the 1st time it went high
-due to alcoholic binge
-episode of vomiting, and subclinical kidney injury - iv fluids
All the above three reasons may increase your blood pressure temporarily and should be back to normal range soon
2) you have tendency for increased pressure
-apart from the advice in last answer.
You May take telmisartan 40 mg twice a a day or olmesartan 40 mg once a day and atenolol t once a day
3) take combination of telmisartan 40 mg and amlodipine 5 mg once and atenolol 50 once a day
4)shifting from atenolol to bisoprolol or nevibulol. The blood pressure reading are persistently high, and the pulse is in normal range and shouldn't be worried for the same.
Wrong move? You cannot take so many telmisartan in one day, it may harm your kidney and.
Don't think much as anxiety itself increases the adrenaline pushed into our body to increased baseline BP.
Considering anyone of the alternatives after discussing it with your family doctor should bring things to normal.
And as a friend, avoid Binge drinking.
Hopefully I could help.
Regards Dr XXXXXXX mody
Be reassured, all reports are normal,
Detailed Answer:
Hello, so addressing your concern point on.
1) as said alcohol is a powerful diuretic, which you have caused so much of dehydration
2) You were right when you took water post the binge, however when you took Orsett that must have stimulated the vomiting center leading to the vomiting episode.
3) all your reports were normal, alp raised mostly due to alcohol, will return to normal in sometime. Also kidney report is borderline raised , so giving Iv fluids just at right time was advisable to prevent any kidney injury,
4) all the meds you describe are for symptomatic relief only and should he stopped as soon as you are all right
5) now coming to you blood pressure recording
1) if always controlled and for the 1st time it went high
-due to alcoholic binge
-episode of vomiting, and subclinical kidney injury - iv fluids
All the above three reasons may increase your blood pressure temporarily and should be back to normal range soon
2) you have tendency for increased pressure
-apart from the advice in last answer.
You May take telmisartan 40 mg twice a a day or olmesartan 40 mg once a day and atenolol t once a day
3) take combination of telmisartan 40 mg and amlodipine 5 mg once and atenolol 50 once a day
4)shifting from atenolol to bisoprolol or nevibulol. The blood pressure reading are persistently high, and the pulse is in normal range and shouldn't be worried for the same.
Wrong move? You cannot take so many telmisartan in one day, it may harm your kidney and.
Don't think much as anxiety itself increases the adrenaline pushed into our body to increased baseline BP.
Considering anyone of the alternatives after discussing it with your family doctor should bring things to normal.
And as a friend, avoid Binge drinking.
Hopefully I could help.
Regards Dr XXXXXXX mody
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Sir,
Thanks for your valuable advice.
In the meanwhile i visited a local physician. He advised me Tab Telsar H, (telmisaratan 40mg with hydrochlorothiazide 12.5 mg) BD. No atenolol. I took these a day. But my pulse rate now is remaining high.... 90 to 100. He has advised optionally alprazolam .5 mg TDS. I suppose Atonolol or equivalent drug is must for me to keep the pulse rate normal. As suggested by you Bisoprolol should be a good option for me,
Plz prescribe a final list of drugs accordingly, Sir.
I promise i will never drink alcohol anymore considering the phase I am going through. Sir, Please also consider Sertraline in mind if it may work for me.
Rx
Tab Telmesartan 40 mg BD
Tab Amlodipine 5mg OD
Tab Bisoprolol 5mg OD
Light aerobic exercise for half an hour at least for 5 days a week
Cut salt from your diet
Be cheerful
will it look like this Sir? Just an imagination from your advices Sir.
Thanks for your valuable advice.
In the meanwhile i visited a local physician. He advised me Tab Telsar H, (telmisaratan 40mg with hydrochlorothiazide 12.5 mg) BD. No atenolol. I took these a day. But my pulse rate now is remaining high.... 90 to 100. He has advised optionally alprazolam .5 mg TDS. I suppose Atonolol or equivalent drug is must for me to keep the pulse rate normal. As suggested by you Bisoprolol should be a good option for me,
Plz prescribe a final list of drugs accordingly, Sir.
I promise i will never drink alcohol anymore considering the phase I am going through. Sir, Please also consider Sertraline in mind if it may work for me.
Rx
Tab Telmesartan 40 mg BD
Tab Amlodipine 5mg OD
Tab Bisoprolol 5mg OD
Light aerobic exercise for half an hour at least for 5 days a week
Cut salt from your diet
Be cheerful
will it look like this Sir? Just an imagination from your advices Sir.
Brief Answer:
Pretty close, though I would fine tune for you :)
Detailed Answer:
Haha, do I sound so preachy.
Nyways ok you were only on telsar 40 and atenolol
Now if you take telsar H, twice and at night, you would end up going to the loo to urinate throughout the night, so not a good option and because you were already dehydrated adding a diuretic was not wise.
However I would like to go slow on uptitratation and try balancing your blood pressure with minimum drugs so.
Presently considering all the dynamics
Morning Tab concor. Cor(5mg) and
Tab telsar am (5mg) at night.
Measure the blood pressure and pulse directly after 3 days, unless you have symptoms in between, otherwise whatever I know of your nature you would become more anxious . Let the drugs act.
Mostly the above combination wouldn't cause any side effects
Again alprazolam three times a day will knock you off, I think night dose would be enough. Still you feel anxious and panicky 1/2 tab in afternoon XXXXXXX These drugs are addictive, so don't make yourself dependant upon it.
Hoping I could help
Regards Dr. Priyank Mody
Lilavati Hospital, XXXXXXX
For future reference you can directly access me on
Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Pretty close, though I would fine tune for you :)
Detailed Answer:
Haha, do I sound so preachy.
Nyways ok you were only on telsar 40 and atenolol
Now if you take telsar H, twice and at night, you would end up going to the loo to urinate throughout the night, so not a good option and because you were already dehydrated adding a diuretic was not wise.
However I would like to go slow on uptitratation and try balancing your blood pressure with minimum drugs so.
Presently considering all the dynamics
Morning Tab concor. Cor(5mg) and
Tab telsar am (5mg) at night.
Measure the blood pressure and pulse directly after 3 days, unless you have symptoms in between, otherwise whatever I know of your nature you would become more anxious . Let the drugs act.
Mostly the above combination wouldn't cause any side effects
Again alprazolam three times a day will knock you off, I think night dose would be enough. Still you feel anxious and panicky 1/2 tab in afternoon XXXXXXX These drugs are addictive, so don't make yourself dependant upon it.
Hoping I could help
Regards Dr. Priyank Mody
Lilavati Hospital, XXXXXXX
For future reference you can directly access me on
Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you sir.
one query sir.... Tab Telsar am 5mg?
I feel blessed to have you to advice me, Sir. May god bless you, Sir.
one query sir.... Tab Telsar am 5mg?
I feel blessed to have you to advice me, Sir. May god bless you, Sir.
Brief Answer:
All the best
Detailed Answer:
Thank you for the kind words.
Importantly I believe in minimum medication to control your blood pressure which should be our aim, so maybe we might have to increase if needed (mostly we wouldn't require)
Because you were taking telsar I suggested
Tab telsar am it contains combination of telmisartan 40mg plus amlodipine 5mg, hence to a pharmacy you have to say Telsar Am / Telma AM
Also I am not against your drinking, it's your personal choice, if you respect your body the body would respect you.
All the best for life.
Dr. Priyank Mody
All the best
Detailed Answer:
Thank you for the kind words.
Importantly I believe in minimum medication to control your blood pressure which should be our aim, so maybe we might have to increase if needed (mostly we wouldn't require)
Because you were taking telsar I suggested
Tab telsar am it contains combination of telmisartan 40mg plus amlodipine 5mg, hence to a pharmacy you have to say Telsar Am / Telma AM
Also I am not against your drinking, it's your personal choice, if you respect your body the body would respect you.
All the best for life.
Dr. Priyank Mody
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Above answer was peer-reviewed by :
Dr. Shanthi.E
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