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Suggest Treatment For Resistant Hypertension
Question: Blood pressure high on several meds with diabetes 65 yo male
Bp 175/93 sometimes higher. Med provider change since going on mail order in
AUgust.
Currently on 1000 mgx2 metformin, 2mg x2replaginide, 125 mg x2 levothyroxine, 25mg hydrchorathizide, 7mg losartin, 100 mg x3 labetol, 5mg finasteride, 0.4 mg tamsulosin, 60 mg x6 mestanoin, 7mg amlodapine, 20mg Crestor
Concerned about higher bp readings had been well controlled recently in August 145/85. Wondering if a medication change might get bp under control?
Prostate ca survivor thyroid cancer survivor
Bp 175/93 sometimes higher. Med provider change since going on mail order in
AUgust.
Currently on 1000 mgx2 metformin, 2mg x2replaginide, 125 mg x2 levothyroxine, 25mg hydrchorathizide, 7mg losartin, 100 mg x3 labetol, 5mg finasteride, 0.4 mg tamsulosin, 60 mg x6 mestanoin, 7mg amlodapine, 20mg Crestor
Concerned about higher bp readings had been well controlled recently in August 145/85. Wondering if a medication change might get bp under control?
Prostate ca survivor thyroid cancer survivor
Brief Answer:
investigation is required
Detailed Answer:
Hello,
Being uncontrolled with your current regimen means that you have resistant hypertension. Resistant hypertension requires investigation for secondary hypertension, which means that a cause may be identified. Potential causes include primary aldosteronism, pheochromocytoma, renal artery stenosis, sleep-apnea, etc.
Reducing the effect of various worsening factors is essential. Salt restriction, reduced alcohol intake, increased fiber consumption, low fat diet, increased physical activity are some good examples of such factors.
If investigation reveals secondary hypertension then the primary cause has to be treated accordingly. Otherwise treatment escalation with other drug classes can be tried. The field of resistant hypertension treatment is not a vastly explored one. In your case additional choices might be spironolactone (or eplerenone) and an alpha-blocker. Both drugs would further reduce your blood pressure and perhaps help to control it. But investigation comes first.
So in conclusion, your doctor should initiate investigation for secondary hypertension. If the investigation has already been concluded then treatment escalation with the remaining classes of antihypertensives is recommended. Finally maximizing the dosages of your current regimen should be the last step...
I hope you find my comments helpful!
Please contact me again, if you'd like any clarification or further information.
Kind Regards!
investigation is required
Detailed Answer:
Hello,
Being uncontrolled with your current regimen means that you have resistant hypertension. Resistant hypertension requires investigation for secondary hypertension, which means that a cause may be identified. Potential causes include primary aldosteronism, pheochromocytoma, renal artery stenosis, sleep-apnea, etc.
Reducing the effect of various worsening factors is essential. Salt restriction, reduced alcohol intake, increased fiber consumption, low fat diet, increased physical activity are some good examples of such factors.
If investigation reveals secondary hypertension then the primary cause has to be treated accordingly. Otherwise treatment escalation with other drug classes can be tried. The field of resistant hypertension treatment is not a vastly explored one. In your case additional choices might be spironolactone (or eplerenone) and an alpha-blocker. Both drugs would further reduce your blood pressure and perhaps help to control it. But investigation comes first.
So in conclusion, your doctor should initiate investigation for secondary hypertension. If the investigation has already been concluded then treatment escalation with the remaining classes of antihypertensives is recommended. Finally maximizing the dosages of your current regimen should be the last step...
I hope you find my comments helpful!
Please contact me again, if you'd like any clarification or further information.
Kind Regards!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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