
Suggest Ways To Lower Systolic Pressure

I would recommend as follows:
Detailed Answer:
Hello dear XXXXXXX
Thank you for asking on HCM!
I understand your concern regarding your resistant high blood pressure management.
It seems that Nifedipine and Clonidine have exerted unacceptable adverse effects.
Meanwhile you are using maximal daily doses of Valsartan (320mg) and Hydralazine (400mg), but this seems to be necessary facing your high blood pressure and body weight.
You should also know that almost all antihypertensive drugs may exert adverse effects, but their occurrence would depend on individual tolerability and also increased doses (dose dependent).
In your case, as you refer that calcium channel blockers have been shown effective in controlling your blood pressure, I would recommend trying alternative calcium channel blockers to Nifedipine, such as Amlodipine or Lercanidipine (starting with 10mg daily dose respectively and increasing thereafter as needed), which have shown to be more safe regarding this side effect (gingival hyperplasia), based on clinical evidence.
Once the blood pressure seems to be controlled, I recommend trying to reduce Hydralazine daily dosage, in order to avoid potential adverse effects.
It is also important performing some tests to exclude any possible secondary cause of uncontrolled high blood pressure.
I would recommend performing these tests (probably you have done some of them):
- thyroid hormone levels
- aldosterone plasma levels (in upright and supine position)
- plasma renin activity
- urinary metanephrines
- creatinine and BUN
- blood electrolyte levels
- arterial blood gas analysis
You should discuss with your attending doctor on the above mentioned advices.
Hope to have been helpful!
Kind regards,
Dr. Iliri

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