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Suggest Ways To Lower Systolic Pressure
Question: Hello Doctors online, My name is XXXX and I have serious problem with High Blood Pressure. I am being treated by a Cardiologtist. I have had a TIA, about 14 months ago. Since then I have logged my HBP on a daily basis , doctors instructions. My systolic is consistently high.Average range 155 to 190. My dystolic runs 65 to 75. Heartrate runs 52 to 65. My periodonist says do not take calicum channel blocker HPB meds. I needed surgury to remove over growth of gums taking Nifedipine. Since then ,no calicum channel blocker. I was taking Clonidine on as needed basis( it did lower my systolic, but my heart rate fell so much , I started passing out (broke two ribs which puncture right lung-needed surgery to repair-5 days in hospital. Now . no clonidine!! Current meds include: Hydralazine(100mg-4x aday;Lisinopril(40mg-2x aday);Carvedidol(12.5mg-2tabs-2xaday);Valsartan-HCTZ(320/12.5-1tab-aday); Potassium Cler(20 meg-1tab aday); Lasik-(40mg-2tabs aday);Aspirin(89mg-1tab aday;Gabapentin-(300mg-4xaday) Doxasosin(4mg-1tab aday);Metformin(500mg-1aday) Finasteride(5mg-1aday). I am 73 years old, type 2 diabetic, BPH ,TIA History, with current systolic BP not controlled. Since TIA , I have exercised at least 4 days a week @ about 2hours. I have changed my diet to mostly fruits and vegetables. I have lost 40 lbs. I no longer use alcohol(quit one and half years ago) Please give me direction to lower my systolic. My wife has dementia and needs a healthy caregiver. My e-mail address : YYYY@YYYY
Brief Answer:
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
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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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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