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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Persistent High BP Despite Taking Metoprolol And Amlodipine?

I am a 45 yrs old female about 185 lbs. Diagnosed with a subarachnoid hemorrhage that occurred on 5/15/2017 & hypertension. My medication list is Metoprolol 50 mg 2x daily (10:00a 16:00p) Hydrochlorot 25 mg 1x daily (10:00a) Amlodipine 5 mg 1x daily (10:00a) Tramadol 50 mg 4x daily as needed for pain. (10:00a 16:00p 22:00p 2:00a) Tizanidine (Zanaflex) 2 mg 3x daily (10:00a 16:00p 22:00p) Diclofenac 25mg 3x daily (10:00a 16:00p 22:00p) Gabapentin 300mg 3x daily (10:00a 16:00p 22:00p) My current BP is 137/102 P 74 What should I do?
Fri, 13 Oct 2017
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Internal Medicine Specialist 's  Response
Why your using diclofenac we don't know but using pain killer with hypertensive medicine cause poor control of blood pressure.
But better to take long acting nifidipine/nimodipine for SAH. You can take up 180mg per day.
Nimodipine is indicated to reduce poor outcome related to aneurysmal subarachnoid hemorrhage. While studies have shown benefit regarding severity of neurologic deficits caused by cerebral vasospasm following SAH, no evidence exists that nimodipine either prevents or relieves spasms of cerebral arteries.
Along with gabapentin you can take phenytoin.
Low salt diet may help. But pain management important.
In place of metaprolol you can use Labetalol. blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure.
Why your using tizanidine not mentioned?? Are you suffering from amoebic dysentery you can continue. You can continue one benzodiapine also.
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What Causes Persistent High BP Despite Taking Metoprolol And Amlodipine?

Why your using diclofenac we don t know but using pain killer with hypertensive medicine cause poor control of blood pressure. But better to take long acting nifidipine/nimodipine for SAH. You can take up 180mg per day. Nimodipine is indicated to reduce poor outcome related to aneurysmal subarachnoid hemorrhage. While studies have shown benefit regarding severity of neurologic deficits caused by cerebral vasospasm following SAH, no evidence exists that nimodipine either prevents or relieves spasms of cerebral arteries. Along with gabapentin you can take phenytoin. Low salt diet may help. But pain management important. In place of metaprolol you can use Labetalol. blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing blood pressure. Why your using tizanidine not mentioned?? Are you suffering from amoebic dysentery you can continue. You can continue one benzodiapine also.