Is there a blood pressure drug that has no adverse effects?

Question

Hi doctor,

I have been a cardiac patient for 16 years after a massive MI followed by an angioplasty. Thereafter, I was taking medication to control high BP along with Aspirin as well as for cholesterol.

Recently, I had another mild attack and did my second angioplasty. My BP is fluctuating between 150/90 mmHg to 140/80 mmHg. However, I am on the following medication. Nebistar 5 mg, Repace 50, Aspirin 150, Clopilet 75 and Aztor 40 mg. On taking these medicines, I feel I am experiencing some side effects such as headache, depression, and ED.

Is there any medication to avoid these side effects? I am 60 years old and active in social work. My clinical reports are normal. I am not a diabetic. My creatinine is normal and HDL and LDL are average. I am expecting your medical advice. Please suggest a BP medicine with fewer side effects.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Nebivolol is a beta blocker and is associated with dizziness and erectile dysfunction. I would suggest you shift from Nebivolol 5 mg to Carvedilol 6.25 mg twice daily for two weeks and thereafter increase the dosage to 12.5 mg twice daily optimum for heart patients.

Carvedilol is a highly selective beta blocker and has the least side effects as compared to beta blockers. Beta-blocker is a must post angioplasty, so it is the safest option. Repace 50 mg is a Losartan AT1 antagonist. Though side effects of AT1 antagonists as dry cough is very rare, if you feel it.

I would suggest you initially make the dose of Repace 25 mg once a day for two weeks and add tablet Eptus (Eplerenone) 25 mg twice, which is a mild anti-hypertensive potassium-sparing agent. It prevents cardiac remodeling. It is very good for patients with myocardial infarction.

A serum potassium level is to be checked every month to regulate the dosage. You have not mentioned the time since the last angioplasty and your left ventricle ejection fraction. In case LVEF is less, then tablet Flavedon MR (Trimetazidine) can also be added in a 35 mg (twice daily) dose. If possible, please send the details of your 2D echo reports, angioplasty reports, and stent details. Kindly consult your treating doctor, discuss with him or her, and take the treatment with consent.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.