How can I manage hypertension effectively?

Question

Hello doctor,

I have hypertension and also suffer from asthma. I have been prescribed ARBs, but I experienced respiratory side effects (dyspnea) that led me to discontinue the medication. The side effects are a class effect, meaning all drugs in this class will likely have these effects. I cannot use ACE inhibitors, ARBs, or beta-blockers due to my asthma. The only options available to me are CCBs and/or diuretics.

Regarding CCBs, I tried Amlodipine, but it caused significant fatigue. I then tried Nifedipine XL, which led to intolerable headaches. I have been advised to use Felodipine, but it is not available in my country. Finally, I was prescribed Diltiazem 90 mg BID and a low dose of Hydrochlorothiazide (12.5 mg). However, I can no longer take HCTZ because it causes me severe sciatica. Unfortunately, the medication Chlorthalidone is also not available in my country.

What should I take instead of HCTZ? Diltiazem alone is not sufficient for me. My current blood pressure is 150/95 mmHg, and my pulse rate is 87 beats per minute. Should the dose of Diltiazem be adjusted, or should another medication be added?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your health query and understand your concerns about hypertension and appropriate medications. While a thorough physical evaluation is essential, I can assist you based on the details you have provided. I suggest you begin with a combination of lifestyle changes and medication.

First, it is important to get your BMI (body mass index) within normal limits. For every 10 pounds you lose, your blood pressure can decrease by approximately 5 mmHg. Additionally, you should consult a dietitian to develop a diet plan that supports a healthy lifestyle. It is also essential to manage your weight and cholesterol levels through these lifestyle changes. I am confident you can achieve this, but it will require serious effort.

Ultimately, the effectiveness of medications will depend on your commitment to these changes. If you can control your weight and cholesterol, you may find that you need less medication to manage your blood pressure. If necessary, your physician can adjust the dosage of Diltiazem accordingly until your blood pressure is within normal limits.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, it would be very helpful for you to consult a dietitian, as you need to address this issue in depth and obtain a prescription renewal. While Diltiazem 90 mg twice a day is a high dose, it is not the maximum limit you can take in a day. You should consult your treating physician for proper guidance on how they can adjust the dose according to your needs. In many patients, it can be safely increased. Some patients take more than 120 mg per dose, and there are generally no issues with this; the typical upper limit for hypertension is between 480 to 540 mg per day. Your doctor may titrate the dosage over a couple of weeks to see how it works for you. However, this all depends on your physician's evaluation.

I hope this helps.

Thank you.