Patient's Query
Hello doctor,
My 94-year-old mother has hypertension and is under therapy for blood pressure. She has been visiting her cardiologist regularly and has taken therapy for years. She is otherwise in good condition. However, two months before, her blood pressure started to fluctuate in the mornings. She had lower or normal pressure, so she omitted morning therapy. We visited her cardiologist, and they corrected my mother's therapy accordingly. I have attached the cardiologist's full report for your interpretation.
Now comes the problem: A week ago, a couple of weeks after visiting a cardiologist, my mother had unstable blood pressure with peaks up to 200 mmHg systolic. She is highly distressed both day and night. We have to frequently change therapy, even with a two-hour time difference between two successive drugs, to drop the pressure.
My mother is now afraid to sleep because of unpredictable blood pressure. She will get exhausted soon. Do you know how to stabilize blood pressure and establish regularity in therapy? Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I have read your query, and I can understand your concern.
She should take Lercanidipine and Perindopril once a day, as both are long-acting medications. It is essential to consult with a specialist doctor before starting or adjusting the medication. The doctor will assess the condition and recommend the appropriate dosage. If blood pressure remains uncontrolled at the current dose, the doctor may decide to increase the dose.
In addition to medication, lifestyle changes play a significant role in managing blood pressure. Reducing salt intake is crucial, as excessive salt can raise blood pressure. It is also important to avoid situations that cause anxiety, as stress can contribute to high blood pressure. Ensuring adequate sleep is vital for overall health and can help regulate blood pressure levels.
Incorporating relaxation exercises, such as deep breathing, can be highly effective in managing stress and lowering blood pressure. These exercises help calm the nervous system and improve circulation, which benefits overall cardiovascular health.
By following the prescribed treatment and adopting these lifestyle measures, it is possible to manage and control blood pressure effectively. Regular follow-ups with the doctor are recommended to monitor progress and adjust the treatment plan as needed.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
I accidentally missed sending you all the cardiovascular data, as I promised. In my first query, you can check if I sent you everything you needed for the correct therapy.
Thank you.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
These medicines are fine. Laboratory reports are okay, but hemoglobin is low (attachment removed to protect the patient’s identity).
Make your diet better, check your blood pressure daily, and make a chart for a week to see your average blood pressure. Medicines are adjusted on average blood pressure, not on single readings.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
We started the therapy you prescribed with the dosage of Lercanidipine 20 mg and Perindopril 8 mg and got the following outcome:
This dosage is inadequate to cover the whole day with one daily intake. Should we continue that treatment and dosage?
Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
Do not take these medicines so frequently and at random times. Antihypertensives should be taken at the same time daily.
Lercanidipine 20 mg once a day.
Perindopril 16 mg once a day.
Do not check blood pressure so frequently as it will cause anxiety and it will increase blood pressure. Also, have renal function tests and electrolyte levels analysis done, including urea, creatinine, and electrolytes. Always take medications at the same time daily and check blood pressure once or twice a day. Most antihypertensives take one or two weeks to exert full effects, and then the dose is adjusted. Consult a specialist doctor, talk to them, and then take the medication.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
We followed all your instructions. My mother took medications at 7:30 AM, and here is the systolic blood pressure at that time for your reference:
About 12 hours after taking therapy at 07:30 AM, there is an emergency event where around two hours, blood pressure constantly rises above 190 mmHg. We try to let blood pressure settle by itself with just one daily intake; however, sometimes we enter an "emergency" as I should call it. Are we doing it accurately?
Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
Is she taking only Lercanidipine 20 mg? I suggest she should take both. Lercanidipine and Perindopril. She had a significantly lower GFR (glomerular filtration rate), signifying kidney dysfunction. It is age-related, but this decreases the efficacy of antihypertensives. If she is taking both medicines and her blood pressure is still more than 140 mmHg, then a third medicine will be added. Please let me know what medications she takes, how much she takes, and how her blood pressure is managed.
I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the reply.
I confirm she takes both medicines at 7:30 AM once a day as you prescribed, with no exception. The medicine Lercanidipine and Perindopril. Blood pressure control is fine during the daytime, and we do not measure it then. But between 8:00 PM and 10:00 PM, we check blood pressure every hour, and sometimes we find rising blood pressure in that period, as I described previously. That is the only deviation from what you expected, during which we use Lercanidipine as an emergency. She also started exercising, such as riding a bicycle two sets for 15 minutes or walking for 25 minutes. She started doing meditation for 10 minutes. As you see, we are trying our best to follow what you prescribe.
Hello,
Welcome back to icliniq.com.
I have read your query, and I can understand your concern.
Good to know you are trying your best. I suggest you give her Perindopril, Arginine, and Indapamide (combination drug), Perindopril, and Lercanidipine 10 mg twice daily. Consult a specialist doctor, talk to them, and then take the medication. Please note Indapamide in the combination drug is a diuretic and will increase urine output. Then, check blood pressure every day or alternate day. After a week, let us see how much blood pressure settles. This way, step-by-step medicines are added, especially for old age people.
I hope this will help you.
Thank you.
Was this conversation helpful?
Answered byDr. Muhammad Zohaib Siddiq
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
Related Questions
What is the reason for fluctuating BP a year after heart attack?
Hypertension and Organ Damage: Understanding the Silent Threat
Can long hot shower cause a tingling sensation in the arms?
Hypertension in Children - Causes, Risk Factors, Diagnosis, and Treatment
Can taking a calcium channel blocker resolve my chest tightness and tachycardia?
I am feeling uneasy and my BP reading is lower than usual. Why?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.
