My blood pressure value varies in the morning and afternoon. Why?

Hello,

Welcome to icliniq. com.

I understand your concern.

It seems you have heart failure. Valsartan is recommended to be taken twice a day in heart failure. This will also lower your blood pressure. Record BP (blood pressure) by following the proper method. Moreover, you are taking Lercanidipine, which should be avoided in heart failure. And you have diabetes, so it is recommended to take cholesterol-lowering medicine Rosuvastatin 10 mg daily.

I hope this helps.

Thank you.

Hello,

Welcome to icliniq. com.

I understand your concern.

Your ejection fraction is 46 percent, which is mildly reduced. Based upon your partial echocardiography report (attachment removed to protect patient identity) and blood pressure, you should be taking the following medicines. Take Valsartan 80 mg in the morning and evening, Bisoprolol 10 mg in the morning, Furosemide 25 mg in the morning (can be skipped if there is no chest congestion, shortness of breath, and no body swelling), and Rosuvastatin 10 mg daily in the evening.

Regarding Methyldopa, this is used for high blood pressure but has no beneficial effect on the heart, so if blood pressure is controlled with Valsartan, then no need for this. Regarding Lercanidipine, this medicine is used for high blood pressure but has a detrimental effect on the heart's pumping function, so this must be avoided.

1. Why are you using insulin for diabetes?

2. Do you have type 1 diabetes mellitus, or were your blood sugar levels not controllable even on multiple oral medicines?

Insulin is best for controlling blood sugar levels but has no beneficial effect on the heart, whereas some newer antidiabetic oral drugs are even beneficial for the heart and kidneys and control blood sugar levels. I prescribe those medicines unless the patient has very uncontrolled sugar levels and is given insulin as a last resort.

Your prescription can still be refined if you tell your doctor about your current symptoms, when your heart failure was diagnosed, when this echocardiography was done, etc. Send your ECG (electrocardiogram) and any other tests, such as thyroid function tests.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

I suggest the following instructions.

1. Continue the insulin.

2. For blood pressure, take Valsartan twice a day. Additionally, adopt the following general measures to control blood pressure.

3. Avoid smoking and other addictions.

4. Reduce salt intake in the diet. Reduce fatty foods, junk foods, and saturated fats.

5. Avoid stress and anxiety.

6. Do regular moderate-intensity exercise such as a brisk walk for 30 minutes.

7. Have a proper night's sleep, at least eight hours per 24 hours, including at least six hours at night (uninterrupted sleep).

8. Reduce weight even if the weight is within the normal range.

9. Drink plenty of water. Do deep breathing exercises and meditation.

10. Measure BP (blood pressure) while you are relaxed; sit for five minutes in a quiet room without talking to anyone.

11. Empty bowel and bladder before checking BP.

12. Avoid tea or coffee 30 minutes before checking BP.

13. Sit on a chair with feet on the ground, back supported, hand supported on a table, and cuff at the heart position. Check BP and repeat after five minutes. Then check the BP in the other arm and repeat after five minutes. During the entire period, remain relaxed and quiet. Arm with higher BP readings is your blood pressure. You may take at least two readings, and the average of the readings is your actual BP.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Lercanidipine, Nifedipine, Nicardipine, and Nimodipine are all calcium channel blockers. These have adverse effects on the heart, which has a low ejection fraction. They reduce the power of pumping and lower blood pressure at the expense of raising the heart rate. High heart rate and decreased pump efficiency further impair cardiac function.

Amlodipine is the only calcium channel blocker used for blood pressure in heart failure if blood pressure is not adequately controlled on a maximum tolerated dose of ARBs or ABEi (drug groups). For blood pressure control, these drugs, Methyldopa and Nifedipine, are given in pregnant patients only because there are many other potent antihypertensives available for nonpregnant patients (which are contraindicated in pregnancy).

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Thanks for the query. She was taking Valsartan 80 mg once; now she takes it twice. This change in medicine may take a few days to take effect fully. Methyldopa also reduces blood pressure. Blood pressure keeps on changing throughout the 24 hours, and that is normal. Blood Pressure will be a bit higher when one cannot sleep, or has pain in the body, or is stressed, etc. Check blood pressure multiple times per day, especially when she is fully relaxed and sitting calmly. Continue taking medicines.

I hope this helps.

Thanks you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Methyldopa tablets are taken two or three times per day. Are you taking Valsartan 80 mg twice a day as well? If you are taking Valsartan 80 mg twice a day and Methyldopa 500 mg three times a day, and your blood pressure is still persistently high, the dose of Valsartan can be increased to 160 mg in the morning and 80 mg in the evening.

Persistently high blood pressure" means that blood pressure remains high every time you check, and almost every day. If blood pressure remains within range most of the day and only one or two times it's elevated, then this is not a problem. For example, if you check your blood pressure 5 times a day and it is normal four times and high one time, this is not a problem.

But if it's high four times and normal one time almost daily, this is called uncontrolled Blood pressure. And in this case, medicines are increased or changed. If you are taking only Methyldopa for blood pressure control, then it is not a good choice to control BP. It is only prescribed during high BP in pregnancy along with one or more other BP medicines.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, it is fine. Methyldopa should be taken at least twice because it is a short-acting medicine. If blood pressure still remains elevated on these medicines almost every time you check BP, then increase Valsartan to 160 mg in the morning and 80 mg in the evening. Another option is to continue the same dosage and add the tablet Amlodipine 10 mg once a day in the morning. Night sleep should be adequate because if sleep is inadequate, then the next day, BP will remain elevated. At least six hours of uninterrupted night sleep and 2 hours of sleep during the day is called adequate sleep.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Captopril is also an antihypertensive medicine; it is short-acting and needs to be taken 3 times a day. It is usually given to patients who have newly diagnosed hypertension or to those who have episodic hypertension. It is also given in cases of sudden, severe Hypertension in the hospital's emergency department.

It should not be combined with Valsartan. Remember, ACE inhibitors (such as Captopril) and ARBs (such as Valsartan) are absolutely contraindicated in pregnancy and breastfeeding.

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Clopidogrel is a blood-thinning medicine. Aspirin is also a blood thinner. Aspirin is given to those who have had a heart attack or stroke at any point in their life or to those who have angina. When someone is allergic to Aspirin, then Clopidogrel is given. Otherwise, there is no need for these medicines, especially in people aged more than 75 years. Atorvastatin is a lipid-lowering medicine.

It is given to those with a heart attack or stroke, or elevated LDL levels, and a high risk of heart attack and stroke. It is also given to those with diabetes, regardless of cholesterol level. Continue Atorvastatin 20 mg daily. No need for Clopidogrel if you have never had a heart attack.

Atorvastatin is contraindicated during pregnancy and breastfeeding. Side effects are muscular pains, especially in the thighs and shoulders, liver damage, and generalized weakness.

I hope this helps.

Thank you.

Hello,

Welcome to icliniq. com.

I understand your concern.

When you are taking regular medicines such as Valsartan and Methyldopa, or Amlodipine, blood pressure should remain within range (it takes weeks for persistent high blood pressure to come to normal range). If the BP is still high, then the dosage can be increased.

When blood pressure remains normal, and occasionally it rises to 180 or more, then the first step is to calm down, relax, sit or lie down calmly for half an hour. Then check blood pressure, if it is still more than 180, then Captopril can be taken under the tongue, but this is not the recommended route. It is better to swallow the tablet with water. It takes 2 to 3 hours to lower bp after taking Captopril. Try to control blood pressure with usual medicines.

I hope this helps.

Thank you.