How can blood pressure be controlled in a diabetic person?

Hello,

Welcome to icliniq.com.

I understand your concern.

What is your mother's blood pressure on these medicines? Your mother is taking multiple medicines to control her blood pressure, but it is still not under control. The cause may be secondary hypertension, with kidney disease being the most common cause. Is there any history of heart disease or stroke? For proper blood pressure control, follow these guidelines: Avoid junk and fatty foods, and reduce salt intake in the diet. Maintain a healthy weight, with a BMI (body mass index) of less than 25. Measure blood pressure at home while the patient is seated and resting against a backrest, with the cuff at heart level and the arm resting on the table. The patient should be relaxed for 15 minutes before measuring the blood pressure. Repeat the blood pressure measurement in the other arm. Recheck the blood pressure in the arm with the higher reading after 10 minutes. The lower of the two readings is considered the patient's blood pressure. Take medications at the same time each day and ensure adequate sleep.

For better blood pressure control, I recommend getting renal function tests, electrolyte levels, and an ultrasound of the kidneys. These reports may lead to changes in the medications or dosages for hypertension. I suggest trying a tablet containing a combination of Amlodipine 10 mg, Valsartan 160 mg, and Hydrochlorothiazide 12.5 mg once a day in the daytime. Measure blood pressure at random times every day and track it for 10 days. Continue Bisoprolol. There is no need for Methyldopa. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent. After 10 days, we will assess how much the blood pressure is controlled and identify any trends. Then, we can decide on further management. Continue insulin therapy and keep blood sugar levels under control.

Thanks and regards.

Hello,

Welcome back to icliniq.com.

The medication I have suggested is a combination of three drugs, all of which are used to lower blood pressure (BP). Regarding Lercanidipine, I do not prefer it for two reasons (a bit technical). First, your mother’s left ventricular (LV) ejection fraction is moderately reduced, at 46 percent, and drugs in the same class as Lercanidipine are generally not used because they can have detrimental effects on left ventricular function. These drugs lower BP but can reflexively raise the heart rate. Your mother is taking Bisoprolol, which helps lower the heart rate to protect the heart. If Bisoprolol is combined with Lercanidipine, it would counteract the heart rate-reducing effects of Bisoprolol. To minimize these side effects, I have prescribed Amlodipine, which lowers BP without adversely affecting left ventricular function.

Regarding Furosemide, this drug is used to increase urine formation. However, I have prescribed a combination pill that also contains a diuretic, Hydrochlorothiazide (HCT). Ninety percent of patients prefer a single pill, which is why doctors often prescribe multi-drug combination pills for ease and better compliance. Therefore, I have prescribed the Amlodipine, Valsartan, and HCT combination.

The urine report shows a urinary infection. For this, I suggest taking Ciprofloxacin 500 mg twice a day for five days. Another finding from this report (attachment removed to protect patient identity) is that diabetes is not well controlled. Please monitor blood glucose levels and keep them within the recommended range: fasting levels below 130, random levels below 200, and HbA1c below 8.

Please ensure compliance with the prescribed medications and laboratory tests, monitor daily blood pressure, keep a record of it, and follow up after 10 days.

I hope this helps you.

Thank you.

Hello,

Welcome back to icliniq.com.

Yes, Amlodipine is safe from a cardiac standpoint. What is your mother's blood pressure, and what medications is she currently taking? I had prescribed Amlodipine, Valsartan, and Hydrochlorothiazide. Is she taking these, or any other medications?

Thanks and regards.

Hello,

Welcome back to icliniq.com.

Is she still taking Bisoprolol, Furosemide, and Lercanidipine? I had suggested a combination tablet of Amlodipine, Valsartan, and Hydrochlorothiazide, or they can also be taken separately if preferred. Please continue with Bisoprolol as well. Kindly ensure that the prescribed medications are taken regularly, and keep an eye on your mother’s blood pressure.

I hope you are satisfied with my answer.

Thank you.