Dr. Muhammad Zohaib Siddiq
Cardiology
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Patient's Query
Hello doctor,
I am a doctor and want to have an opinion for my father. A 70-year-old man with a history of diabetes and an acute MI (myocardial infarction) episode five years ago. He has been on medications since then. This is the current prescription he is following, tablet Metoprolol 25 mg twice a day, tablet.Aspirin/Clopidogrel 81/75 mg once daily, tablet. Atorvastatin 10 mg once daily, Captopril 12.5 % twice a day, Metformin 500 mg once daily, Gliclazide 20 mg once daily. His blood pressure has been constant at 110/70 mmHg for the previous five years on this regimen, but it is currently 140/68 mmHg. I also raised his Captopril to 50 mg three times daily, but there has been no change, and his blood pressure ranges between 130-145/60-70 mmHg. What exactly are our options to control it ?
Kindly help.
Hello,
Welcome to icliniq.com.
Captopril is okay, but I prefer long-acting drugs like the tablet Lisinopril (ACE inhibitor) or Valsartan (angiotensin receptor blocker) once daily. Please check his EF (ejection fraction) in echo. If it is less than 40 %, Sacubitril or Valsartan tablets (antihypertensive) are good choices regarding blood pressure and mortality benefits. If it is above 40 %, then switch to a tablet. Lisinopril 10 mg plus or tablet Amlodipine 10 mg (calcium channel blocker) once daily. He can continue the tablet Captopril three times a day and add tablet Amlodipine 10 mg once a day. Check RFTs (renal function test) and electrolytes, and maintain a low sodium diet.
I hope this helps. Thank you.
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Cardiology
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