My wife's BP is high after switching from Amlodipine to Cilnidipine. Why?

Question

Hello doctor,

My wife is 70 years old. She is a diabetic for 15 years, has mild BP for more than 20 years, and hypothyroidism for eight years. All are under control. She is taking Glycomet 500 mg twice a day, Thyronorm 50 mcg, and Cilacar 10 mg at breakfast time.

I recorded her BP readings on Omron digital meter consecutively for five days latest. Earlier readings were measured at the doctor's clinic. I am attaching both readings. She is taking Cilacar for the past six months. Earlier she used to take Stamlo 5 mg for more than 20 years. Last year she got mild swelling in her ankles. Hence, her doctor has changed the medicine to Cilacar. Readings are much less when she used to take Stamlo. But when Cilacar is prescribed, her readings are slightly on the higher side, I believe.

Her morning readings in the clinic range from 120/80 to 130/80 mmHg. Stamlo 5 mg (Amlodipine) stopped from this day since she has developed pedal edema by the attending physician. Tablet Cilacar (Clinidipine) is started, and after 15 days, the reading is 140/84.

The following are the readings on the Omron digital apparatus taken at home.

Monday - 166/75 133/64 148/72.

Tuesday - 151/65 137/68 138/70.

Wednesday - 139/68 121/68 149/70.

Thursday - 138/71 138/74 130/74.

Friday - 142/69 135/75 131/73.

Kindly advise your valuable opinion.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your question. The recording and monitoring that you are doing are quite commendable.

Coming to the query, the change from Amlodipine to Cilnidipine was justified as Amlodipine is known to cause pedal edema that is swelling of the feet.

From your rigorous monitoring, it is evident that the readings after the change have gone up slightly though not very significantly. It is expected as Cilnidipine is less efficacious than Amlodipine, though to a very minute level.

Your latest recordings show BP to be slightly higher in the morning, but it is under control during afternoon and evening. This is an expected pattern as BP tends to be slightly higher in the mornings due to increased cortisol levels in the morning. This is just for your information.

I would like to point out that above 50 years of age, we do not do very rigorous control of BP as the arteries hardened up as age increases and requires more pressure to propel blood around.

According to me, BP are at quite acceptable levels. If you want to change the drug, I would advise you to get a urine routine and microscopy. Since she has diabetes there are chances of the kidney getting affected. When and if the kidney gets affected there will be proteins present in the urine. If this protein is seen in the urine when we get the test done, we can change the drug to a different antihypertensive class, which will also provide additional protection against this change in kidney function.

You will get a dual benefit, that is, her BP will be under control, and her kidney will get some protection from diabetes. So it was up to me. I would get the urine analysis done and then decide whether to change the drug or not.

Do let me know how you want to proceed. Do you want to change the drug, or do you want to continue the same?

Answer 2

Hello,

Welcome back to icliniq.com.

I am happy to help you. Keep in touch for further doubts.