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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?
Investigations to be done:Urine routine and microscopy.
Probable diagnosis:Hypertension.
Treatment plan:Shall decide after the the urine analysis is done.