I suffer from high blood pressure despite taking medications. Do my medications need to be changed?
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Q. What causes a rise in blood pressure despite taking medications?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 30, 2023 and last reviewed on: Sep 20, 2023

Hi doctor,

I had consulted with you before also. I am a 65-year-old widowed woman with one daughter. I am hypertensive and put on non-diabetics. First, I used to take three medications: Olmezest (olmesartan medoxomil) CH 20 milligrams, Rozavel (Rosuvastatin) 5 milligrams, and Nexpro RD (esomeprazole and domperidone) 40 milligrams. Taking these three medications, my blood pressure remained normal at 126/84 mmHg. Then, one day, I took a painkiller, and my blood pressure became very high, along with vertigo. So, I consulted with a local doctor, and all these medications were changed. Now, I was taking tablet Cilacar 10 milligrams for blood pressure, tablet Rozavel 5 milligrams, tablet Esoz 40 milligrams, and Levogen for hemoglobin. These tablets I took for the last 12 days. After taking these medications, my blood pressure used to remain at 143/86 mmHg. Today, suddenly, at 8 PM in the evening, my blood pressure became very high to 174/98 mmHg. After this, I took another dose of Cilacar 10 milligrams, but my blood pressure was not coming down. I have had this blood pressure problem for a long time. First, I used to take Olmezest CH 20 milligrams, and my blood pressure used to remain quite normal. But this blood pressure medicine was changed, as my sodium and potassium level was imbalanced after taking a painkiller. Now, for the present time, what must I do to lower blood pressure? Should I take Olmezest CH 40 milligrams for lowering blood pressure? Or should I perform my blood tests again? Kindly help.

Thank you!

#

Hi,

Welcome to icliniq.com.

I understand your concern.

You can discuss with your treating doctor regarding the increase in the dose of Cilacar (Cilnidipine and Telmisartan) to 10 milligrams twice daily instead of once daily. If it can control the BP (blood pressure), then you can continue with the same. If Cilacar is not helping, then you can shift back to Olmezest CH 20 milligrams (Olmesartan medoxomil and Chlorthalidone). However, it is better to confirm that the kidney function test (urea creatinine, sodium, and potassium) is normal before restarting it. Sometimes, the medicine may take time to act, so you can wait for BP to come down after Cilacar if it is not rising above 180 mmHg systolic. Also, make sure you are taking painkillers (NSAIDs), as they can precipitate high BP. Also, avoid a high salt diet, and have plenty of green vegetables and fruits.

I appreciate your trust in icliniq.com and for giving me the chance to serve you.

Our goal is to prioritize your health and help you according to your preferences and needs.

Hello doctor,

Thank you for your advice. Another thing I did not tell you is that yesterday night after posting my query to you, I called up my local doctor, who prescribed me Cilacar 10 mg. I narrated my whole incident, and he prescribed me another BP medicine Benitowa 4 mg. Yesterday night, I again took Benitowa 4 mg to lower my BP. After taking this medicine, I started having frequent urination at an interval of 30 minutes. In this way, since yesterday night, I urinated nearly 15 times. After this, today in the morning, I measured my BP, and it came down to 145/86 mmHg, and my pulse rate was 88 BPM. After this, urination became normal. Now, I am not urinating so frequently. So my question to you is, will I now take Benitowa 4 mg instead of Cilacar 10 mg if this medicine suits me? Will there be frequent urination if I take Benitowa 4 mg? Do I need to perform any medical tests now, like blood, urine, ECG, or ECHO?

#

Hello,

Welcome back to icliniq.com.

Cilnidipine and Benitowa (Benidipine) have a similar mechanism of action, so you can either take Cilnidipine or Benitowa, but not both of these. You can continue with Benitowa if it is controlling your blood pressure. Frequent urination will likely settle. Repeat kidney function tests (urea, creatinine, sodium, and potassium) will be enough, and other tests need not be undergone.

Hope this helps.

Thank you.

Hello doctor,

Thanks for the reply.

I have been taking Benitowa 4 mg for the last two days, but since yesterday, I have been suffering from constipation. Today, in the morning, there was extreme constipation. The urination problem is not there now. My urine is normal now. Currently, I am taking Benitowa 4 mg, Rozavel 5 mg, Esoz D, and Livogen-XT tablets. Since yesterday, I have been suffering from extreme constipation. I had a constipation problem with Esoz D before also when I used to take Cilacar 10 mg. Now, after changing to Benitowa 4 mg, this constipation has enhanced more. I am having a great problem with constipation currently. Sometime back, when I used to take Olmezest CH 20 mg, I was prescribed Nexpro RD 40 mg, and at that time, this constipation problem was not there, but there was extreme weakness with Olmezest CH 20 mg. But after this painkiller issue of mine, all the medications have been changed, and now no weakness is there, but there is constipation. Is Benitowa 4 mg a good medicine for BP? Today, in the morning, my BP was 134/78 mmHg, and my pulse rate was 81 BPM. This constipation problem is occurring due to which medication, Benitowa 4 mg or Esoz D? Can you prescribe me a solution for my constipation problem? Every day, I go out for work, and in the morning, if I face a constipation problem, then it will really hamper my daily routine. Kindly advise what medications must be taken now. Which medications must be changed now, the BP medicine or the indigestion? I will soon follow up with my recent blood reports.

#

Hello,

Welcome back to icliniq.com.

I understand your concern.

As of now, you can continue with Benitowa 4 mg (Benidipine) itself, and we should wait for a few days before changing it. You can take syrup Cremaffin plus (sodium picosulfate, liquid paraffin, and milk of magnesia) one to two teaspoons at bedtime, depending upon the requirement. You can start with one teaspoon at bedtime and may increase it if it is not effective.

Hope this addresses your concern.

Regards.

Hello doctor,

Thanks again.

I am consulting with you after quite a long time. As you know, I am hypertensive but non-diabetic. Regularly, I take the following 4 medications, Rozavel 5 mg, Benitowa 4 mg, Esoz 40 mg, and Livogen-XT. My recent problem is that, since yesterday, while brushing my teeth, when I was cleaning my tongue and applying pressure, I had a nosebleed. I had a bleed today also while brushing my teeth and cleaning my tongue. Then today, in the afternoon, I checked my BP, and it was a bit high, 147/91 mmHg, and my pulse rate was 88 BPM. My BP generally stays in the range of 130/85 mmHg every day. I am quite scared now regarding my nosebleed. Is it something to worry about? Kindly advise. I had my last medical test done four months ago.

#

Hello,

Welcome back to icliniq.com.

I understand your concern.

I have gone through your reports (attachments are hidden to protect the patient's identity). They are fine except for ESR (erythrocyte sedimentation rate), which was elevated. You should get it repeated and also ask for CRP (C-reactive protein) level, which can tell us if there is any inflammation going on in the body. Regarding your nosebleed, most of the time, causes are not worrisome. However, it is better to get it checked by an ENT (ear, nose, and throat) doctor. This much elevated blood pressure is unlikely to cause a nosebleed. However, you should monitor blood pressure regularly, and if most of the readings are above 140 mmHg systolic, then you need to take Benitowa 8 mg. Avoid fingering or putting any object in the nose if you used to do it.

Hope this answers your query.

Regards.

Hello doctor,

Thanks again. As you know, I am a hypertensive but non-diabetic woman. My age now is 65 years. Every day, I am taking the following medications, Benitowa 4 mg for BP, Rozavel 5 mg, Esoz 40, and Livogen-XT. My BP generally stays in the range of 135/85 mmHg. A few days ago, as I had told you while brushing, I had a bleed but did not go to the ENT doctor. At that time, my BP was 150/95 mmHg. For two days, I had a nose bleed, but after that, my BP came down to normal. This happened at the start of this month. After this, I did not have a nosebleed. But yesterday, suddenly, in the evening, my BP rose to 160/100 mmHg. So, after taking Benitowa 4 mg, I took 1 dose of Cilacar 10 mg. Today in the morning, my BP was the same. So, I took 1 dose of Olmezest CH 40 mg to lower my BP. Today, in the evening, my BP came down to 140/91 mg. So, I did not take Benitowa 4 mg. At 12 AM night, my BP again began to rise to 149/99 mmHg. Immediately, after this, I took Benitowa 4 mg. I will wait throughout the night and see what happens in the morning. After retirement, I am going through stress and tension regarding my unmarried daughter. I do not know whether these fluctuations in BP are occurring for that or not. I am really scared regarding this fluctuation in BP. Is it something to worry about? Can this fluctuation in BP occur due to Livogen XT? I have been taking it for the last six months. Do I need to perform any medical tests now? After retirement, I am really missing my workplace. Kindly advise what I must do now regarding my fluctuations in BP. Will I become alright? Will I continue with Benitowa 4 mg? If tomorrow morning, my BP does not come down, then what must I do? I am urinating normally after taking BP medications. Can these fluctuations in BP occur because of indigestion, as I am mostly at home? You know in the last few days, my eyes have become a bit red.

#

Hello,

Welcome back to icliniq.com.

I understand your concern.

Fluctuations in blood pressure are quite usual and may occur due to various reasons like lack of physical activities, reduced temperature (cold weather), intake of painkillers, stress, etc. It is unlikely to be related to Livogen intake. Also, a peak reading of 160 mmHg systolic is not a very high BP reading. You can continue with Benitowa 4 mg twice daily, as once daily is unlikely to help you. If Benitowa 4 mg twice daily does not help, then we will need to add another antihypertensive for the time being, like the CH component of your previous medicine (Chlorthalidone 12.5 mg). An alternative option is to shift on Olmezest CH 40 mg altogether and stop all other medicines provided there is no kidney dysfunction (which was normal during the last check-up). Olmezest CH 40 alone is a good and potent antihypertensive. It takes a few days to act fully. You should get yourself examined by ENT or any other local doctor for nose bleeding.

Hope this addresses your concern.

Regards.


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