This query is related to my wife's blood pressure condition. She has hypertension. She is 70 years old. She also has type II non-insulin-dependent diabetes mellitus for many years and subclinical hypothyroidism. She used to take Stamlo (Amlodipine) 5 mg. She has shown swelling in the feet two years back. After waiting for three days, I took her to my doctor, who said it is pedal edema, and asked her to stop Stamlo and prescribed Cilacar (Cilnidipine) 10 mg once a day. I am very much confused about whether her blood pressure levels are normal or not? My doctor always says that her blood pressure reading is normal and asked her to continue. I am here to give the chart, which you, please go through that and advise whether you also concur with my doctor that blood pressure levels are normal. If her levels are high, please suggest good and safest medicine and its dosage for which act of kindness I will be ever grateful to you.
I am eagerly awaiting your kind reply.
Welcome to icliniq.com.
Thanks for the query.
For those with known hypertension and on medicines, reasonable control is said to be when blood pressure is 130/80 or less, but 140/90 or less is also normal.
Amlodipine alone causes feet swelling, but if combined with other medicine, swelling may not develop.
Measures to control blood pressure:
1. Avoid smoking and other addictions.
2. Reduce salt intake in the diet.
3. Reduce fatty foods, junk foods, saturated fats.
4. Avoid stress and anxiety.
5. Do regular moderate-intensity exercise such as brisk walk for 30 minutes.
6. Have proper night sleep, atleast 8 hours per 24 hours, including at least 6 hours uninterrupted night sleep.
7. Reduce weight even if the weight is within normal range.
8. Drink plenty of water.
9. Do deep breathing exercises and meditation.
Measure blood pressure while you are totally relaxed, sit for five minutes in a quiet room without talking to anyone. Empty your bowel and bladder before checking blood pressure. Avoid tea or coffee 30 minutes before checking blood pressure. Sit on the chair with feet on the ground, back supported, hand supported on a table, and cuff at the position of the heart. Check blood pressure, and repeat after five minutes again. Then check blood pressure in the other arm and repeat after five minutes. During the entire period, remain relaxed and quiet. Arm with higher blood pressure readings is your blood pressure. You may take atleast two or more readings, and the average of readings is your actual blood pressure.
If these measures do not help, then switch medicines. But before switching, have a renal function test and electrolytes done. If tests are normal and you are not allergic to components of the following medicines:
Tablet Amlodipine or Valsartan 5/160 mg.
Take daily in the morning or evening time. Measure blood pressure daily as described above for 2 to 3 weeks. If it normalizes, continue medicine, if not re-consult.
Please repeat renal function tests and electrolytes after one week of starting this medicine. If both reports differ, re-consult the doctor.
Is my wife's blood pressure levels normal or not? Are 130/80 and 140/80 normal? Why my doctor says that the blood pressure is normal in consideration of her age. Is it age related?
Welcome back to icliniq.com.
Thanks for follow-up.
According to the latest guidelines upper limit of blood pressure in those on antihypertensives is 130/80 regardless of age, and another country's guidelines say 140/90 regardless of age. These limits are evidence-based. Over these values, organs begin to get damaged, such as kidneys and heart. I see some of the readings are above 160, which should not be. She is also diabetic, so her blood sugar should be controlled. Diabetes may cause kidney disease, which itself increases blood pressure. All diseases are interlinked. Have renal function tests and electrolytes levels done? If normal, the combination of two medicines are used if blood pressure is not controlled on one (such as Valsartan 40 mg combined with Cilnidipine)
She is diabetic. Ideally, she should also be on cholesterol-lowering medicine to reduce the risk of cardiac events. Regarding blood pressure, if she feels comfortable at 150, no issue, but BP above 160 should be avoided in all circumstances. Sometimes, there is an improper technique of taking blood pressure which causes blood pressure to appear higher. I described the proper technique. Her diastolic pressures are normal, and some systolic values are higher. Cilnidipine and Amlodipine are both calcium channel blockers, both have an equal effect on lowering blood pressure, but Amlodipine causes feet swelling, whereas Clinidipine does not. Evidence suggests antihypertensives called ACE (Angiotensin-converting enzyme) inhibitors and ARBs (Angiotensin II receptor blockers) are first-line medicines as these medicines also prevent atrial fibrillation and kidney damage, especially in diabetic patients. If there are no contraindications for these medicines, these are better than calcium channel blockers. The decision to choose a treatment option is always the right of the patient and her family. Doctor can only guide you and has no right to impose a decision.
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