Q. Please suggest hypertension medicines which will not cause dyspnea.

Answered by Dr. Sagar Ramesh Makode and medically reviewed by iCliniq medical review team.

 

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Hello doctor,

I have hypertension, and in my childhood, I suffered from asthma. I have been prescribed ARB (angiotensin receptor blockers) to treat my hypertension; however, I have experienced side effects that lead to discontinuing the medication. Losartan 100 mg caused nervousness. Candesartan 8 mg and Telmisartan 20 mg caused respiratory difficulty (dyspnea). Now, I do not know which medication to try. I was doing a little research, and here in my country, we have Valsartan and Irbesartan. I would like to know which one of those would be better to give a try with lesser chances to get respiratory difficulty or nervousness. Thanks in advance for your response.


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Dr. Sagar Ramesh Makode
MBBS., MD, GENERAL MEDICINE ., DM, CARDIOLOGY(SENIOR RESIDENT
Cardiology, General Medicine, Internal Medicine

Hello,

Welcome to icliniq.com.

Do not worry about it, as there are multiple options available. The side effects are class effect and all drugs from this class will have these effects and will not suit you. You need to change to other class of medicine.

I suggest tablet Amlodipine 5 mg, once a day in the morning. We will see the response and modify dose accordingly. We can increase the dose gradually and may add Hydrochlorothiazide if needed.

You should have a healthy lifestyle as follows:

  1. Avoid fatty, oily, and high-calorie diet.
  2. Have low salt diet and monitor blood pressure regularly, thrice a day for one week then once or twice a week.
  3. Regular exercises like brisk walking and jogging according to your capacity for at least 30 minutes a day and five days a week.
  4. Consume a lot of green leafy vegetables, fruits, fish once or twice a week, avoid meat.
  5. Avoid smoking and alcohol, if any.
  6. Try to lose weight. Get your lipid profile and sugars tested once.

If your BP is persistently more than 140/90 mmHg, then we will increase the dose.

Hope this helps you and get back if you have any doubts.

For further queries consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 

Hello doctor,

Thank you for your suggestions. I am already using Amlodipine 5 mg once a day, but it sometimes helps me and sometimes not. When I feel moody or angry, my head starts to pain, and I get palpitations. The same happens when I try to exercise at home. Why is that? Is exercise good and safe for hypertensive individuals like me? I have some side effects with Amlodipine, and it makes me feel tired, is that normal? From the calcium blockers, is Amlodipine the best option?

I have been told that Hydrochlorothiazide cannot be taken for long periods of time, is that true? In my case, the systolic rate is the first one to get lower when I take Amlodipine, but the diastolic is more difficult to control. Why is that? Obesity is causing me a lot of trouble. Unfortunately, its root is the use of Mirtazapine for insomnia problems. I cannot stop the drug, so I have to change my diet to try to lose weight. Thanks for your responses.

 

Dr. Sagar Ramesh Makode
MBBS., MD, GENERAL MEDICINE ., DM, CARDIOLOGY(SENIOR RESIDENT
Cardiology, General Medicine, Internal Medicine

Hi,

Welcome back to icliniq.com.

Yes, exercise is entirely safe for hypertensive individuals. But you should not have sudden strenuous exercises, rather daily regular exercises like brisk walking and jogging. You should begin gradually and then build up your exercise.

Having palpitations and headache is nothing but the sympathetic response to anger and stress. Do not worry about it, but try to avoid it as it can raise your BP. Use relaxation techniques and yoga for it along with medicine.

  • One may have intermittent readings above the threshold but, if your majority of BP readings are high, then we need to increase the dose, and you can have 5 mg in the morning and evening. Fatigue can occur with BP medicine, but do not worry about it. Amlodipine is older medicine and has a good experience with this. However, we also have newer medicine like tablet Cilnidipine, which is theoretically better without a much practical difference.
  • Our target is systolic blood pressure, as diastolic will only come down with your weight loss and also systolic is more importantly implicated in all diseases. Hydrochlorothiazide can be taken for a long time and even lifelong. We just need to check sodium levels, especially in elders and if having any symptoms of low sodium, which can sometimes be caused by Hydrochlorothiazide. Otherwise, it is safe.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 

Hi doctor,

I currently have high blood pressure; my reading is 147/98 mmHg. I am taking 5 mg Amlodipine at night and 5 mg in the morning, however, the readings are still high. Here in my country, Cilnidipine is not available. I would not want to use Hydrochlorothiazide because it is just a temporary remedy or a rescue remedy. I am looking for something more like long-term use. I cannot use ACE inhibitors or ARB (Angiotensin Receptor Blockers) because they cause me respiratory problems. Could you please suggest me a good CCB (Calcium Channel Blocker) besides Amlodipine? Thanks in advance for your response.

 

Dr. Sagar Ramesh Makode
MBBS., MD, GENERAL MEDICINE ., DM, CARDIOLOGY(SENIOR RESIDENT
Cardiology, General Medicine, Internal Medicine

Hello,

Welcome back to icliniq.com.

Amlodipine is also a good antihypertensive. However, since your BP is not under control, we can try other CCB like Benidipine 4 mg once a day and if not responding then 8 mg.

However, if Benidipine is also not available, then we need to add other class of drug like a beta blocker. You should then use tablet Metolar XR (Metoprolol extended release) 25 mg once a day if your resting pulse rate is more than 70. Also, Hydrochlorothiazide can also be used on a long-term basis. All the best.

For further doubts consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 

Hello doctor,

Benidipine is not available. Are beta blockers useful for people who have asthma like me? Regarding Hydrochlorothiazide, what dose can be used? Is it fine to use it on a long-term basis? I have recently used Nifedipine, and BP is still high.

 

Dr. Sagar Ramesh Makode
MBBS., MD, GENERAL MEDICINE ., DM, CARDIOLOGY(SENIOR RESIDENT
Cardiology, General Medicine, Internal Medicine

Hi,

Welcome back to icliniq.com.

Although beta blocker like Metoprolol considered safe, it is better to avoid it. So, next option for you is tablet Hydrochlorothiazide 25 mg once a day at 8 am. It is a starting dose and can be increased gradually. If you are comfortable using it then we have to switch on second options like Prazosin but before that, I would advise using Hydrochlorothiazide. All the best.

For further doubts consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 

Hello doctor,

Is Hydrochlorothiazide safe to use on a long-term basis? Does it cause potassium or sodium imbalance? Should I take it alone or in combination with another drug?

 

Dr. Sagar Ramesh Makode
MBBS., MD, GENERAL MEDICINE ., DM, CARDIOLOGY(SENIOR RESIDENT
Cardiology, General Medicine, Internal Medicine

Hi,

Welcome back to icliniq.com.

It can be taken on a long-term basis. It can cause decreased sodium but not always. You can get your baseline sodium checked and recheck after a week. You can take it with Amlodipine.

For further information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 

Hello doctor,

Would you recommend to use it in combination with Amlodipine or would you prefer to see if it lowers my blood pressure alone?

 

Dr. Sagar Ramesh Makode
MBBS., MD, GENERAL MEDICINE ., DM, CARDIOLOGY(SENIOR RESIDENT
Cardiology, General Medicine, Internal Medicine

Hi,

Welcome back to icliniq.com.

Please take it in addition to Amlodipine only. When you take it alone it will not be as effective as Amlodipine.

For further information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

 
 
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