Which hypertension medications do not cause dyspnea?

Question

Hello doctor,

I have hypertension and suffered from asthma during childhood. I was prescribed ARBs (angiotensin receptor blockers) to manage my hypertension; however, I experienced side effects that led to discontinuing the medications. Losartan 100 mg caused nervousness, while Candesartan 8 mg and Telmisartan 20 mg caused respiratory difficulties (dyspnea). I am now uncertain which medication to try next. After doing some research, I found that Valsartan and Irbesartan are available in my country. I would appreciate your advice on which of these options might have a lower risk of causing respiratory difficulties or nervousness.

Thank you in advance for your help.

Answer 1

Hello,

Welcome to icliniq.com.

Do not worry, as there are multiple treatment options available. The side effects you have experienced are likely due to a class effect, meaning all drugs in this class may cause similar reactions and may not be suitable for you. You will need to switch to a different class of medication. I recommend starting with Amlodipine 5 mg, taken once a day in the morning. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent. We will monitor your response and adjust the dose accordingly. If necessary, we can gradually increase the dose and consider adding Hydrochlorothiazide.

In addition, it is important to maintain a healthy lifestyle, including the following:

Avoid fatty, oily, and high-calorie foods.
Stick to a low-salt diet and monitor your blood pressure regularly, three times a day for one week, then once or twice a week.
Engage in regular exercise, such as brisk walking or jogging, for at least 30 minutes a day, five days a week, depending on your capacity.
Eat plenty of green leafy vegetables, fruits, and fish once or twice a week, and avoid red meat.
Avoid smoking and alcohol if applicable.
Focus on weight loss.
Also, get your lipid profile and blood sugar levels checked. If your blood pressure consistently remains above 140/90 mmHg, we will consider increasing the dose.

I hope this helps, and feel free to reach out if you have any further questions

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, exercise is entirely safe for individuals with hypertension. However, you should avoid sudden strenuous activities and instead focus on regular daily exercises, such as brisk walking and jogging. Begin gradually and then increase your exercise intensity over time. Experiencing palpitations and headaches is simply a sympathetic response to anger and stress. Do not worry about it, but try to manage your stress, as it can raise your blood pressure. Incorporating relaxation techniques and yoga alongside your medication can be beneficial.

It is normal to have occasional blood pressure readings above the threshold, but if the majority of your readings are high, we may need to increase the dose. You can take 5 mg in the morning and 5 mg in the evening if necessary. Fatigue can occur with blood pressure medication, but it is usually nothing to worry about.

Amlodipine is an older medication with a good track record. However, we also have newer medications like Cilnidipine, which is theoretically better but does not show much practical difference. Our primary target is systolic blood pressure, as diastolic pressure tends to decrease with weight loss, and systolic pressure is more significantly associated with various health issues.

Hydrochlorothiazide can be taken for a long time, even for life. We just need to monitor sodium levels, especially in older adults. If any symptoms of low sodium arise, which can sometimes be caused by Hydrochlorothiazide, we will address it. Otherwise, it is safe.

Thanks and regards.

Answer 3

Hello,

Welcome back to icliniq.com.

Amlodipine is also a good antihypertensive. However, since your BP is not under control, we can try other CCBs (calcium channel blockers) 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 another class of drug like a beta blocker. You should then use the tablet 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.

I hope this helps you.

Answer 4

Hello,

Welcome back to icliniq.com.

Although beta blockers like Metoprolol are considered safe, it is better to avoid them. Therefore, the next option for you is Hydrochlorothiazide 25 mg once a day at 8 a.m. This is a starting dose that can be increased gradually. If you find it comfortable to use, we can then consider switching to a second option like Prazosin, but I would recommend starting with Hydrochlorothiazide first.

Answer 5

Hello,

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.

Answer 6

Hello,

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.

I hope this helps you.

Thank you.