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Q. How do we treat portal hypertension, diabetes, and hypertension in my 56-year-old brother?

Answered by
Dr. Sugreev Singh
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 06, 2022

Hello doctor,

I am giving the medical history of my brother, who is 56 years old.

He is presently suffering from hypertension, diabetes type-1, hypothyroidism, and portal hypertension in liver gastropathy. He has a cyst on his left kidney. He has been suffering from pancreatitis for the last 36 years with calcification in the pancreas. Several times stents were put in the pancreases duct, but they did not work out. Around 12 years back, he went for LPJ (lateral pancreaticojejunostomy – Puestow procedure ) operation at a hospital. After that, his acute attacks of pancreatitis were no more, but six years back, he developed diabetes and two years back hypothyroidism. In between, he also developed funds in the liver area due to hypertension of the portal vein. He is now doing proper Yoga and diet control. He also had a sleep test, which diagnosed sleep apnea. But he is doing nothing for it. He brought a CPAP machine but was not comfortable using it.

Two years back, it was found that he had a kidney cyst on the left side of size 159 X 93 mm, and last year, the same cyst was measured to be 160 X 148 X 96 mm (in ultrasonogram) and 10.6 cm X 10.3 cm X 13 cm on the left side and 26 x 22 mm in the right side (in CT Scan).

In September last year, he had severe abdomen pain, and he was admitted to the hospital. He used to have vomiting and pain only. They have done CECT, and CECT WA showed MID small bowel obstruction.

Conservative treatment did not help my brother, and he went for surgery. Exploratory laparotomy, band release, and closure of internal hernia defect under general anesthesia were performed in November last year. After taking a rest of 2 weeks, he returned to his home. But the next day, he got a fever, and we did all his blood parameters, and all blood parameters were found deranged.

He again was admitted to the hospital. Lots of investigations were done, and nothing could be found. The only final opinion the doctor gave was that it was post-operative sepsis and infection. Recently for the last five days, he has had a fever with a throat infection. He has taken five days course of Azithral 500 mg and Montair LC 1 tablet at bedtime. His fever was around 99.6° F; then, we went for his CBC, urine routine, and RT-PCR test.

In CBC, we found the following:

Hb-11 g/dL.

RBC- 3.92 million/uL.

HCT- 33.5 %.

Neutrophils- 76 %.

EST- 31 mm/hr.

TLC- 2700 cells/cubic millimeters.

Platelet- 1.52 lakh cells/cu mm.

In urine, we found:

Sugar- +++ (manually checked).

RT-PCR was positive.

Other all reports in CBC and urine are normal.

His blood sugar fasting is 144 mg/dL, and his postprandial was 252 mg/dL.

At present, he is taking the following medicines.

Early morning- Thyroxine Sodium 75 mg.

Before breakfast: Razo, Diamicron XR 60.

After breakfast: Telday 40 mg, Stamlo 10, Ciplar LA 40 - 1/2, Creon 25000, Antoxid P.

After lunch: Ciplar LA 40 - 1/2, Creon 25000.

After dinner: Creon 25000, Storvas 10 mg, Antoxid P, Ciplar LA 40 - 1/2, Glyciphage 250.

At night: Softovac- 2 Spoon.

Now we are concerned about:

1. For sugar, the endocrinologist has increased the night medicine of Glyciphage from 250 mg to 500 mg Glyciphage SR.

2. Now, the fever is settled down.

3. His TLC was 2700, and it always remains under 3600; for this, we added Livigen XT and Meganeouron OD-Plus for the time being.

Our main concern is his control of blood pressure. His reading day before yesterday was: at 5.30 AM- 134/100 mm/Hg, at 10.40 AM- 138/96 mm/Hg, at 2.30 PM- 134/96 mm/Hg, at 4.30 PM- 121/93 mm/Hg, at 6.30 PM- 131/89 mm/Hg.

Yesterday his blood pressure was: at 8.00 AM- 135/100 mm/Hg, at 11.20-AM- 130/99 mm/Hg, at 7.10 PM- 129/88 mm/Hg, at 10.45 PM- 135/88 mm/Hg. Today morning his blood pressure was 136/94 mm/Hg at 7.40 AM.

His pulse remains between 64 TO 71 beats per minute.

For blood pressure, he is taking Telday 40 mg 1 tablet daily in the morning and Stamlo 10 mg 1 tablet after breakfast. He is also taking Ciplar LA 40 mg half a tablet three times a day for portal hypertension. I have discussed the issue with a cardiologist, and he is suggesting waiting and watching. I am slightly unhappy as he is having multiple problems, and he has come out of COVID just now. Should it not be our target to control his blood pressure?

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#

Hello,

Welcome to icliniq.com.

Thank you for writing, and I understand your concern.

Actually, post-COVID hypertension is common; that is why the cardiologist is suggesting to wait and watch. I would suggest you do the same, and once his immunity gets stronger, then everything will be fine. He has multi-organ diseases, specifically kidney disease, which makes it difficult to lower blood pressure. You can wait for one week and reduce salt intake in his diet. Trace blood pressure for one week and see. In my opinion, it will definitely settle down; if not, we can go for further management.

Dear Dr Sugreevji,

Once again this is Dr R K Mundra here. I am sharing the blood pressure records of my brother of last 10 days :-

31.07.2022-------------------AT 9.00 AM ------ BP- 134/87....PULSE-68

30.07.2022............................... AT 7.45 AM ........ BP- 127/87...PULSE- 63

24.07.2022............................... AT 12.15 PM---- BP- 135/93.. PULSE- 68

22.07.2022................................ AT 12.15 PM.. BP- 131/96- PULSE- 70

20.07.2022................................ AT 12.15 AM.. BP- 131/93- PULSE- 64

19.07.2022................................ AT 11.15 AM- BP- 133/90-PULSE-72

19.07.2022..................... ........... AT 10.00 PM- BP- 118/82- PULSE-67

18.07.2022............................ AT 11.15 AM BP- 133/90-PULSE-72

18.07.2022................................ AT 10.30 PM- BP- 117/82- PULSE-63

17.07.2022.................................... AT 11.30 AM BP- 138/98-PULSE-70

17.07.2022.................................... AT 11.15 PM- BP- 140/92--PULSE-68

16.07.2022.................................... AT 11.20 AM BP- 130/99- PULSE-69

16.07-2022. AT 10.45 PM- BP- 135/88- PULSE-66

FOR YOUR INFORMATION FOR BP HE IS TAKING

TELMA-40 MG-1 TABLET IN THE MORNING

STAMLO- 10 MG -1 TABLET IN THE MORNING

NOTE:- HE IS NOT DIVIDING STAMLO AT 5 MG -BD, BECAUSE NIGHT TABLET CAUSE HIM EXCESS URINE PASS AT NIGHT AND HENCE SLEEP IS DISTUREBED.

FURTHER FOR PORTAL HYPERTENSION, HE HAS BEEN ADVISED

CIPLAR-LA-40 MG- HALF TABLET THREE TIMES A DAY.

SIR,PLEASE ADVISE ANY PRECAUTION REQUIRED ON PART OF HTN
# Hi Dr R K mudra
Welcome back to Icliniq
Thank you for writing and I understand your concern.
I have gone through the chart and it looks perfect so need to go continue with same line of treatment.
According to his age his blood pressure is under good control so don’t worry about anything.
He is responding well to medications
Just give Healthy diet and keep control on salt
Salt limitation helps to lower down the blood pressure.
If he is able to walk them ask him to walk few steps daily.
If anything else please let me know
Thank you

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