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

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?

Thank you doctor for the reply,

I am sharing the blood pressure records of my brother for the last ten days:-

1. At 9:00 AM, the BP was 134/8 mm of Hg, and the pulse was 68 beats per minute.
2. At 7:45 AM, the BP was 127/87 mm of Hg, and the pulse was 63 beats per minute.
3. At 12:15 PM, the BP was135/93 mm of Hg, and the pulse was 68 beats per minute.
4. AT 12:15 PM, the BP was131/96 mm of Hg, and the pulse was 70 beats per minute.
5. AT 12:15 AM, the BP was131/93 mm of Hg, and the pulse was 64 beats per minute.
6. AT 11:15 AM, the BP was 133/90 mm of Hg, and the pulse was 72 beats per minute.
7. AT 10.00 PM, the BP was 118/82 mm of Hg, and the pulse was 67 beats per minute.
8. AT 11.15 AM, the BP was133/90 mm of Hg, and the pulse was 72 beats per minute.
9. AT 10:30 PM, the BP was117/82 mm of Hg, and the pulse was 63 beats per minute.
10. AT 11:30 AM, the BP was138/98 mm of Hg, and the pulse was 70 beats per minute.
11. AT 11:1 PM, the BP was 140/92 mm of Hg, and the pulse was 68 beats per minute.
12. AT 11:20 AM, the BP was130/99 mm of Hg, and the pulse was 69 beats per minute.

He is taking the tablet Telma 40 mg in the morning. In addition, he has been advised the tablet Ciplar 40 mg for portal hypertension.