Dr. Sagar Ramesh Makode
Cardiology
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Patient's Query
Hi doctor,
My father is in his 80s and is diabetes for almost 30 years. He has a history of bypass surgery. He is taking Mixtard Insulin 30/70 - 50 units morning, 13 units in the night, tablet Glycomet GP2 one in the morning and night, and tablet Linagliptin 5 mg once daily only in the morning. His regular medications are Mixtard Insulin 30/70 - 42 units morning, 12 units at night and tablet Glycomet GP2 twice daily, tablet Linagliptin 5 mg once daily, and tablet Fibator 10 mg once daily at night. Also, he takes tablet Telma CT 12.5 mg half in the morning daily, capsule Dynapress 0.4 mg once daily at night, capsule Arreno once daily at night, tablet Ecosprin 75 1-0-0, tablet Thyronorm 25 mg one tablet Monday to Thursday, two tablets Friday to Sunday, and capsule Uprise once a month. He had just recovered from COVID-19. And his blood pressure has been somewhat elevated, ranging from 150/70 mmHg to 160/70 mmHg. In addition, his pulse rate has constantly been between 56 and 66 for many years. So now he only takes tablet Telma CT 40/12.5 half a tablet once daily. After this reading, the doctor advised adding tablet Amlong 2.5 and tablet Telma CT 40/12.5 half in the morning. After this, his systolic pressure improved slightly, but diastolic pressure went from 52 to 63. So our cardiologist asked us to stop all and start taking tablet Metolar 25 mg twice a day. We would want to know which one would work best for him. Also, what range of low blood pressure, as well as pulse rate, are normal?
Hello,
Welcome to icliniq.com.
I understand your concern. I would suggest that rather than adding any more drugs. I believe that increasing the tablet Telma CT (Telmisartan and Chlorthalidone) to one tablet daily would have been the best option. However, of the two alternatives offered here, half tablet Telma CT (Telmisartan and Chlorthalidone) and 2.5 mg are preferable. This is because his pulse rate is already low, and a tablet of Metolar (Lopressor) 25 mg would drop it even more. As a result, it can be harmful. Also, it is not an effective antihypertensive medicine. Therefore, it is recommended to administer Metolar (Lopressor) 25 mg under close supervision if it is added to the regimen. Diastolic blood pressure is not a concern. It will not be harmful if it goes below 50 degrees. However, systolic blood pressure is quite important. Furthermore, any effective antihypertensive might cause diastolic blood pressure to drop.
Patient's Query
Hi doctor,
Thank you for the reply. We began with Amlong 2.5 at night with an existing Telma CT 12.5 half. After two days, his systolic blood pressure dropped to 155 mmHg. I was curious how long it would take for the systolic blood pressure to drop further. Also, what would be ideal systolic pressure for him? Now his heart rate is between 60 and 66 beats per minute. I would like to know if this type of systolic hypertension is also frequent in elderly adults, particularly those who have undergone a bypass.
Hello,
Welcome back to icliniq.com.
I understand your concern. I would like to know his ejection fraction on Echo (echocardiography). Blood pressure should be less than 140 for systolic and 90 for diastolic. Tablet Amlodipine works quickly, and blood pressure will drop within a day or two. However, because 2.5 mg is such a small quantity, it may or may not make a difference. He would require 5 mg to control. However, the dosage of tablet Amlodipine should be increased if the ejection fraction on Echo (echocardiography) is greater than 40 to 45 percent. If his blood pressure remains high, he might consider increasing the dose of tablet Telma CT to once daily.
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