How can high blood pressure be managed?

Question

Hello doctor,

I have been a patient with high blood pressure and sinus bradycardia (heart rate of 52 beats per minute) for the last four years. I used to take S-Metoprolol succinate 25 mg after breakfast based on my cardiologist's advice. For the past six months, I experienced headaches and confusion, along with slightly increased urination. Last week, I visited another cardiologist who checked my blood pressure, which was very high, measuring 175/105 mmHg. He advised me to start taking Telmisartan 40 mg and S-Metoprolol succinate 50 mg after breakfast.

I underwent various blood tests. My uric acid level is slightly elevated at 7.8 mg/dL, and my Vitamin D level is deficient at 10 ng/mL. All other tests, including the lipid profile, renal function tests, liver function tests, sodium, potassium, and blood sugar, are normal. My headache has resolved after starting the new medications; however, I am feeling bloated most of the time.

I have the following questions:

Is bloating a side effect of Telmisartan 40 mg?
Can you recommend an alternative medication?
Is S-Metoprolol succinate 50 mg advisable in the context of sinus bradycardia (heart rate of 52 beats per minute)?

Please assist me with the next course of action.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly, it is advisable to avoid S-Metoprolol succinate if your resting heart rate is on the lower side; it should ideally be above 55 to 60 beats per minute. We have other options available for blood pressure control, so it would be better to reduce the dose to 25 mg and monitor whether your heart rate remains below 60. If it does, consider stopping the medication. If necessary, we can add Amlodipine 5 mg once a day if your blood pressure remains high.

I recommend following a low-salt diet and regularly monitoring your blood pressure—three times a day for one week, then once or twice a week thereafter. If your blood pressure is persistently above 140/90 mmHg, we may need to add more medications.

Engaging in regular exercise, such as brisk walking or jogging for at least 30 minutes a day, five days a week, will be beneficial. Incorporate plenty of green leafy vegetables and fruits into your diet, and include fish once or twice a week while avoiding meat. Weight loss will also aid in managing both bloating and blood pressure.

Regarding bloating, while Telmisartan can cause it, this is not very common. In fact, dietary factors and lifestyle choices play a more significant role. To minimize bloating, avoid fatty, oily, and spicy foods. Consider taking a walk after meals instead of resting. Aim to have multiple small meals throughout the day rather than heavy ones, maintain regular sleep habits, and manage stress effectively.

Avoid smoking and alcohol, if applicable. I suggest taking a combination of Pantoprazole and Domperidone or the Esomeprazole and Domperidone combination once a day before breakfast for a week, and then as needed. Consult your specialist doctor to discuss this and obtain their consent before taking any medication.

I hope this information is helpful! Please feel free to reach out if you have any further questions or concerns.

Answer 2

Hello,

Welcome back to icliniq.com.

Firstly, you need to decrease the dose of S-Metoprolol succinate to 25 mg, as we cannot stop it suddenly. If your heart rate remains below 60, then we will discontinue it completely. I recommend the following:

Please consult your specialist doctor, discuss this with them, and obtain their consent before taking the following medications:

Take a combination of Telmisartan and Chlorthalidone once a day.
Take a combination of Domperidone and Pantoprazole before breakfast once a day for a week.
Take Amlodipine 5 mg once a day in the morning, but only if your blood pressure is persistently above 140/90 mmHg. Please inform me of your blood pressure readings before starting this regimen.

All the best!

Answer 3

Hello,

Welcome back to icliniq.com.

All the best.