Q: I am 65 years old female suffering from hypertension for more than 10 years, recently high pressure h to h up high pressure difference is often greater than 60 often dizziness, my blood lipids, blood sugar and other normal. I have been treated at the First People’s Hospital in Lianyungang, Jiangsu Province, and have eaten Shoubishan and Nifedipine. Recently, I have been taking Felodipine 2.5 mg/tablet, twice a day, 1 tablet each time. A: The most common cause is still caused by atherosclerosis, there may also be aortic valve insufficiency, further examination is needed to confirm. This condition is likely to cause cerebral blood supply deficiency, usually should take oral aspirin, but also with some drugs to improve circulation. When lowering blood pressure, be careful not to focus only on high pressure, and low pressure should not be too low, otherwise insufficient blood supply to the heart and brain may cause serious infarction. Q: Thank you very much for your reply in your busy schedule. I don’t know what tests have to be performed to confirm what caused it, sclerosis is very possible, my mother died of cerebral hemorrhage when she was 47 years old. I am taking felodipine, and these days the high and low pressure difference is even greater, and I feel pain in my head all the time. I’m taking antihypertensive medication, but my high pressure is still above 140mmHg, so if I increase the dosage, my high pressure is normal and my low pressure is low, around 70mmHg. Please give advice. A: Low pressure generally should not be lower than 65, may be a long time, will be lower. However, you can try to lower your blood pressure without causing discomfort. Also pay attention to the side effects of drugs, in addition to conventional blood pressure control lipid antiplatelet drugs, such as aspirin, statin drugs, you can also take some drugs containing salvia or ginkgo biloba preparations to reduce dizziness and discomfort. Q: I wonder if there is any medication that can soften the hardened blood vessels. Another problem is that taking simvastatin can cause liver pain, which has been tested many times. Thanks A: You can take pravastatin or fluvastatin, and there is also a kind of Rosuvastatin that works better. Q: I was found to have hypertrophy of the left ventricle of my heart the year before last, but I was not sure if I had coronary artery disease because I did not have an angiogram. Should I take a combination of antihypertensive drugs in this case? A: It means that your long-term blood pressure is not well controlled. You can choose for example Benazepril (or other similar drugs) + Amlodipine (or other long-acting similar drugs), but some people may experience coughing side effects and should be observed; you can also choose Metoprolol (or other similar drugs) + Amlodipine (or other similar drugs), but pay attention to whether there is bradycardia or lower limb edema and other inappropriate conditions. There are other different combinations that can be considered for trial. Q: I had taken Amlodipine but for some reason my blood pressure didn’t drop after taking it, so I changed my medication, does it take a few days for my blood pressure to start dropping? I have taken Boydine, I don’t know which one is better for lowering high pressure, but I’ll follow your idea: Boydine 5 mmg/day plus Metoprolol 25 mmg/day twice. In addition, the minimum heart rate control at what is appropriate, my usual heart rate in 62 beats per minute or so. A: Amlodipine has a slow onset of action, and the antihypertensive effect is similar to that of Boydin, so your combination is fine. Heart rate control between 55-65 times is more appropriate, which can reduce myocardial oxygen consumption and ensure systemic blood supply, so that angina is not likely to occur. Q: After taking Boydin, the blood pressure cannot be stabilized for 24 hours, and the blood pressure drops within 10 minutes after taking the medicine.
The blood pressure usually rises again in about 20 hours, and the stabilization time is not quite the same every day. And just after the blood pressure is normal, it will rise again in about 10 minutes, so I have to take the medicine again immediately. This makes it difficult to control the time to take the medicine. I can’t take it once every 24 hours like the instructions. I want to switch to amlodipine, but I may not have mastered the way to take it before, so it’s not effective. Can you guide me on how to take amlodipine to lower my blood pressure smoothly? (Also after taking Metoprolol 25mmg my heart rate dropped to 52 beats per minute so I switched to Benadryl and according to my blood pressure after taking Boydin I am currently only taking 1/4 tablet without coughing) Thank you! A: Amlodipine itself is a long-acting antihypertensive drug, and breaking it up does not affect the effectiveness of the drug. If felodipine extended-release tablets are broken open, it may shorten the half-life, so it is generally not recommended to break open. Benazepril, if taken without coughing, can be combined with amlodipine, the antihypertensive effect has a synergistic effect, but also to reduce the lower limb edema adverse reactions, you can eat a period of time to see the blood pressure drop, the dose can be gradually increased. There is another antihypertensive drug called telmisartan, this drug has a longer half-life, but the onset of action is slower, adhere to take 4 weeks blood concentration can reach a stable state, blood pressure is not easy to fluctuate, but women of your age take this drug to observe whether there is joint pain, if there are such adverse reactions, do not eat. In addition, it does not matter if your blood pressure fluctuates within a short period of time, do not deliberately try to lower it, because everyone’s blood pressure is fluctuating, as long as it does not continue to rise, do not pay too much attention to it. Q: Through your introduction I think amlodipine is more suitable for me, because my own joints are not good, varicose veins in the lower extremities and edema. I am going to switch to Amlodipine plus Benadryl after I finish the Boydin, starting with a smaller dose and gradually increasing the dose to normal depending on how my blood pressure drops. I also found that there are many manufacturers of Amlodipine, and I can’t tell which one has the quality assurance. Can you recommend one or more of them to me? A: The combination of Benadryl and Amlodipine can reduce the lower limb edema side effects of Amlodipine. You have varicose veins and edema in your lower limbs, and it is necessary to observe whether the combination of Amlodipine and Benadryl can avoid lower limb edema. If your lower limbs are not swollen, you should continue to take it. In case your lower limbs are still edematous, the combination of Benadryl + Shupesan can avoid lower limb edema. I hope that you will carefully experience the effects and discomfort of each drug combination, and that there will be a combination that is suitable for you. There are many manufacturers of amlodipine, but generally speaking, the ingredients of western drugs are relatively single and fixed, so the efficacy should be similar. Q: I would like to try the combination of Benadryl + Sobiesan to avoid lower limb edema, but I don’t know if this combination is long-acting and how to control the amount. What else should I pay attention to? I am confident that under your guidance I will be able to find the right combination for me, thank you. If the blood pressure does not reach the desired level, Benadryl can be increased to a maximum of 30mg/day. Because Shoubisan is a diuretic antihypertensive drug, try to take it in the morning to avoid the increase of night urination which affects rest. Q: I am sorry to bother you again, but I don’t need to take Benadryl after taking it to sleep at night, so I still take Amlodipine. So I have to take less medicine. I bought 5mg of Amlodipine, but I can only take a quarter of the tablets, and the high pressure is 140mmhg and the low pressure is only 70mmhg, I still have headache and vague pain in the heart area, if I increase the dosage again, I am afraid that the low pressure will be even lower in the evening and at night, only about 65mmhg. Can you help me think of a way? A: You can increase the amount again, as for the low blood pressure at night is not a big problem, because at night people are in the sleep lying position, this posture position even if the blood pressure is low can ensure the brain blood supply, you can try. From the normal physiological law, blood pressure is lower at night than during the day, so you should not worry too much about low blood pressure at night. Q: Hello! My blood pressure has been relatively stable in the past few months under your medication guidance. I would like to thank you once again! I found a plaque in my right carotid artery last year in Beijing at the Ciming Medical Examination Center, but I did not pay attention to it at that time and did not take any medication. In addition, when I took my blood pressure, I found that the blood pressure values of my left and right arms were different by about 7mmhg each time, and the right side was lower than the left side. Usually, I used to measure my blood pressure on my right arm. Also, my tinnitus has been getting worse in the past two years. My hearing is also getting worse. Is it all related to this plaque? Is there any way to eliminate the plaque? I hope you can take some time out of your busy schedule again to answer my questions, thank you! A: The carotid plaque you found is an atherosclerotic lesion and you need to take a statin to stabilize the plaque. You have a history of liver pain from taking simvastatin in the past, I have suggested you to take pravastatin or fluvastatin, but now the newest one is Rosuvastatin which is more effective and has less side effects, we suggest you to take this statin, it is good for stabilizing and eliminating the plaque, 10mg/day at night before going to bed. Your left and right side blood pressure is not the same, but the difference is within the normal range, we suggest that future measurements should be taken on the higher side. Your tinnitus and hearing loss symptoms are the manifestation of cerebral arteriosclerosis and capillary blood supply deficiency and occlusion, if it is aggravated in the short term, it is recommended to use Salvia, Ginkgo biloba preparation or combined with Prostil (intravenous infusion) to improve blood supply as soon as possible, if the blood is smooth and sufficient supply the symptoms will disappear, but the effect of your 2 years history may not be very satisfactory, but will be reduced. If there is no effect at all, it means that the narrowing of blood vessels is relatively heavy, and then the tinnitus will gradually disappear, but you will be deaf.