Uncontrolled hypertension

A 60 year old female presents to the OPD with BP uncontrolled Her BP 3 months back was 212/100, then decreased, but in last two visits it has been 175/90 mmHg Her sugars are controlled History Known case of T2DM with HTN with lipid profile improved Investigations KFT, LFT,CBC - WNL S. Uric Acid - WNL HBA1C decreased from 12.2 to 10.9 in last 3 months Management She is currently on - Telista trio CL morning, Nulong 10 night, Vildapride M 50/1000 BD, Gibtulio 25 mg OD after lunch, Lipirose F 5 HS Will replacing Nulong 10 (Cilnidipine 10mg) at night by cardioselective beta blocker like Bisoprolol help? Or Moxonidine/Clonidine? What changes need to be instituted in BP management?

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Still hba1c is quite high Diabetic pt with hypertension gr4 Replace telmisartan with olmesartan or azilsartan Add metaprolol 50mg at bed time Control sugar with insulin and OHA

Thanx dr Anil Gangani
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NEED'S.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. FOR .. BETTER PROGNOSIS..WITH.. INSULIN .. OHA.. ENDOCRINOLOGIST OPINION.. R/O .. CAUSE OF.. HIGH BLOOD PRESSURE .. NEED'S.. METOPROLOL.. SR 50 MG.. TELMISARTAN.. / OMLESARTAN.. SALT RESTRICTIONS..

Tnx Dr Ashok Leel sir
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You have done good work in reducing HbA1c which surely is a difficult task in uncontrolled diabetes I may prefer to add a different group of medicine than replace it, hypertension is multifactorial disease. At high blood pressure level if only one group of medicine is given other factors may compensate for the decrease in blood pressure and thus keep the blood pressure constant. For example if only calcium channel blockers medicine is used then our body may compensate reduction in blood pressure by increasing the sympathetic tone and hormone, or by increasing production of more antidiuretic hormone and retaining more sodium Therefore it is important to add two or three drugs with different mechanisms to control blood pressure when the blood pressure is very high It would be difficult to achieve normal blood pressure with only one group of medication Diuretic is important group of medication when there is high blood pressure, it need to be one of the part of group of medication.

hypertension Rx If you are sure that it's not secondary or there is no underlying lesion. I have seen many patients in naturopathy centre getting controlled on high BP. They were taught of Jal neti / jal enema and pranayama. You may also teach it. It has to be performed daily.Though it takes only 30 - 40 minutes in morning total. Your Ayurveda dravya selection is fine

Thanks doctor, will try it too
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First r/o the cause of uncontrolled HTN,what about her CKD profile? Instead of bisoprolol add minipress xl and arkamine if still not controlled then add minoxidil 5 mg BD

KFT is wnl
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Strict control of diabetes Telmesartin + Amlodopine in morning time Tab Metaprolol 50 mg at bed time

Thank you doctor
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Consider clonidine or moxanidine Bisoprolol or carvedilol.

Your idia is alright But if start amlopin+atenol bds Whould u think it more efficient to lower down BP

I agree
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Dm- inj hai in hgt chart TDs Inj lantus 12 mg night time continue 1 month Htn- tab ctd 12.5 mg evening Tab telma am morning night time Tab atorva 10 mg od Tab ecosprin 75 mg od After 7 days repeat sugar fasting and pp

Rx Sarpgandha tab 2bd Muktavati 2bd Jatamansi tab 2bd Sanshamni vati 2bd

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