Uncontrolled Hypertension

60 years female, who had reported to me with generalised fatigue and uncontrolled sugar and BP HBAIC - 9.7 S.Cr - 0.7 LDL 130 K+ - 4.5 She was already taking Telista AM 80 so I changed and put her on combination of Telmisartan 40 + CH 12.5 + Cilnidipine 10, I also added Cardivas 3.125 BD to the treatment Her sugars are better now, FBS 90 and PPBS 140 Her Morning BP is in the range of 150-160/80-95 At my clinic today it is 186/111 Management Which should be the next drug to add? Moxonidine or Spironolactone

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Better keep antihypertensives in divided doses Telmisartan+chlorthalidone in morning Tab metaprolol 50mg at bed time Rest you can continue keep followup

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First of all know etiology of raised BP , Need Clinical investigation, DO ECG, 2 D ECHO, CXR P/A, SERUM ELECTROLYTE, RFT, USG W/A, Add. Diuretics 10 mg od, Met xl 50, ECOSPRIN AV 75/10 Clinical Examination

Since how long he is hypertensive.? Rule out secondary hypertension . Do RFT including s Na + K+ , Serum Renin , TFT

Sir, TFT, NA, K all are normal
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Get a baseline ecg & echo for left ventricle status & cardiac status, rule out obstructive sleep apnea, BMI , look for renal or endocrine cause also . Atorvas & ecosporin to be added with ongoing anti hypertension medication

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In absence of secondary cause,,, I think centrally acting AHT like Prazocin can help to control BP..

I am agree with@Dr. Shivraj Agarwal Sir.

Change her bp medicine To Tab. Met -xl 50 1-0-1/2 Tab. Telsartan 40 1-0-0 Tab. Ecosprin 75 mg 1-0-0 Tab. Stator 10 mg 0-1-0

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And see after 15 day With medicine advice her to reduce salt. And fatty foods Start regular walking. And take rest

Adv echo and renal Doppler. Rft Fundoscopy Gradual reduction in BP. USG abd pelvs.

Can also consider prazosin ( mini press xl )

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