Which ARB to start with in HTN with hypothyroidism & episodic sweats?

50 years female, with history of hypothyroidism for past 9-10 years, with hypertriglyceridaemia presenting with recently diagnosed hypertension 136/90 average on ambulatory measurements with complaints of episodic sweating lasting for less than one minute, 7-10 episodes per day, aggravated in warm temperatures. Was started on Lisinopril 2.5 mg OD, BP came down, but with persistence of episodic sweats and lisinopril induced dry cough. Renal function tests and routine haematological parameters are WNL. 1. What would be the ideal ARB to start with? 2. What may be the aetiology for episodic sweats?

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May be Post menopausal hot flashes In menopause oestrogen levels reduced overstimulate thermal regulatory centre in hypo pituitary, with sometimes mild changes in temperature leads to excessive sweating. Each episode last from 30 Sec to 10-15 mins & occurs from 1 to 10- 12 episodes a day. Other causes Thyroid disorder DM IHD Autonomic dysfunctions Stress Infection Cancer Rx Treat underlying causes if any Menopausal hot flash—> no treatment Try Low dose fluoxetine, venlafaxine , peroxetine Propranolol Vitamin E Clonidine if h/o HTN Stress relief- yoga , meditation HRT- hormone replacement therapy by expert Gynaec only

Thank you for your opinion. And, the explanation too.
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Postmenopausal women with bp 136/90 I don't think need to be classified as hypertensive and need to put on antihypertensives Rather needs to be treated for postmenopausal syndrome So far ARB concerned you can use any one now a days telmisartan or olmesartan are used But in this case particularly with hypothyroidism and c/o sweating episodes i will prefer propanolol in sustained release form unless contraindicated

Thank you for your valuable opinion
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Need to check Thyroid profile ,to see whether there is drug induced hyperthyroidism Anxiety as a cause of sweating to be considered. Lipid friendly beta blocker like nebivolol can be tried instead of ARB. Prediabetes with hypoglycemic episodes need to be ruled out.

Thank you doctor
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Causes of sweating Post menopausal Infection Hypothyroidism Hyperparathyrodism get PTH check Cancer IHD dM Start ARB tab lisinopril 2.5 od Adv : Renal Doppler study, ECG, ECHO , TFT, PTH

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Start Telmisartan 40 mg od Check for fasting and post prandial blood sugar

Thank you for your opinion
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