Heart & Cardiology/BP-metapolol etc

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Question
QUESTION: Dear Doctor

I have 1 cardiac stent for IHD. I originally suffered atypical angina 5 years ago and was stented.

Since then, I have been on a regular (normal) cardio regime of 1 aspirin, 50mg metapolol BD, 5mg amlodipine and a gastric liner. I also have raised cholesterol (moderate) and take simvastatin 20mg.
My doc offered me Verapamil instead of betablockers (because of ED) but the betablocker seems to give less symptoms. I occasionally take 25mg Viagra, from my cardiologist!

My problem now is that I seem to have a raised BP for 2-3 weeks. It has gone from a very good 120-80 to 140-95mmhg. I check it with a home machine. I was an ER head nurse for many years.

I propose to raise the metapolol to 75mg BD. Or should I change to Verapamil, which I have at home but don't use.

I will see my Cardio doc in 2weeks, but I am wondering what to do.

Thanks

paul

ANSWER: Hello Paul,

Yes, increase the metoprolol first.  If that causes impotence, lower it again and add the verapamil.  Then report to you doctor.

Please write back if this doesn’t answer all your questions.

David Richardson


---------- FOLLOW-UP ----------

QUESTION: Thank You Doc

Can I mix bblocker and verapamil? What should the 2 doses be? The verapamil here is 240mg 1 a day I think.

Does metropolol have xactly the same effects as verapamil? Why did my doc give me one and not the other? Is one, say, better for angina, and one better for BP? Is it normal to have more impotence with bblockers? Maybe I should change to Verapamil entirely?

I should add that I have a fatty liver and am 15kg obese. Is it OK to take so many drugs?

Thanks again

Paul

Answer
Yes, the can be mixed.  One 240 mg. of verapamil a day.  No, different effects  Both are good for angina and BP, verapamil a little better for BP.  Impotence with beta blockers is uncommon, but not unheard of.  It's okay to try verapamil alone.  It's okay to take verapamil and metoprolol together.  Please lose weight to prevent coronary disease when you're older.

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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