AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question QUESTION: Hello and thank you for your expertise; I'm a young 62 female and (except for elevated BP) in perfect health; I jog 2 miles a day five days a week, weigh 118 pounds, watch my diet, cholesterol 190, all blood work recently normal, take vitamin supplements and don't feel any different physically than I did 20 years ago. Now, the dilemma: about twelve years ago my then primary care physician (who was a cardiologist) put me on 50MG/Toprol XL once daily because my BP was (for me, who always had 110/70) elevated. Six years ago (after moving to another part of the state) my then physician increased this to 100MG/day because a one time visit my BP was 170/95 (I was very stressed out during this visit.) I've been walking around like a zombie for the past two years; because of increased exercise during the last two years I lost about 15 pounds and my resting BP was as low as 95/62 at night last month! So my present physician suggested I go off Toprol (very slowly) and I am now taking 25MG/day (reduced from 100MG/day over the past 4 weeks); however, 8 days ago he added Norvasc, originally 5MG/day which dropped my BP too low, 2.5MG a day as of today. So I am now taking: 25/MG day Toprol XL and 2.5MG day Vascor.
Since reducing the Toprol, my insomnia seems to be diminishing (I never KNEW this drug could cause insomnia/waking at 3AM, I've been suffering with it ever since increasing the Toprol come to think of it!), but this Norvasc is giving me diarrhea and a bad taste in my mouth. I've had diarrhea for a week now, began two days after starting the Norvasc. My BP was 113/79 at 10:30am (low for me at this time of day). I've been reading about these calcium channel blockers and frankly I'm getting pretty worried and scared. I have (proven benign) occasional PVCs and PACs (full cardiac workup was perfect) and I've read that Norvasc can CAUSE arrhythmia, last thing I need (I'm anxious enough as it is, have a depressed young adult child and my very elderly parent lives in my house!). I'm on the verge of telling my present Dr. that I don't want to take this Norvasc at all and will take my chances with Toprol at 50MG/day or try another beta blocker. CAN YOU ADVISE ME? Am I being neurotic here? Isn't my BP too low?? Do I need a BP medication at all now? I'm really confused; I don't know this present Dr. well enough to know if I can trust him and, frankly, I haven't had a Dr. I can trust in a long time. I appreciate any advice you can offer and apologize for sounding like a neurotic! :o(
ANSWER: By no means are you sounding neurotic. Taking your blood pressure at home (if you are not already doing this) would be a good idea. These values could be used to adjust your medications. There are multiple other medication classes other than a beta-blocker or a calcium channel blocker. That being said before another medication is added to the mixed or substituted for the Norvasc more blood pressure readings are in order. If you would let me know where you live I might have a name of someone in the area that I know who would have special expertise in hypertension.
Regards,
Domenic Sica, M.D.
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QUESTION: Thank you for your quick response; I live in Kingston, New York area. I'd appreciate any referral even if I needed to drive an hour or so up or down state. Also, is Norvasc SAFE or are the horror stories I've been reading on the internet about calcium channel blockers true? I'm in excellent health, I'd hate to drop dead because of a medication I might not even need. Thank you again.
Answer The problems with calcium-channel blockers are grossly overplayed. Much of the concern with these medications was misplaced and occurred 10-years ago. They are now shown to be very safe and effective medications. As to a referral the people I know best in that region are either in Valhalla (New York Medical College) or Farmington (UCONN). Let me know.
