Expert: Domenic Sica - 5/23/2009

Question
QUESTION: Many regards from Harsvadan from India. Sir, as you have responded my queries in the past, I am encouraged to ask you this query.

Currently I am on Tenormin 100 Losartan 100 and Indapamide 1.5 Amlodepine 10 mg. Recently in a reputed hospital, I had a healyh check up where all the parameters of the blood were normal except that my 2D echo stated Severe LVH with Dystolic dyfunction EF 65%. Cardiologist made changes ; He suggested Tenormin 100 to Bispoprolol 5 mg Telmisartan 80 in place of Losartan 100 Other drugs to continue. Further, he asked me to take Rosuvastatin 10 mg as according to him all hypertensive patients need to take statin. I have a BP Male 51 years My lipid levels are normal. I have a impaired glucose tolerance for which he suggested Metformin 500mg. I am now at a different place I do not know whether the change is a good one. I seek your guidance as to whether the changed drug regimen is OK. Mainly I have HBP ( Essential HBP)Tachycardia and IGT) I shall be highly obliged to receive your detailed



ANSWER: I would think tight blood pressure control is most important herein. What are your blood pressure readings running on the current regimen ?

Regards,

Domenic Sica, M.D.

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

QUESTION: It is around 135/90 140/90 consistently. Please also let me know whether the dose of atenolol 100 is bisoprolol  5mg or 10 mg.  

Answer
It more closely equates with 10-mg of bisoprolol. If the degree of left ventricular hypertrophy is what it is then your average blood pressure over 24-hrs is probably higher than the values cited. You might speak to your physician about how best to bring your blood pressure down to a systolic of 120-130 mm Hg. An increase in the indapamide dose might be one consideration and/or the addition of the drug spironolactone. Your treating physician no doubt should have the final say in this.

Regards,

Domenic Sica, M.D.