About Charles Cusumano, FMP, PA-C Expertise I will answer questions about the different causes of Hypertension; the complications; the treatments and the drugs used.Hypertension is a silent, potentially deadly disease that`s completely treatable. Knowledge is power.
Experience Nationally Certified Physician Assistant/Family Medicine Practitioner.
I've been in practice since 1975.
Organizations I am currently serving as an expert in the Family, General and Internal Medicine site right here at AllExperts.com. You can visit my profile there. I was also honored as a Distinguished Fellow in the AAPA.
Awards and Honors Distinguished Fellow American Academy of Physician Assistants
Question QUESTION: My wife, 69 yrs, is diagnosed as hypertensive patient for the past 2 years. First she was given the drug NIFEDIPINE 30 MG 1 TAB. daily @ Singapore, for one year.(2007)
When we came over to India, Indian doctors have prescribed the drug NICARDIA RETARD (BRAND NAME OF NIFEDIPINE) 20 MG daily for one more year (2008). In April 2009, she had an episode of guiddiness on postural changes for about a week. When we consulted the doctor, he stopped the drug NICARDIA RETARD and replaced the following drugs.
Her pressure is having wide range of fluctuations. At home, when we take pressure in DIGITAL B.P. Apparatus (TERUMO DIGITAL BP MONITOR MODEL ES-P110), the pressure will be in the average range of 100 to 120 systolic and 60 TO 80 diastolic. But whenever the pressure is taken at doctor's clinic, it will be in the range of 160 to 200 systolic and 90 to 100 diastolic. Doctor advises to continue medication prescribed by him. We are under the confusion, whether the patient is really hypertensive and she requires these drugs. Also we would like to know whether the regimen of the drugs prescribed is a good selection to control her fluctuating pressure.
Secondly we would like to know whether she has to undergo any lab. investigations, periodically, to rule out any side effects because of long term treatment by these drugs.
Moreover, my wife has undergone 320 slice CT Heart Scan in April, 2009 and the report was Soft plaque in 2 arteries.
What does this mean and what precautions she has to take in this regard.
I request your kind clarifications for my querries and advise for follow up.
ANSWER: Hi Balasubramanium,
Unfortunately, the names of these drugs you mention are not fmiliar to me. They are not any we use in the USA.
That said, if her pressure at home is in normal range, then it is a good possibility that her elevated readings are likely “white coat" in nature.
There are no specific labs to check for side effects of her medicines.
The soft plaque in two of her arteries simply means that she has partial blockages of the coronary arteries. She should probably be on, at minimum, an 81 mg aspirin a day.
She should also be on a plaque reducing drug such as Crestor.
---------- FOLLOW-UP ----------
QUESTION: Hi doctor
First of all, I thank you for your guidance.
I am giving the composition of each drug which is prescribed to control BP of my wife. I presume this could help you in advising me the side effects and suitability of these drugs.
1. SELOKEN XL: 100 MG
COMPOSITION: Metaprolol succinate 95 mg, equivalent to Metaprolol tartarate 100 mg
2. STUGERON
COMPOSITION: Cinnarizine 25 mg
PHARMACOLOGICAL ACTION: It inhibits contractions of vascularsmooth muscle cells by blocking calcium channels
3. TAZLOC-H
COMPOSITION: Telmisartan 40 mg & Hydrochlorothiazide 12.5 mg
Also when her LDL cholesterol level was in 180 range, she was given Simverstatin (in the year 2007) and the level was reduced to 112 mg% (in August 2008)and was advised to discontinue this drug. Since CRESTOR (cholesterol lowering drug advised by you) is not available in India, Can she continue to take SIMVERSTATN. I request you to advise me in this regard.
Answer Hi Balasubramanium,
Thank you for the clarification. So, she’s on a beta blocker, a calcium channel blocker and an combination drug of HCTZ and an Angiotensin receptor blocker. These are all powerful drugs. All are good in managing hypertension and helping the heart lessen its work.
I stll think she has whte coat syndrome. As long as her pressures at home are low, there is no need to change anything.
I thnk she should remain on simvastatin given her plaque issues. It doesn’t do the same job as crestor in reducing plaque but it will keep her LDL low (should be under 100). Also, an aspirin a day is a good idea as long as there are no reasons not to take one.
