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: Sir, As everybody knows presence of Type 2 DM and Hypertension both increases risk complications. My Dad-in-Law is 58 years old and diabetic & hypertensive for last 25 years. He was on Lisinopril + Amlodipine(5mg) for hypertension and Glimepiride + Vlidagliptine for diabetes. He is on a strict diet control & exercise programme. He has no diabetic retinopathy , nephropathy (microalbuminuria)or no macrovascular complications. He is experiencing edema in b/l foot for last 1 month. Doctors couldn't established any organic disease. I strongly suspect Amlodipine as a culprit. I am going to add diuretics to him. Will changing from Amlodipine to Cilnidipine will help? Should i change the drug altogether to Beta blocker though he has no Ischemic Heart disease? How much diuretics & beta blocker will affect his sugar control? What should be the best regime from him?
ANSWER: Amlodipine can cause peripheral edema but not by a mechanism that involves fluid retention; thus, diuretics do not help this form of edema. If amlodipine is the culprit then stopping it for two to three days should resolve the edema. If so, then consideration can be given to either lowering the dose of going to another drug class. If amlodipine was the cause of the edema then clinidipine is likely to produce edema as well. Not knowing what his current blood pressure is or what the goal blood pressure is for him it is hard to tell you what might be effective substitute drug classes. A low dose diuretic is usually quite effective for blood pressure reduction when combined with a drug such as lisinopril. I would probably do that first before adding a beta-blocker.
Regards,
Domenic Sica, M.D.
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QUESTION: His blood pressure goal is < 125/85 mmHg. But he is maintaining blood pressure of 135/85 mmHg. ACE inhibitor + Diuretic will probably not address his goal. Should I add beta Blocker like Metoprolol Extended Release?
Answer The addition of a beta-blocker to lisinopril typically would not offer that much incremental benefit for blood pressure reduction unless the patient has a prevailing high heart rate. I am puzzled by your belief that a diuretic does not lower blood pressure further in a meaningful way when added to an ACE inhibitor. Everything I have written in this area and a huge amount of published literature states otherwise. However, each patient is unique so maybe there is some difference relative to your father-in-law that I would only appreciate if I was formally seeing him. You can best test your theory by adding the beta-blocker with the proviso that it is not titrated too high and his heart rate does not drop too low.
