Hypertension/hypertension

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Question
Indian living in India,Age 67,weight 85 Kg,height 175cm, Hypertension- 180/95, Vegetarian but do take dairy products,no hard drinks,no smoking. 2-3 cups of tea with milk and sugar a day,
Have been on Loram 5,(Generic Name : Ramipril)
Therapeutic Classification : ACE Inhibitors- for last 2 months on physician.s advice but BP still runs high.
Have prostrate problem-no medications yet for that

Answer
Hello, Mool.

Your blood pressure is very poorly controlled and if it is not kept below 140/90 you will be at high risk for heart attack, heart failure, stroke and/or kidney failure.

First, you need a low salt  (sodium) diet. You should have no added salt to your food, either at the stove when it is prepared or at the table when it is served.  You should not eat food that you can see salt on. You should not eat canned foods nor food that comes in a plastic vacuum wrapper (like processed meats).  These are all preserved with salt. This is approximately a four gram sodium diet, is tolerable and facilitates good control of blood pressure.

Secondly,  Your dose of ramipril is much too low.  It should be increased to 10 mg/day and then to I'm/day a week later if your BP remains above target.

Thirdly, if your BP remains above the target of 140/90,  I would ADD hydrochlorthiazide (HCTZ) 25 mg per day then a nondihydropyridine calcium channel blocker like norvasc (amlodipine), two weeks later, if your blood pressure is still too high.

If the above is not adequate in controlling your blood pressure, then,  I think you need to see a nephrologist to be evaluated for resistant hypertension as there could be something causing your elevated pressure, like a narrowing of one of your renal arteries. First, however, the above treatment needs to be carried out.

Hope this is helpful.  Good luck to you and feel free to follow up is anything is unclear.

Dr Falkinburg  

Hypertension

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Newell R. Falkinburg, M.D. FACP

Expertise

Any question regarding hypertension or clinical nephrology

Experience

35 years of experience in the field of nephrology & hypertension. Emeritus Professor of clinical Medicine at a major medical school and director of Nephrology & Hypertension at a university affiliated medical center.

Education/Credentials
M.D. Board certified internal medicine Board certified Nephrology & hypertension

Awards and Honors
Fellow, American College of Physicians

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