AboutDr. Ravindra Bhaskar Ghooi Expertise I can provide information on drugs and medicines, their actions, uses, interactions and adverse effects. To avoid confusion, generic names of
medicines may please be provided. I am a pharmacologist, having worked
on animal and human pharmacology, and presently I am the Dean of Bilcare Research Academy, where we teach courses on clinical research. We dont work on saturdays and sundays, hence questions reachng me on these days will be replied on Monday, please bear with me.
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: Hi Harsvadan,
LVH is not a disease but the market of a heart disease. Due to excessive load on the left ventricle it has gone in hypertrophy. You are on losartan and atenolol, both these drugs work well in LVH, though losartan is a shade better than atenolol.
None the less after a trial in Spain the authors concluded that "We conclude that bisoprolol reduces left ventricular mass, preserves systolic function, and improves diastolic function of the left ventricle in hypertensive subjects with left ventricular hypertrophy" We thus have emperical evidence that in people like you (with LVH and essential hypertension) Bisoprolol is a an effective drug.
For this reason I would accept the change from atenolol to bisoprolol. The side effects of bisoprolol are lower due to its lower oil/water partition coefficient (a property that decides how much drug enters the brain).
Coming to sugar control, since you have only IGT and not frank diabetes, one could say that your could control blood sugar with exercise and diet. Yet if we look at the cardiac risks that you have, (I recall you spoke about your weight problem) I believe you have hypertension, a lot of stress, over weight and probably not a very active life style. This puts you in high risk of cardiac disease.
For such cases I would advice every precaution, rosuvatatin or atorvastatin would be good and even an aspirin a day.
After all we are not merely trying to prevent cardiac accidents we are aiming towards a high quality of life.
I think the new doctor is right and his recommendations are good.
---------- FOLLOW-UP ----------
QUESTION: Many thanx for the detailed and elaborate response. I shall adgere your advices. I need your comments for change of losartan Dr has suggested telmisartan 80 in place of losartan 100 Is this change desirable Thanx
Answer Hi Harsvadan,
Sorry I missed out the issue of telmisartan versus losartan. A comparative study between these two drugs concluded as follows:
"In a meta-analysis of two flexible-dose studies, telmisartan produced superior reductions in blood pressure than losartan. These data are from two 8-week studies in 720 patients with mild-to-moderate hypertension.1 Patients were started at the lower dose, with up-titration to the higher dose allowed if seated trough cuff DBP was ≥90 mmHg at Week 4. By Week 8, the reduction in SBP and DBP in the last 6 h of the dosing interval was greater in the telmisartan arm than in the losartan arm. Telmisartan-induced reductions were also greater for the majority of the observed hourly mean ambulatory SBP and DBP values over the entire 24-h dosing interval. 1. Smith DH, et al. Comparison of telmisartan versus losartan: meta-analysis of titration-to-response studies. Blood Press Monit 2003;8:111–117."
So I think telmisartan is a superior drug, there is advantage in making the change.
50 mg of losartan costs between Rs. 20 to 40/10 tab while telmisartan costs around double this amount, so economics is an issue, when you are on a number of medications. There si a lot of variation in prices of these drugs hence you should compare the prices carefully. You will detailed prices of all brands on www.medlineindia.com
Ravi Ghooi
