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هدية لا تغبطوا الأحياء إلا على ما تغبطون عليه الأموات الفعاليات القادمة
استطلاع الرأي إلى أي مدى تعتبر أنّ الدراسة النظريّة للطبّ في كليتنا ستخدمك سريرياً في المستقبل؟ أعتبر أنّ الفائدة معدومة في ظل النظام التدريسيّ الحالي. 29% الفائدة كبيرة جداً، وهي أساس التميز العملي. 6% الأمر نسبي، يختلف من طالب لآخر، ومن مادة لأخرى. 66% عدد الأصوات: 345 أهلاً بك ! تفضل الإبحار |
 
I need your advice
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hypertension dilemma, I suggest the following:
first of all, life style modification is mandatory, she need to exercise and to loose weight by diet changes "i.e become vegetarian", I know you’ll say that she can’t, but there are some programs for people as sedentary as she is, I will try to look online for some exercises and will link you later.
Meanwhile, take renal function , liver function, EKG, later she may need ultrasound cardiograph to assess the cardiac function complications to such long term uncontrolled hypertension.
Keep on the regimen you are using now, even though she is on high doses of anti-hypertensive medications, their side effects are much easier than an ischemic attack “hypertrophic cardiomyopathy”, and way much easier than intra-cranial bleed or stroke.
Also, you need to take down a little of beta blocker “target heart rate is 55-60”, so she is bradycardiac… I believe 100 mg atenolol daily are sufficient, and to increase her dose of ACEI and CCB, because it’s safer as the highest dose is still far away which is 40mg/day. and the highest dose of amlodipin is 10mg/day, if you don't want to increase the CCB dose, i believe you can safely use nitroderm pathcs 10mg/day, it is safe and it can be helpful antill you've figured it out, long acting isosorbide dinitrate is also safe...
the msot important thing is, if she can't take her medications regularly, then she has to break her fasting and pay "KAFFARAH", Islam do not take blame for patients, they have the right to break their fasting if they need to.
this was a small, inexperienced, internal medicine resident opinion.
the strongest suggestion, and the safest one of all is, to go all the way to Damascus and discuss the case with a fine cardiologist.
best wishes الله يحميلك ياها ويخلليها فوق راسك.
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I wish I could help but your grandma is 4 times the age of my oldest patient. sorry, hope she gets well soon
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according to uptodate there is not additional benefit of atenolol doses over 100mg daily
regarding lisinopril the maximum does is 40 mg daily and for amleodipine it is 10mg daily
for nitrate, I think there is no use of it in treating HTN ?!!!!
anyway I put her now on 100mg atenolol, 20mg lisinopril and 5mg amleodipine and her BP reading is in the area of 160/90
I can do nothing more
thanks again for your advice
وَلاَ تَمْشِ فِي الأَرْضِ مَرَحًا إِنَّكَ لَن تَخْرِقَ الأَرْضَ وَلَن تَبْلُغَ الْجِبَالَ طُولاً
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you're welcome.
about nitroderm patches "لصاقات نتروديرم أكيد شايف منها" 10mg/day, there main use is ischemic heart disease not hypertension, but the do reduce blood pressure, i asked you to use them untill you find a better way. 160/90 is still VERY high for a person with ischemic heart disease.
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Actually I realized that a main cause of the huge gap btw the first world and the third one is the patients themselves
the cause of my grandma consistently elevated BP is that she secretly take some OTC medication for cough which contain cortisone, she would never have talk to me about it, but yesterday while I was semi asleep, I heard her talking with my mom about it and that she shall not tell me about it as she know I will through it away
thanks again for your support
وَلاَ تَمْشِ فِي الأَرْضِ مَرَحًا إِنَّكَ لَن تَخْرِقَ الأَرْضَ وَلَن تَبْلُغَ الْجِبَالَ طُولاً