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Dr  S.A.Alam
Dr S.A.Alam, Doctor
Category: Medical
Satisfied Customers: 3686
Experience:  MBBS/FCPS(R)/MRCP(R) U.K
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I have been using Telma 40 for the last 10 years

Resolved Question:

I have been using Telma 40 for the last 10 years since my LIMA/LAD single

artery minibypass . I take 1 tablet every morning . However , my BP systolic still

jumps upto 150 , but the dystolic is always 70/80 . Should I think of changing

my drug or change the dose . My pulse rate usually is on the low side 58/65 .

My age is 75 .
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Su S replied 2 years ago.
Greetings,

How is your usual systolic pressure? Is there any other symptom?


Regards.
Customer: replied 2 years ago.
The usual systolic pressure is 135/140. I would like it to come down to 120.
Expert:  Dr Su S replied 2 years ago.

Thank you for the input.


Blood pressure may change over years. As people age, systolic blood pressure can be higher. I feel you will need addition of other medicines. A small dose of diuretic is often necessary. You can discuss with your doctor.


Any query, please feel free to ask.
It will be my privilege to assist you.
Regards.

Customer: replied 2 years ago.
I missed out one thing. I am also using cardinsiel 2.5mg. Can Telma be replaced by another medicine in order to bring the systolic pressure to 120? How about Olmesartan Medoxomil 20mg?
Expert:  Dr Su S replied 2 years ago.
Olmesartan & telma belong to the same group. If you feel difficulty with telma, your doctor can change it. Cardensiel is beta blocker. It can lower the heart rate.
Customer: replied 2 years ago.

 

 

I would like to know if after using Telma 40 for 10 years it has become less effective . Would change help . Any safe drug you would like to suggest .

Expert:  Dr Su S replied 2 years ago.


I believe telma is working.These group of drugs or ARBs are usually safe. When you are taking for 10 years, it is probably not a problem. You likely need to increase the dose or medicine. It has been observed that in some stage a water pill is helpful.

Customer: replied 2 years ago.

 

Final question. What is water pill . How does one get it .

 

Can you suggest a way I can give up these medicines

Expert:  Dr Su S replied 2 years ago.
Water pills are also called diuretics. Common ones used in case of high blood pressure are indapamide, hydrochlorothiazide. You need to consult your doctor. He can prescribe it after evaluation whether it will be suitable for you.
Customer: replied 2 years ago.

 

I am not satisfied with your reply and info . I would like to know how to bring

 

down my BP to 120/70 . Finally , how reliable is OMORON electronic meter .

 

Expert:  Dr Su S replied 2 years ago.
Sorry I am opting out of your question, & let other experts help you.
Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

Welcome to JustAnswer and thank you for your question.

I am fellow expert in cardiology and will try to help you out.

It is true that medicine over time can become less effective because the blood vessels become more hard due to deposition of plague and calcium in them.
In your case best option is to increase the dose of telma, as your heart rate is already on the slow side so we cannot increase the dose of cardensiel as it will further lower your heart rate.
I hope this helps.
Let me know if you have more questions.
Have a nice day.
Customer: replied 2 years ago.

Is TELMA 80 available . Will it be unsafe to switch over . Will OLMESAR be better . My brother has found it very effective and his BP remains 120/70 .

 

What about taking Telma40 , morning and night .

 

Finally , my pulse rate remains steady between 56 and 64 , which probably is low . Should I give up Cardensiel . What should be the ideal Pulse rate .

 

Please advise satisfactorily so that I can release the payment . Thanks !

 

 

Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

Thank you for your reply,

I would recommend taking telma 40 in the morning and evening as twice daily dose always gives better control of blood pressure then single dose.
Olmesar is an alternative and can be used but there are no studies that have shown this medicine to be superior to Telma. So i would continue you on this medicine and will increase the dose to 40mg twice daily.
Yes your heart rate is low, we usually keep the heart rate from 60-70b/min, if you do not get dizzy spells, blackouts then this heart rate does not need to be increased and is fine.

I hope this helps.
Let me know if you have more questions.
Have a nice day and keep in touch.
Dr S.A.Alam, Doctor
Category: Medical
Satisfied Customers: 3686
Experience: MBBS/FCPS(R)/MRCP(R) U.K
Dr S.A.Alam and 7 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

Is it safe for me to give up taking Cardensiel . Tachicardia was detected a couple of years ago, and the doctor put me on to this medicine . I am keen

to minimise the medicines I am taking . Is it acceptable to give up Cardensiel

and see what happens . If pulse rate shoots up I can start again .

 

I am feeling a bit lazy and tired after some physical effort . Could it be

due to low pulse rate .

 

Please advise .

 

Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

Thank you for your reply,

You cannot take off this medicine by yourself as suddenly stopping this medicine leads to withdrawal symptoms which can present in the form of uncontrolled fast heart rate, may also lead to tacharrythmias.This drug needs to be taken off slowly, around 30% dose decrement every 2 weeks is an ideal plan.
Yes your laziness and tired feeling can be due to slow heart rate.
I would recommend lowering the dose rather than completely taking off this medicine, just to keep the heart rate in the range of 70-80 beats per minute.

I hope this helps.
Have a nice day and keep in touch.
Customer: replied 2 years ago.

I guess you are right . I am taking 1 tablet of 2.5mg every morning . Is there

 

a smaller dose available . Please advise .

 

Thanks

Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

Thank you for your reply,

They are available in most countries, you can check for the local pharmacy for this. Even if not available you can split the 2.5mg tablet into half.

I hope this helps.
Have a nice day.
Customer: replied 2 years ago.

Doctor ,

Ever since my single graft LIMA/LAD CABG operation 10 years ago , I have

 

had a rather painful keloid on my 3 inch incision on my sternum . I have tried

 

a few treatments like lasers and creams , but of no avail . I have read thru

 

GOOGLE that certain Silicone Gels are very effective . Could you give me some

advice on this .

Thanks

Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

Thank you for your reply,

Yes these silicon gels have been recommended in the treatment of keloid scars. Combination of steroid creams, vitamin E and silicon have shown better results when used in combination.
see this web address.
http://emedicine.medscape.com/article/1057599-treatment

I hope this helps.
Customer: replied 2 years ago.

Doctor,

 

This concerns my BP . You had prescribed extra Telma 40 at night and reducing

cardensiel to half of 1.25 mg in order to reduce my sistolic and increase my

pulse rate ( see previous mails ) . My pulse rate still is 52-60 , and sistolic 120-160.

 

Please advise .

 

Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

Thank you for your reply,

With lowering the dose of cardensiel to half the pulse should have gone up rather then becoming more slower.
Also increasing the dose of Telma should have reduced the blood pressure as this is almost twice the dose you were taking initially.
Normally this should not happen, only options i can think of is some underlying cardiac event that may have gone unnoticed, needs blood tests like troponins, ECG to see if the slow heart rate is due to some heart blocks it is very common with ischemic heart disease. And other possibility is electrolyte imbalance.
I hope this helps.
Let me know if you have more queries.

Customer: replied 2 years ago.

Hello ,

Thanks for replying . Its scary to know that I could still have cardiac problem.

About 18 months ago I was started on 5mg Bisoprolol in India. In Mauritius after a TMT

doctor reduced it to 2.5mg. Now last 4/5 days I reduced to 1.25mg after advice from you . I wonder if needs more time to increase the pulse rate . It is only my systolic

that worries me . Dystolic is always 65-75. Which is more relevant and important.

What is your opinion on electronic BP meters. Are they pretty reliable.

Which troponin( I or T ) test should be done . And what electrolytes .

 

 

Expert:  Dr S.A.Alam replied 2 years ago.
Hello,

THank you for your reply,

Electronic meters are not as reliable as the mercury meters.

Troponin I is more sensitive.

Serum potassium, sodium, calcium are more useful.

It is possible that it needs more time for the heart rate to recover. It can take 2-3 weeks for the heart rate to recover.

I hope this helps.

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