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Ask Anthony Bray, MD Your Own Question
Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10337
Experience:  14 years experience in the field of Family Practice
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I had an stem put in almost 2 weeks ago, I'm taking blood

Customer Question

I had an stem put in almost 2 weeks ago, I'm taking blood thiner and high pressure medicing, still I have 93, 163.
Submitted: 11 months ago.
Category: Medical
Expert:  Anthony Bray, MD replied 11 months ago.

Hello!

Do you mean a stent put in? Where was the stent? >> heart? artery such as iliac or renal artery ??

What blood pressure medicine do you take?

Expert:  Anthony Bray, MD replied 11 months ago.

The high blood pressure is not automatically controlled by a single medicine > It may often take 2 meds and at times three or four to control it.

Blood pressure may creep up over time despite treatment . This may occur in particular if you have decrease efficiency of the kidneys. Renal artery stenosis may impair blood flow to the kidneys for example and this may lead to slower elimination of salts and fluids and thus your blood pressure may stay higher despite treatment . CKD = Chronic Kidney Disease is a common reason for chronic or increasing trouble with blood pressure control...

Your diet should be low salt/sodium of course as I'm sure that you know...

Let me know what meds you take adn other questions or points of discussion. I will be happy to get back wtih you!

Best regards ***** *****

If my answers are helpful and to your satisfaction then please remember to leave positive feedback. Thank you and Best Regards,

Anthony Bray MD

Customer: replied 11 months ago.
Hello Anthony, thank you very much for your help, I really appreciate your time. I'm sending you a file with information.
I'm 47, no diabetes, 134 pounds.
I'm taking.
Aspiring 81 MG ones a day
Atorvastatin 80 MG ones a day
Enalapril 5 MG ones a day
Metropolol 25 MG 2 time a day
Ticcagrelor 90 MG 2 times a dayThe stent was put in the left circumflex, if you have the time in the attached file is more information.Thank you again.
Expert:  Anthony Bray, MD replied 11 months ago.

Hello again!

Thank you for the added information . it sounds that you had a good result from the angioplasty and stent placement of the left circumflex vessel. So that is good.

With blood pressure you should keep in mind that it is the AVERAGE RESTING BP MEASURES THAT COUNT --- should be checked in seated position after 10 minutes rest ..

Your BP should be in range of 100 to 130/ 60 to 80 ( tighter control best with history of the heart disease )

If your average is close to the high blood pressure that you mentioned above then you should have your blood pressure medication adjusted

There are several options that may be considered to adjust your blood pressure medication and this if course will be up to your doctor ....

The enalapril is low dose I notice so I think that this could be increased or substituted for an A2 receptor blocker (Avapro , Cozaar , Benicar, Diovan as options ) Toprol XL at 100 MG A DAY would be an upward dose of the beta blocker ....so there are many options ...keep record of your PULSE AND BLOOD PRESSURE --- a good record of 12 to 20 readings is helpful for you to review with your doctor. The readings outside the doctors office help to rule out "white coat hypertension"

I hope that this is helpful for you

Let me know if you have further questions.

Best Regards!

Anthony Bray MD

Customer: replied 11 months ago.
Sorry I wasn't able to reply before or leave you a review, I spend Sunday and Monday in the hospital, I started with some chest pain and my family doctor told me to go to the ER. Everything ended ok, they did blood work and echo and things look good.
They changed my med's, the biggest change is from Ticcagrelor 90 MG 2 times a day to plavis one time a day. It looks like the side effects from Ticcagrelor were causing must of the problems, like shortness of breath, tiredness, diarrhea.
I feel mutch better and my blood pressure is 115 over 73, very big change, before was always in the 140,s ove 90,s all the time.
Here is my question, what do you think about Plavis, I understand about the bleeding, but I think that's must of the blood thiners.
Expert:  Anthony Bray, MD replied 11 months ago.

Hello again !

I'm glad that you are feeling better and that your blood pressure is doing well. I have used Plavix in many patients ( it works very similar to aspirin) as it makes blood clots less likely to form. You are right that anything that reduces clotting risk ( and therefore heart attack risk) will always increase bleeding risk in some way...bruising more easily is most common but other problems such as making a bleeding ulcer worse could be quite serious

The Ticagrelor is not one I have used much but yes it may cause side effects of shortness of breath and chest discomfort . It can reduce the efficiency of the kidneys and this well would explain your hump in blood pressure. So I'm glad that this cause was discovered and corrected for you. It sounds to me that your physician did a very good job for you here!!! Excellent work for you!

Let me know if you have further questions or concerns.I will be happy to get back with you.Best regards!!

Anthony Bray MD