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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10341
Experience:  14 years experience in the field of Family Practice
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58 yr old obese male, my blood pressure meds that had worked

Customer Question

58 yr old obese male, my blood pressure meds that had worked great for 10 years stopped working and my pressure hit 200/103. Was taking atenolol 100mg X1, HCTZ 25mg X1, benazepril 40mg X2. I also take metformin and wellbutrin for other problems and Xanax rarely.
Now I take atenolol 100mg X2, HCTZ 50mg X1, Isosorbide DN 10mg X2, benazepril 40mg X2. Plus my metformin and wellbutrin. I never had angina. The pressure is now 160 to 200 on the top number and 80 to 88 on the low number.
I feel terrible. I have taken the medicines for 2 weeks. I feel a little dizzy, tired, lightheaded, like the flu without the gastric symptoms. And it does not seem to be really doing the job.
What do you think of all this? Do you find this combination acceptable? Is there a combination with fewer side effects? I should mention my doctor does not want to try Norvasc because I took it many years ago and had some really bad reactions. What combination would you try?
Submitted: 11 months ago.
Category: Medical
Expert:  Anthony Bray, MD replied 11 months ago.

Hello!

I would advise that you have your kidney function needs to be checked and blood flow through the kidneys ...

If you should have renal insufficiency or renal artery stenosis then that may be a cause of very difficult to treat high blood pressure ...that needs to be checked in your case ...

I would recommend an alpha / beta blocker such as Trandate or Coreg probably one of these at a moderate to high dose ...

Plus an A2 blocker which is of her more potent than ACE inhibitor class but similar mechanism

Plus a diuretic I think ....

A + B + C in that order I mention above ....

There are many tools in the toolbox ...

You should have control to have resting blood pressure ( seated out of doctors office ) less than 135/85 for decent blood pressure control ...

I hope that this information is helpful for you

Let me know if you have further questions or concerns

I will be happy to get back with you

If my answer has been helpful and to your satisfaction then please remember to leave positive feedback Thank you and Best Regards,

Anthony Bray MD

Expert:  Anthony Bray, MD replied 11 months ago.

You likely may need a STRONGER diuretic than HCTZ at 50 mg

Lasix 20 mg per day would be stronger

An A2 blocker example could be BENICAR 40 MG

TRANDATE 200 mg twice a day

The above regimen is for example demonstarion but would be expected to be stronger than what you are on....

Expert:  Anthony Bray, MD replied 11 months ago.

I would check 24 hour urine for creatinine clearance ....

Serum BUN / creatine and electrolytes

Thyroid function checked

Echocardiogram checked

Serum calcium and PTH checked

Renal angiogram should be set up I think ...this to check blood flow to your kidneys ...

I hope that this is helpful for you

Best Regards!

Anthony Bray MD