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Dr. Ravoof
Dr. Ravoof, Doctor
Category: Medical
Satisfied Customers: 2366
Experience:  Experienced Physician in the field of Medicine and Surgery.
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My dad has had blood pressure and type two diabetes for

Customer Question

Hi, my dad has had blood pressure and type two diabetes for quite some time. No heart problems. He is currently taking candesartan 32mg in the morning, metoprolol 50mg in the morning and night, hydrochlorthiazide 25mg in the morning, aspiring 100mg in the morning, metformin 850mg at night, lercanidipine 10mg at night and gliclazide 80mg at lunch. Just recently he has had an episode of what dr says is postural hypotension. He felt dizzy and almost fell. He does sit up in bed before standing and dr has advised him to not stand in one spot for too long. She has suggested previously lowering his BP meds, but dad was concerned his BP might go up so it remained same. Just a few days ago after the episode, his BP measurements in the morning were low and also his heart rate was 50. Worried about his heart rate, he reduced his metoprolol and started taking 25mg at lunch (instead of morning) and 25mg at night. Before his BP readings were like 135-140/60-65 and now they are 140-148/70ish. Family dr is currrently on holiday and he will see her when she returns, but considering she had previously suggested lowering his BP med, is it ok for him to have lowered his metoprolol as he did? Is it appropriate? Also wondering whether postural hypo was caused by metoprolol or made worse by? And when you get post hypo does it also cause you to have low heart rate of is that because of the metoprolol that was previously taking in the morning? He felt he didnt want to take in the morning and add to the low BP, and decided to wait till lunchtime to take it and also decided to halve the dosage. He has struggled a bit with what dr says is isolated systolic hypertension for a few years now and his previous dr had said if BP was 150/70 its fine and wasnt keen on lowering diastolic too much but this dr had been ok with lower diastolic.
Submitted: 2 months ago.
Category: Medical
Expert:  Dr. Ravoof replied 2 months ago.

Dear customer,

Thanks for your question.

Yes it is in fact recommended that he lower the dosages as advised by his doctor in view of the postural hypotension. With diabetes his treatment goal should be to maintain the blood pressure less than 140/90 mm Hg.

Generally patients having an isolated increase in systolic blood pressure means a relative intravascular volume overload. This is the reason for the sensitivity that these patients have to diuretic therapy, even at low doses (ie, 12.5 mg hydrochlorothiazide or less). Therefore instead of lowering the metoprolol I would advice you to consult with his doctor about whether you can lower the dosage of hydrochlorothiazide or even discontinue it. Metoprolol is less likely to cause postural hypotension when compared to diuretics. Metoprolol may lower the heart rate.

So if he has been diagnosed with postural hypotension he will most likely benefit from lowering the diuretic medication and this should be done only after consulting his doctor.

Take care.

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