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tazechip
tazechip, MD
Category: Cardiology
Satisfied Customers: 32728
Experience:  Yeard of experience in Critical Care Medicine
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My father had a heart attack in his LAD in Feb 2017 luckily

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My father had a heart attack in his LAD in Feb 2017 luckily they got in and stented had his EF tested three months later and it is 55%. All other arteries were clear. He was a heavy smoker but quit that day and has not returned to it. His BP after his heart attack and quitting smoking became very unstable. High during the day but would be normal later evening and night. He was put on double his beta blockers, 360 of Diovan, a diuretic to treat it. He is also on Brilinta and cholesterol meds with a baby aspirin which was all added post heart attack. His BP stabilized finally with double meds. Since then he has been walking daily, not smoking, and trying to eat healthier (he is only about 15 lbs overweight). A couple weeks ago he was getting very drained later evening and night. We started cking his BP 80/40 range which of course was too low. So the cardiologist took him off the diuretic and decreased his Diovan dose to 180 mg. He was also taking the Diovan at 12 pm every day so he changed to the morning. The last two days his early morning BP just 20-30 min after pills have been taken has been around 165/100 but mid day and night normal. His current schedule AM pills include 1, 180 mg of Diovan, 1 baby aspirin, 1 brilinta, 1 carvedilol max dose and his PM is 1 carvedilol max dose, 1 brilinta,cholesterol meds, and cialis.

Hello I'm Dr Chip

Thank you for all that information

Did you have a specific question about this?

Customer: replied 1 month ago.
I am worried about his early AM BP especially since he is on a blood thinner. I fear a hemorrhage stroke. Why is his BP so out of wack from AM to later? And any recommendations to get this more stable rather than allowing it to get so high.

I understand

What's his AM BP before he takes those pills?

Customer: replied 1 month ago.
The last two days it has been 165/100 range. He forgot his night pills on Sunday night so it made sense yesterday, but today it was the same.

OK

Were I his doctor, I would add another 180 mg of the Diovan at night to have his AM pressure better stabilized

So I suggest he let his cardiologist know about this

Please let me know if you need any more information

Customer: replied 1 month ago.
Thats the issue his night BP is low it was running 80/40

And what is the night time BP running now?

Customer: replied 1 month ago.
By changing the meds night time has been more desirable like 100/70

OK

Then as a different approach I would give him 50 mg of metoprolol at night

That shouldn't drop his PM pressure but it would help to drop his AM pressure

Customer: replied 1 month ago.
Is that another pill? What family is that in? Also would adding a fish oil supplement to his daily routine be beneficial to him?

It's a beta blocker medication

And yes indeed an Omega 3 fatty acid would definitely help

Customer: replied 1 month ago.
Last question. With his pressure being high in the AM and then normal the rest of the day how high is his risk for stroke? Thank you so much for helping.

Well since that pressure is only high for a few hours it's less likely it would cause a stroke but it still should be treated

My pleasure helping you here

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