I have been on the Lotrel over six weeks now. The botton part of my BP reading has lowered to around 73 as an average, but the top part is still around 144 to 150. I am exercising, not eating salt. What else can I do. I mentioned to the Dr. that Lotrel has a stronger pill than the 5/10 I am taking, but he said that this was working and to give it some time. Can anyone tell me if a stronger dose is needed? How much time di I give it?
The good news- Your doctor isn't one of those alarmist pill pushers! A rare bird indeed!!
The bad news- Lotrel 5/10 in theory should have kicked in by now. 4 weeks is usually time enough for optimum results.
However, there's absolutely no harm in waiting a few more weeks just in case you need that extra time..not everyone responds to a drug in pure "textbook" fashion.
Next step would be to up the dose. You're diastolic is great but your systolic just may need that extra "push".
Are you monitoring your own BP at home?
Apart from regular exercise (are you doing about 30 minutes of something daily?) and being extra vigilent about sodium intake (throw out the salt shaker and read labels on everything...aim for less than 2400mg sodium a day), try to eat more fish and reduce your intake of trans and saturated fats drastically.
Eat plenty of fruits and veggies.
And last but not least-----
Try not to obsess about your BP too much! You're very close to good #s. Most of us here on this board have had to experiment at the beginning. Too bad one pill doesn't fit all!
It seems you've given a pretty potent beta-blocker a fair trial and it failed.
If I were you, I'd replace it with either a diuretic like HCTZ or clorthalidone, or else I try an ACE Inhibitor; if you cough, then go to an ARB.
Better to try ha alternatives than to rely on rules of thumb.
My first trial would be a thiazide in case you are very salt sensitive. Then you can let up on the salt-fasting, which is a chore, I know.
Everybody is different and the best way to find out what works for you is by trial and error.
Stress typically affects the systolic more than the diastolic pressure. If you are feeling stressed, try to do things to combat that - get plenty of regular cardio exercise, do some deep breathing exercises, try meditation or prayer. Eat plenty of low-calorie vegetables, such as celery, peppers, broccoli, cauliflower, spinach, tomatoes, etc. Celery, for example, contains a mild diuretic, and other contributions from the vegetable group help give one a calming effect and assist with BP control. Eat fruit, too, just don't go overboard because of the sugar content. Reduce the amount of empty carbs in the diet.
Since your diastolic pressure is already good and your systolic doesn't have that far to go, the above recommendations just might be enough to get things down to normal, depending upon what your stress level and fruit/vegetable intake already is.
I have an alergy to Sulfa so I can't take a diuretic . I do try to eat veggies as much as possible. Thanks for the celery tip, I plan to load up on celery as a basic snack. This morning the top # was 159/73 so something isn't right. I do take my BP at home, and believe it or not, I get better results at home than the nurse gets at the Dr.s office as it is often higher when she takes my BP.
Ethacryinic acid (Edecrin) is the a diuretic for people who have an allergy to sulfa. I have no experience with it but maybe you could give it a run for the money.
The University Of Saskatchuan School of Pharmacy also recommends these three alternative diuretics:
amiloride, spironolactone, triamterene.
Medscape recommends these:
Loop diuretics are grouped in what is typically labeled the "first line of defense" for the treatment of congestive heart failure (CHF). They are also the diuretic of choice for patients who are refractory to other diuretics or present an allergy to sulfa containing medications. To relieve excess extracellular fluid volume and to regulate vascular osmolarity, loop diuretics are the most potent and expedient diuretics available. Loop diuretics inhibit the reaborption of sodium, chloride, and potassium ions in the ascending loop of Henle. It is also believed that loop diuretics cause renal vasodilatation and a transient rise in glomerular filtration rate. The combination of increased renal blood flow and the prevention of the sodium-potassium-chloride co-transport system allows for a patient suffering from CHF to excrete large volumes of fluid and electrolytes (primarily as sodium chloride) in their urine. These agents in conjunction with anti-hypertensives and adrenergic blocking agents act to potentiate the management of hypertension resultant of CHF. Loop diuretics have systemic hemodynamic effects: increased venous capacitance (which reduces left ventricular filling pressures or preload), increased ejection fraction (an indicator of improved ventricular function), decreased systemic and peripheral vascular resistance (reduced pulmonary, organ, and extracellular edema or afterload) which all allow for a reduction in blood pressure and cardiac workload.
Loop Diuretics Commonly Used In Heart Failure Treatment