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Old 02-14-2008, 04:55 AM   #1
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Smile Calcium channel vs ACE

High all, Im 65 and 95 kg 210lbs 5ft 11", male caucasian

I had a scary time 10 days ago, when my blood pressure shot up from around 160/100 (which i knew was high and i should do something) to 225/125 bop 100 when i went to hospital for a check up. Of course the pressure spike was no doubt cause by anxiety (though i never knew it could be that bad). Strange thing is that i would never have know were i t not for my faithfull Microlife HBPM which Id bought about 2 months ago. I had no clinical symptoms

The doc put me on 10mg of Norvasc CCB and 20 mg of Enalapril ACE

He also suggested beta blockers for an irregular heart beat which id never had before. thankfully i declined his offer

So they had the desired effect and i now regularly (every 3 hours) test at around 120/70 resting bp 65-70 to 135/85 active with bp 85- 90

great result!

But what to do next cos this is a serious dose of meds. I should be aiming for the lowest effective dose

I am also on gembrifrazol to reduce my triglycerides (350 vs <200 target )
but i dont think they are of conern.

The side effects are

drowsiness (sleep 12 hours a day)
muddled and forgetful - cant do my computer work effectively
Sudden loss of interest in sex - my wife thinks i dont love her any more and frets. I just cant get my head around that area just now

I have researched the net but cant get any guidance (I suppose drug companies want you to take more not less

Which should I try for

One or the other ie 5mg of ccb or 20mg of ACE?
5mg of ccb and 10mg of Ace?

I can get generics at a 1/4 of the price but I ve read that generics dont always perform the same

Is one any better than the other. Is there merit in taking 2 types of meds?

bit like taking aspirin and paracetamol for a headache, I suppose

Id be very please to hear your observations

 
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Old 02-14-2008, 12:33 PM   #2
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Re: Calcium channel vs ACE

Hi,

I agree that 10mg Norvasc and 20mg ACE inhibitor seem an excessive dose given your age, weight and stage of your hypertension. One reason that can justify this dosage is a need for a quick blood pressure reduction in the presence of multiple risk factors for a cardiovascular disease (besides hypertension), or an attempt to prevent or lessen the end organ damage due to your previously UNCONTROLLED hypertension. Be glad that you found out about it when you did and that you have now taken steps to get your blood pressure under control. It sounds just about perfect now. I'd be very hesitant to experiment with the medication dosage just yet.

The reason the beta blocker was suggested as part of your drug regimen was the likelihood of the occurence of tachycardia, an adverse side effect frequently seen with the calcium channel blocker. (Unless other indications for the beta blocker were present as well) Because your dose of the CCB is at the daily recommended maximum, the chance that fast heart beat will occur at some point is considerable. I have heart rhythm irregularities with mine (same dose). Beta blockers counter this adverse effect by making the heart beat more slowly, thus reducing the cardiac output and the heart rate.

Under normal circumstances, people are started on low doses of BP medication. The choice of antihypertensives is based on the age and overall health of the patient (coexisting conditions are taken into account), cardiovascular risk assessment and indications for use of specific drugs. Unless contraindicated, one of the medications of choice is usually a diuretic. They are highly effective in blood pressure reduction. If and when you are ready for a reduction in your medication (as determined by your doctor), a low dose of a diuretic should be considered along with your reduced dose of an ACE inhibitor, unless contraindicated. I too am on 20mg ACE inhibitor. They are great for blood pressure control and highly effective when combined with the diuretics.

P.S. Is your CCB strictly for blood pressure control? If it is, you can eventually do very nicely without it.

Good luck!
flowergirl

Last edited by flowergirl2day; 02-14-2008 at 12:46 PM.

 
Old 02-19-2008, 03:53 AM   #3
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Re: Calcium channel vs ACE

FG thank you so much for your observations, most helpful (more than can be said for my dr but thats another story)

I am going to try and go on Enalapril 20 mg alone and cut out (gradually the CCB - Norvasc)
My pal is on this regime. I will add a diuretic HTCZ as suggested. There doesnt appear to be any serious risk or side effect with these (except peeing a lot to staart with)

Where I am the hospitals are so bad they dont take blood pressure correctlY (just put down a notional value of 140/90). One cheeky nurse didnt even bother with a stethoscope

thank goodness for my microlife HBPM - IMHO every one over 50 should have one

 
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