Stubborn BP

[007INMAINE]

Arrggh!
Here goes: I'm a 48yo woman, significantly overweight (5'1" and 175 -- but I wear a size 12 -go figure). ..I have had somewhat elevated BP for several years. (140/90) back in the 1980s. I def. have a stress issue with doctors, but even trying to take it at home, i just get the monitor out and already I can feel my heart rate shoot up anticipating disappointing ratings, and the fear assocated with the seeming fix my BP what's WRONG WITH ME?)
Until this year, have made VERY INFREQUENT trips to DR. (once in 1988, then had gallbladder out in 1993. (After operation, lying in bed BP was 120/70) Weighed about 160 then.)

Had partial physical in 2000, and finally full physical in 2003 - all fine except too fat and high bp. Now reading is about 180/90-95) but it fluctuates a lot.

I am active. I SIT A LOT AT WORK. I MEAN 9 HOURS A DAY. But I do take a walk (1 mile) in afternoon. Also walking 2 miles a day on treadmill at 10% incline, (3.5 mph) take the stairs all the time, etc. and I FEEL GREAT! Lots of energy, etc. I have been much heavier at times in my life. I was 110lbs when I got married!!! I am a stress/emotional eater, and I've got plenty in my life these days. I won't bore you with that. who doesn't.

TESTS DONE: Renal stenosis, negative. Urinalysis for adrenal tumor, negative. Complete urinalysis. Normal. I am not short of breath, have no fatigue, chest pains etc. all other tests NOrmal, cholesterol is 215 (but ratio is TERIFFIC).
(I have had bad periodontal disease in the past but is under control now. related to heart problems?)

MEDICINES: Started atenolol (50mg) in Oct. and HCLT, 25 mg. NO change.
By Jan. added Altace (10 mg) once per day. No change. When I went to the office to have it checked one month after starting the altace, it was 180/100. I rested for a few moments (she took it lying down after and without my speaking) and it dropped to 160/84.) that was the nurse pract. When I told the doctor she had done that, the doctor pooh poohed it.
Now I am on HCL, altace(10 mg) and metaprolol (generic) 50 in am and 50 in pm.
I was only on that for five days when I had to stop it for two and take my renal stenosis test. (I had NO REBOUND when I stopped for 48 hours, pulse stayed at about 65 or so but was up to 80-plus by the time of the test)
Butwhen they took my BP during between the two cat scans (I had a really positive experience there, I felt somewhat relaxed) it was 180/98 first read, 160/88 second read, 172/91 and then 175/98 (took it every 15 minutes for one hour).

I am back on the metoprolol now, with the altace and HCL, have Dr. apt. May 25.

I HAVE NO SIDE EFFECTS FROM MEDS. BUT THEN IT DOESN'T SEEM LIKE THEY ARE DOING ANYTHING EITHER.

I do get swelling in my ankles and lower legs. This has been happening for years whenever I get over 170 pounds. Under that, it does not seem to happen. And when I am this heavy, if I work out and sweat, plus drink LOTS OF WATER, it seems to go away, also.

Doctor obviously wants me to lose the weight, but does not think it's a really big factor in my BP, or the determining factor, anyway.

I don't watch the salt as much as I should. But I don't use the shaker or eat prepared foods. I drink decaf.

I know there are many kinds of meds out there. Maybe they just haven't hit it yet. Norvasc? Who knows. Any ideas?

DASH diet?
All suggestions welcomed.

SORRY FOR THE LOOOONNNNGGG POST.

OO7

[zuzu8]

007,
Welcome to the boards

Well.
Firstly it certainly seems that your physician/s have covered and ruled out the possibility of secondary causes of your hypertension.
There are some alternative med combos you may try, but when hypertension persists on a 3-drug regimen it is also critical to address your weight and sodium intake. Your doc should be giving you a VERY hard time on this (to the point where you wanna kill him for nagging!

If you have the willpower, the Dash Diet is most certainly worth a shot.

By the way, are you on any other medications, even over-the-counter? As you probably know, there are many...even prescription meds, that can interfere with blood pressure control. If you are taking anything else, let us know.

Usually with "resistant" hypertension, the protocol would be to try, as your doc is trying now, a 3-drug regimen.

JUST LIKE CHOOSING FROM A CHINESE MENU (LOL)
it is suggested to try:

1.ORAL DIURETIC:
Equivalent to 25 mg of hydrochlorothiazide (Esidrix, HydroDIURIL, Oretic) or chlorthalidone (Hygroton) or

Equivalent to furosemide (Lasix), 320 mg/day, or metolazone (Zaroxolyn), 10 mg/day (if serum creatinine > 2.5 mg/dL)

plus

2.SYMPATHETIC INHIBITOR like a..
Beta blocker (equivalent to propranolol [Inderal], 320 mg/day, or atenolol [Tenormin], 100 mg/day) or

Clonidine HCl (Catapres), 0.6 mg/day, or

Prazosin (Minipress), 20 mg/day, or

Methyldopa (Aldomet), 2 g/day

or

Another agent like:
An ACE inhibitor(equivalent to captopril [Capoten], 200 mg/day, or benazepril HCl [Lotensin], 40 mg/day) or

An Angiotensin II blocker (ARB) such as Cozaar, Diovan, Benicar...etc

or

A Calcium channel blocker

plus


3. A DIRECT VASODILATOR such as Hydralazine HCl or minoxodil.

Docs often try what you are on now....instead of the direct vasodilator, they prescribe a diuretic with two drugs from group 2 . In your case, you're now on Group 2's beta blocker and an ACE inhibitor.

The next step might be to discuss the possibility of substituting either the ACE inhibitor (Altace) or the beta blocker (metoprolol) with a calcium channel blocker.

Confusing enough yet???

zuzu xxx

[007INMAINE]

Zuzu,
Thanks for all the detailed info. I was hoping you'd weigh in on this. I, too, am suprised about the doctor's (it's a woman) lack of pushing in the weight area. I'd send me to a specialist, kick my as* to the gym (with a prescription for exercise) and some goals and expectations and some hope. (I really like exercise, but she's so .... well, it will probably help SOME....) about it...I am pretty disciplined when I have to be (despite hte eating thing, I really can stick to a program - esp, when there's a gun pointed at my head and bullets in the chamber). I think she underestimates me, or maybe she's afraid to create more stress.

I am always questioning things and I don't think she likes it. too bad. I do my own snooping (hence the OO7)

Three questions:
1. Should I have a veinagram - or an angiogram, whatever it's called - to see if there are any other blockages or narrowed arteries causing problems (other than in the kidneys)? Are there any other tests that you know of, that might tell us something?

2. If you've taken one drug in one class, and it doesn't seem to do anything, does than mean you won't react to any other drugs in that class? Or perhaps to a serious increase in dosage? Just because I haven't reacted to atenolol, does that mean I likely won't get any benefit from other betas?

3. Should I go to a specialist, and what kind? I want to do somthing about this! or at least believe I can. I want someone to take me seriously.

I will relate one experience with her...and leave it at that. I told her the next to the last time I saw her, that I was taking supplements, so she would know: omega three, coq10, magnesium, garlic, and some Bs and Cs. She said "you are a reasonably intelligent person, don't waste your money." Period. Since then, I think she thinks I'm a whack job. I am not. But I read a lot and do my own research...future son in law is in medical school and I ask all kinds of questions...
Thanks for your help,
007

[zip2play]

oo7inmaine,


For long term control you simply must drop 40 or more pounds. Overweight IS the single worst pressor factor.

I'd try JUST using a potent diuretic for a month and see what happens. That clorthalidone that zuzu mentioned is JUST the thing. I've tried it a couple times and to me it seemed the equivalent of about 200 mg. HCTZ....a REALLY strong diuretic (too much for me actually).
Swollen ankles and lower legs are the classic edema marker and carrying water in your legs implies carrying lots in your bloodstream and the extra water increases blood pressure markedly.

At the very least, the diuretic trial will indicate where your primary problem lies (or doesn't.) make sure you keep a good log at home. It's worth a lot more than tesing in an office.
I'm sure your doctor will be amenable to the clorthalidone Rx....I wonder if i still have some lying around somewhere????Hmmm.

[rowell]

oo7inmaine
Girlfriend, stop beating yourself up. I'm 61, overweight diabetic with hypertension. Good diabetic control 6.3, on 5 agents for control of pressure: hydrochlorothiazide 25, atenolol 100, quinapril 40, clonidine 0.3, and as of a few days ago, norvasc 5 which can cause headaches and ankle edema. Good cholesterol, ldl, triglycerides and hdl. I take my pressure sometimes every two hours and at least 3 times which it always goes down with each reading and most of the time I reach my goal of 138/73 and sometimes lower. There is definately a big change since norvasc.
You need to relax, take it easy and start changing your eating habits. Change the way you prepare your food. Instead of frying, try baking, grilling, broiling lean meats, poultry and fish. Eat more fruits and veggies and when you start to feel full, STOP.
If you're not diabetic, you can still have dessert if you desire, but not the whole cake(lol). This is what I started doing about a month ago guided by information read from the DASH diet (Dietary Approach To Stop Hypertension)which I will soon be following and so far I've planned out all of my meals for a month and bought everything I need especially the snacks I'm allowed. Nobody said it's easy to lose weight but I can really try if I want to remain on this earth.
Good Luck