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I guess everyone is different.
For my HPB (genetic) I take the generic combo losartan/HCT (50mg/12.5mg). It has been very effective in controlling my hbp, with essentially no side effects.
I live in the warm south, so am always careful to drink plenty of fluids, mostly water. (NO sodas, sweet drinks, etc).
In my 50's, I often do a lot of physical activity outside and when I know I'm going to be sweating a lot I add a sugar-free electrolyte mix (propel powder) to my water,
and I can literally drink a gallon and a half while cutting wood or forest-clearing.
I did at one time have physician 'split up' the prescription into a separate losartan pill and a separate HCT pill,
to see if I could omit the diuretic during times that I knew I was going to be doing tons of physical activity (sweating) day after day,
just to see if it would help offset/prevent dehydration.
That didn't work so great, my bp shot up anyway when I was omitting the HCT, whether I was sweating a-lot (activity) or not.
The losartan I take is also known as 'losartan potassium' , and actually has potassium in it's formulation,
which can be a good thing if you're like me any normally deficient in potassium,
( I used to have to consistently eat a banana each and every day to prevent getting painful leg/calf cramps),
but NOT a good thing if you happen to have Hyperkalemia.
I do have to watch my magnesium though - hence the electrolytes in water for heavy physical activity.
For #1 & #2- please give a possible historical detail that would justify such mistakes. I cna't even think of any.
For #3, I gave the possible exceptions.
It's not for you to worry about, is it? No reason for me to share a detailed medical history to justify an internet stranger's blanket assumption that all he/she knows about something is all there is to know. Frankly, you're out of line in accusing medical providers of which you know nothing, practicing medicine in the context of their patient's long history, of which you also know nothing, of "not knowing what they are doing".
Which is exactly why I don't get my medical advice from internet strangers, not even if they stayed in a Holiday Inn Express last night.
Good attitude...I'm not suggestimg anyone should take my advice and change their meds...What I'm poinitng out is that many docs, particularly the younger ones, are not well trained and don't use their heads when prescribing-- Here's my reasoning about BP meds-- One needs only some basic knowledge, but apply simple logic wisely-->
Many, if not most newly diagnosed hypertensives can be well treated with only a diuretic....Other BP meds-- ACEs, ARBs, calcium channel blockers, alpha-blockers and many beta-blockers (that about covers them all) cause vasoldiatiation, which leads to edema and return to hi BP in at least 3 out 4 pts (probably more)--> so then they add the diuretic anyways....By not using the diuretic first, you're hoping this pt is the 1 in 4 who can get by without it....You may as well play the odds that the pt is the one in 2 or 3 that needs only the diuetic, then add the others if needed.
1) OP was given Hctz and apparently no attention was given to his K levels until he developed sumptoms. Fortunately his first symptom wasn't a fatal dysrhythmia.
2) Chlorthalidione was ADDED to BP regimen -- it should have been the first med given.
3)Lasix for BP control. I explained why that wasn't a wise choice. That's why the guy had to take occassional second doses to keep BP down.
First three posts-- three mistakes.
you are reading things into the post that aren't there. 'apparently' is doing a lot of lifting in your post
chlorthalidone is preferred 1st but HCTZ is not out of line
I've been on losartan and hctz for years now. Works wonders for my pressure, no side effects. Apparently it raises potassium levels, so in combination with the diuretic, I guess things balance out. My doctor checks for those things during my yearly physical anyway.
Good attitude...I'm not suggestimg anyone should take my advice and change their meds...What I'm poinitng out is that many docs, particularly the younger ones, are not well trained and don't use their heads when prescribing-- Here's my reasoning about BP meds-- One needs only some basic knowledge, but apply simple logic wisely-->
Many, if not most newly diagnosed hypertensives can be well treated with only a diuretic....Other BP meds-- ACEs, ARBs, calcium channel blockers, alpha-blockers and many beta-blockers (that about covers them all) cause vasoldiatiation, which leads to edema and return to hi BP in at least 3 out 4 pts (probably more)--> so then they add the diuretic anyways....By not using the diuretic first, you're hoping this pt is the 1 in 4 who can get by without it....You may as well play the odds that the pt is the one in 2 or 3 that needs only the diuetic, then add the others if needed.
Well, I like your attitude too.
Ok, so here are the mitigating factors, I think, for the order of my prescribed blood pressure meds, over the years. My hypertension is hereditary, and it began relatively early in my life- my dad was the same way. At first ( in my late 20's, early 30's it seemed to be hormone related, elevated on birth control pills, yanked off those, but no meds at this point as it normalized. My first medication for blood pressure control came along in my mid 30's with my last pregnancy, I was prescribed methyl dopa, I think it was. I think at the time that was the standard drug used to control high bp in pregnant women,,and I took it till I gave birth, and my blood pressure went back to normal after my daughter was born.
Well, after that, I figured ok, I'm healthy ( not overweight, exercised, mostly decent diet) and maybe with any luck I can avoid ever needing to see a doctor again ( dumb I know)- so I paid no attention to my blood pressure. When I hit my early 50's I began having some problems with SVT, and I started on medication again after a nonstop SVT ( heart rate over 200 BPM) landed me in the ER for an adenosine IV drip which slowed the heart rate down. Apparently the bp wasn't high there so the medication prescribed was 100 mg metoprolol succinate, which they told me was an SVT preventative I might have to take the rest of my life unless I let them do an ablation.
Follow up visits with the PCP,,along with at home blood pressure testing showed the high blood pressure ( 160/99 or higher would be typical), and that doc started me on Diovan Hzct, which seemed to control thenumbers. I took this med for years along with the metoprolol succinate. A number of years later, another PCP, I hadn't had any more issues with SVT and thought perhaps I could get off the metoprolol. Well, the PCP said no way with a history of SVT but he did cut it back to 50 mg,but added 180 mg diltiazem ER since my blood pressure was climbing again. I stayed on this combination for years- with losartan hzct replacing the diovan at some point, saw the doc once a year but seldom checked my blood pressure.
Fast forward a few more years, I was 68 years old, still taking this med combo, and a nonstop episode of atrial flutter landed me in the ER, where they referred me to a cardiologist, who took me on as a patient. He adjusted the medication, replaced metoprolol succinate with tartrate ( said the extended release fizzles out before it can be taken again), replaced the losartan hzct with losartan hcl ( said I didn't need a diuretic, no evidence of fluid retention), and the other meds the same. He took me off the diltiazem after my heart rate started plummeting intermittently, then more often. Apparently the 50 mg metoprolol wasn't controlling the tachycardia very well, so I spent lots of time with what they said at that point was atrial tachycardia, so he increased the metoprolol to 150 mg/day. I'd had issues with bradycardia ( hr in low 40's, even high 30's sometimes) before, but this increase in metoprolol made it worse, even as it didn't entirely control the tachycardia.
The chlorthalidone was added a few years later by a cardiac electrophysiologist the other guy referred me to treat the sinus node dysfunction ( tachy-brady) that had become symptomatic. The EP stopped the metoprolol ( tapered off) and started diltiazem to see if my bradycardia might improve off the metoprolol and we could achieve decent tachycardia control with the diltiazem- failed miserably on both points. The blood pressure had become a problem again, and the chlorthalidone did seem to help it at that point, and I have continued to take it along with the diltiazem that was prescribed by that EP. The metoprolol was also added back in later ( after they put in the pacemaker) , and along with the diltiazem, the combination did a good job at controlling the atrial tachycardia/afib/flutter, it seemed. The combination has continued to keep the tachycardia ( aflutter/afib now) under control for the most part to this day. Though over time it's taken increased doses of both meds to keep this under better control, but that isn't unexpected and I have long gotten over any side effects of the drugs.
They also put in a dual chamber pacemaker, which was a gamechanger for me as it gave me my quality of life back. Much as we might decry the heavy use of medication, the combination of meds I take do a good job of controlling the blood pressure and the arrhythmias and the pacemaker keeps the heart rate from tanking. I'd much prefer taking rate control drugs that can double for blood pressure control, than venture into taking antiarrhytmic drugs. And though it may have been late to the party, that tiny white or yellow chlorthalidone tablet ( 25 mg) seems to help the blood pressure.. Along with regular exercise, good diet and stress relief as much as I can manage it.
So there is my history- these docs I see aren't that young ( prob in their 50's), and they emphasize life style measures, including moderate regular exercise, as means for controlling whatever it is that ails you. I believe it.
Last edited by Travelassie; 03-01-2023 at 03:15 PM..
^^^ Let's call it a draw-- Your case is one where the beta-blockers, then the Ca-channel blockers were used for dyrhythmias. When your pressure became a problem again, the diuretic was added-- in a sense, it was "started" rather than "added." You just happened to be on the others already for other reasons.....Your earlier history of hi BP was complicated by estrogen-- which causes salt/fluid retention (women often complain of pre-metrual "puffiness.") It's easily treated with diuretics, but that's not a good idea with pregnancy and should be avoided being used if possible. Your guys seem to know what they're doing (Even tho they're just youngsters.)
Methyl-dopa was the best BP med available in the 60s/70s. It had a lot of very common side effects (fatigue & male prollems) that made it less desirable once beta blockeers came out. It may still have the most reliabley predictable dose/respsonse profile of them all.
Beta blockers were a miracle drug when they came out in the early 70s. Before that there was NO way to quickly slow down a rapid heart except to use Digitalis, which is basically a poison with toxic dose very close to the therapeutic dose and had to be built up i the ystem over the course of a few days.
Those PSVT problems can be trouble to treat. You can't predict which drug (beta blckers. vs Ca channel blockers vs other classes) will work, so it's either undergoing EP studies where they can test how each works, or just take a guess, try one and see what happens....Plus, sinus node/AV node problems tend to progress, just like yours have, with time.
I've been trying an experiment. Tried the newly prescribed HCTZ for a few days. Even when taking it early in the AM, it kept me up at night with frequent urination. Lack of sleep adds to my HBP...
So I've stopped the HCTZ and continued to take my Ramipril 2x/day. And have added more magnesium, potassium and calcium-rich foods to my diet and with some supplementation.
And consuming low sodium...really reading the labels now. I just discovered that the "pepper/lemon" spice I'd been using had listed as its first ingredient salt! Isn't that false advertising? I think it should have been labeled as Salt/pepper/lemon.
And I continue with my daily exercise (gym for resistance machines & light weight lifting), yoga, and cycling.
So far the results have been reasonable BP (130's over 70's)--and glory be! Finally good sleep.
So for me, some BP meds plus some lifestyle modifications through diet/exercise seem to work. Everyone's different, but we've got to find what works for us and our quality of life, yes??
Good attitude...I'm not suggestimg anyone should take my advice and change their meds...What I'm poinitng out is that many docs, particularly the younger ones, are not well trained and don't use their heads when prescribing-- Here's my reasoning about BP meds-- One needs only some basic knowledge, but apply simple logic wisely-->
Many, if not most newly diagnosed hypertensives can be well treated with only a diuretic....Other BP meds-- ACEs, ARBs, calcium channel blockers, alpha-blockers and many beta-blockers (that about covers them all) cause vasoldiatiation, which leads to edema and return to hi BP in at least 3 out 4 pts (probably more)--> so then they add the diuretic anyways....By not using the diuretic first, you're hoping this pt is the 1 in 4 who can get by without it....You may as well play the odds that the pt is the one in 2 or 3 that needs only the diuetic, then add the others if needed.
I find this post most interesting...I was recently put on Losartan Potassium for high blood pressure. I had tried a couple of other vasodilators, but both made my migraine/aura much worse. Should I just have been started on a diuretic first??? I would much prefer that approach (I think). Frequent urination could be a pain, but seems maybe fewer side effects? Should I ask my doc to take me off the Losartan and start me on a diuretic instead? My BP still seems to fluctuate quite a bit...sometimes high, sometimes low, sometimes right on target. Any advice?
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