Blood Pressure Medications (Antihypertensives)

My mother started taking Prinzide (20 mg lisinopril, 12.5 mg hydrochlorothiazide) today—her doctor prescribed it twice daily. Her blood pressure was a bit low this evening (116/67), and she’s feeling quite weak; she also mentioned occasional heart palpitations—that "thumping or skipping" sensation. To be fair, she had those even before starting the medication, but I still wouldn't want to brush them off, would I? She hasn't taken her evening dose yet. She did receive several referrals for tests, but I'm wondering what we should do in the interim—you know, before the scheduled testing and/or her next follow-up with the physician (which, honestly, seems a bit absurd given he gave her enough pills to last five months!):

- Should she take the second dose tonight and stick to the twice-daily schedule, even though she feels weak and knows her pressure has dropped significantly? I realize the numbers above aren't extreme hypotension, but for her, they feel quite low. Plus, since her kidney function is slightly diminished, I'm worried about further side effects—specifically, an even deeper drop in blood pressure.
- Should we reduce the dosage to once a day?
- Switch to a lower dose of Prinzide, perhaps using just 10 mg of lisinopril?
- Consider a third therapeutic option? (Before a week-long break that ended this morning, she was on Lacipil, though I'm unsure of the exact dosage. She reacted quite poorly to it—it would essentially "knock her down" and make her extremely drowsy. I haven't deeply researched the interactions yet, but she does occasionally take Amlodipine.)

Thanks in advance!

Has she been on any blood pressure meds before this, who actually put her on this specific regimen, and what does her average reading usually look like?

Hi, lacipil, writes at the bottom of the post. My primary care physician transcribed this, but since she rarely sees her specialist, it isn't exactly being closely monitored. When things are relatively stable, her systolic pressure hits at least 130—and I believe the pulse pressure, the difference between the top and bottom numbers, sits around 40 to 50. Unfortunately, I can't give you an exact average because she hasn't been keeping a log; we've just been discussing it over the phone. I have noticed that she starts feeling unwell even when her systolic reaches 140, which happens quite often. It can even climb to 160 or higher, particularly during the evenings and nighttime, accompanied by intense heart palpitations. The gap between the systolic and diastolic numbers usually doesn't fluctuate too extremely in either direction. She is under an immense amount of stress—the kind of stress one simply cannot eliminate from their life. We don't have any diagnostic tests on hand yet. I should be able to provide some more detailed information regarding the specific readings tomorrow. Thank you!

Here is a bit more detail regarding those high readings—though I realize I can't expect a definitive answer from anyone here since we don't have the full picture, and besides, I still need to convince her to actually start keeping a daily log. 🙂

Not too long ago, after she went several weeks without taking her medication following a particularly stressful stretch (even though, let’s be honest, she’s pretty much under constant stress), she saw her doctor and ended up with a blood pressure reading of 180/160.

Last night, she finally took her second dose, right around midnight. She gets incredibly lightheaded whenever she stands up—it lasts for about half an hour every morning—but she hasn't actually checked her pressure during those episodes, so we have no idea what's truly causing that dizziness. 🙄
Anyway, to make a long story short:

- after taking her meds last night, combined with waking up occasionally during the night because of heart palpitations, she checked her pressure at 7:00 AM and it was 154/102/89.
- Then, after taking her next dose around 7:30 AM, her readings at 10:00 AM were 138/82/93, which she considers normal (if we just ignore the pulse. 😁).

I know, wiredraven94, it's all a bit incomplete and confusing. Hopefully, it will settle down even when the medication concentration is at its peak. 🤷

coppergardener said:Hi, lacipil, writes at the bottom of the post. My primary care physician transcribed this, but since she rarely sees her specialist, it isn't exactly being closely monitored. When things are relatively stable, her systolic pressure hits at least 130—and I believe the pulse pressure, the difference between the top and bottom numbers, sits around 40 to 50. Unfortunately, I can't give you an exact average because she hasn't been keeping a log; we've just been discussing it over the phone. I have noticed that she starts feeling unwell even when her systolic reaches 140, which happens quite often. It can even climb to 160 or higher, particularly during the evenings and nighttime, accompanied by intense heart palpitations. The gap between the systolic and diastolic numbers usually doesn't fluctuate too extremely in either direction. She is under an immense amount of stress—the kind of stress one simply cannot eliminate from their life. We don't have any diagnostic tests on hand yet. I should be able to provide some more detailed information regarding the specific readings tomorrow. Thank you!

Yeah, missed that part, my bad... Managing hypertension is never a quick fix; it's a marathon that requires a ton of patience... though you probably already know that...
It feels a bit weird to me that they went with Irezex instead of a much milder dose of Ramipril if they were already heading in that direction😕... Personally, I'd definitely stick to a treatment plan based on a specialist's recommendation. The headache there is that there are so many different types out there... Since the trend in internal medicine lately has been for everyone to just "treat their own specific organ," finding a truly "holistic" internist can be pretty tough...
In my book, the best internists are the ones working in hemodialysis. They deal with invasive procedures, see all sorts of complex comorbidities, and I feel like they have the best intuition for assessing what's really going on... specifically whether there's a need for extra diagnostic work if the clinical picture doesn't quite fit standard essential hypertension...
She definitely needs to start keeping some kind of blood pressure log... Ideally, check it at roughly the same time every day, and never right after physical activity or exertion...

Forgot to mention... I'm assuming that during those episodes of palpitations and spikes, she had an ECG done, checked her cardiac enzymes, and made sure any coronary events were definitely ruled out...

No, she hasn't had an ECG done in quite some time—and as for the rest of the tests, they are still waiting on those.

Thank you so much for getting back to me! 🙂

In my experience, they went through four different treatment plans before we finally hit on the right one!
Managing blood pressure is such a long haul, and those early stages are easily the most frustrating part!
I’d suggest seeing a nephrologist, but you really need to take a more rigorous approach to the whole thing—get an ECG, a blood pressure and heart rate Holter monitor, and maybe even a stress test to see how things hold up under physical exertion.
Honestly, I don't think a general practitioner can always nail down the perfect medication; you really need a specialist like a nephrologist or an internist to get it right!
If you're dealing with high stress on top of everything else, combining some calming medication might actually be far more effective than just tweaking the blood pressure pills...

First of all, there isn't much room for personal opinion here; the laws and regulations are clear. Under these guidelines, a primary care physician or family doctor is not just permitted, but actually required to prescribe antihypertensive therapy...
Regarding this lady's situation, the wisest course of action for now is to stick to the twice-daily medication schedule. If her symptoms become too severe, she should consult her physician to adjust the treatment. However, the readings you mentioned are nowhere near causing hypotension, let alone any kind of symptomatic low blood pressure, as such a condition essentially doesn't exist in cases like this
The worst thing you could do right now—aside from completely stopping the medication—would be to constantly change the treatment protocol or allow for massive fluctuations in blood pressure, which, I must emphasize, is extremely hard on the body...

Sam Hall15 said:First of all, there isn't much room for personal opinion here; the laws and regulations are clear. Under these guidelines, a primary care physician or family doctor is not just permitted, but actually required to prescribe antihypertensive therapy...
Regarding this lady's situation, the wisest course of action for now is to stick to the twice-daily medication schedule. If her symptoms become too severe, she should consult her physician to adjust the treatment. However, the readings you mentioned are nowhere near causing hypotension, let alone any kind of symptomatic low blood pressure, as such a condition essentially doesn't exist in cases like this
The worst thing you could do right now—aside from completely stopping the medication—would be to constantly change the treatment protocol or allow for massive fluctuations in blood pressure, which, I must emphasize, is extremely hard on the body...

Well, "Doctor on Duty," what I was trying to say is that a specialist is going to prescribe a much better regimen than a GP once all the tests and workups are actually finished!

All those tests should really be handled by a primary care physician first. If they determine that specialized follow-up is necessary, they can then refer the patient to a specialist—someone who undergoes nine years of training specifically to manage things like essential hypertension. In most cases, this falls under the scope of primary care; while there are rare instances where an internist's expertise is required, that doesn't seem to be the case here...

The title is quite direct: I am looking for some clarity on how this process actually works.
I previously posted in the threads regarding hypertension and liver issues because I was dealing with hepatic complications myself.
Now, the day is approaching when I’ll likely need to stop taking Amlodipine/Hydrochlorothiazide, given that my blood pressure struggles were being driven by my liver condition.
Does one simply stop the medication abruptly, or is there a transition to lower dosages? What is the standard medical procedure here? Please share your experiences; I really need to know what to expect in the near future.🙂

Drew Miller48 said:The title is quite direct: I am looking for some clarity on how this process actually works.
I previously posted in the threads regarding hypertension and liver issues because I was dealing with hepatic complications myself.
Now, the day is approaching when I’ll likely need to stop taking Amlodipine/Hydrochlorothiazide, given that my blood pressure struggles were being driven by my liver condition.
Does one simply stop the medication abruptly, or is there a transition to lower dosages? What is the standard medical procedure here? Please share your experiences; I really need to know what to expect in the near future.🙂

What kind of liver disease even causes hypertension?
The way it works is you just stop taking them, though if you're on a Beta Blocker, you absolutely have to taper off gradually.
As for whether they'll cancel the prescription entirely, that’s going to depend on how your blood pressure stabilizes.

vividsailor7 said:What kind of liver disease even causes hypertension?
The way it works is you just stop taking them, though if you're on a Beta Blocker, you absolutely have to taper off gradually.
As for whether they'll cancel the prescription entirely, that’s going to depend on how your blood pressure stabilizes.

To be honest, I have no idea.
That is simply what my doctors told me. Perhaps it isn't the liver causing the high blood pressure, but rather excess weight and a lack of activity. You mentioned blood pressure and liver disease previously. Ultimately, I am waiting for my doctor to return from vacation before I head back for more blood work.
By the way, what do BP and BB stand for? I'm unfamiliar with those abbreviations, excuse me.

Drew Miller48 said:To be honest, I have no idea.
That is simply what my doctors told me. Perhaps it isn't the liver causing the high blood pressure, but rather excess weight and a lack of activity. You mentioned blood pressure and liver disease previously. Ultimately, I am waiting for my doctor to return from vacation before I head back for more blood work.
By the way, what do BP and BB stand for? I'm unfamiliar with those abbreviations, excuse me.

RR is just shorthand for your measured blood pressure reading.

BB stands for beta-blockers, which is a specific group of medications that work on your cardiovascular system.

There's actually an entire thread dedicated to them right here http://www.forum.com/showthread.php?t=189816

swiftbear86 said:RR is just shorthand for your measured blood pressure reading.

BB stands for beta-blockers, which is a specific group of medications that work on your cardiovascular system.

There's actually an entire thread dedicated to them right here http://www.forum.com/showthread.php?t=189816

Thank you for the response.
So, based on that, my medication does not fall under the BB category.
As for the BP—how am I supposed to know when it is within the normal range?
Is that determined by blood work, or something else?

Drew Miller48 said:Thank you for the response.
So, based on that, my medication does not fall under the BB category.
As for the BP—how am I supposed to know when it is within the normal range?
Is that determined by blood work, or something else?

To whom it may concern,

Already answered.

swiftbear86 said:RR is just shorthand for your measured blood pressure reading.

BB stands for beta-blockers, which is a specific group of medications that work on your cardiovascular system.

There's actually an entire thread dedicated to them right here http://www.forum.com/showthread.php?t=189816

Blood pressure is measured using a sphygmomanometer. It’s considered normal when the reading falls within an acceptable range. That upper limit isn't set in stone; it fluctuates based on specific variables—for instance, whether you're managing diabetes or not. Generally speaking, that threshold serves as the standard cutoff for what we call "normal." do (regarding less thanThe targets are pretty clear: 140/90 for the general population, though if you're living with diabetes, you're looking at staying under 130/85.

Blood tests aim to identify any obvious culprits behind elevated blood pressure—what we call secondary hypertension. That said, getting a definitive answer often requires additional testing to check for organ damage caused by high blood pressure. One thing to remember: blood work won't tell you what your actual blood pressure readings are.

Look, just so we're clear: you consider blood pressure to be within the "normal" range when the reading on your monitor stays under 140/90.

Nicholas Myers said:To whom it may concern,

Already answered.

Blood pressure is measured using a sphygmomanometer. It’s considered normal when the reading falls within an acceptable range. That upper limit isn't set in stone; it fluctuates based on specific variables—for instance, whether you're managing diabetes or not. Generally speaking, that threshold serves as the standard cutoff for what we call "normal." do (regarding less thanThe targets are pretty clear: 140/90 for the general population, though if you're living with diabetes, you're looking at staying under 130/85.

Blood tests aim to identify any obvious culprits behind elevated blood pressure—what we call secondary hypertension. That said, getting a definitive answer often requires additional testing to check for organ damage caused by high blood pressure. One thing to remember: blood work won't tell you what your actual blood pressure readings are.

Look, just so we're clear: you consider blood pressure to be within the "normal" range when the reading on your monitor stays under 140/90.

I am interested in this, thank you very much.
For context, I have been measuring my pressure every morning and evening for the past two weeks.
In the mornings before taking my pill, it was around 130/80, and the same in the evenings, give or take 5.
All in all, it seems to be finally back to normal.🙂
Thank you for the answers; I can hardly wait to stop taking these pills!🙂

Drew Miller48 said:To be honest, I have no idea.
That is simply what my doctors told me. Perhaps it isn't the liver causing the high blood pressure, but rather excess weight and a lack of activity. You mentioned blood pressure and liver disease previously. Ultimately, I am waiting for my doctor to return from vacation before I head back for more blood work.
By the way, what do BP and BB stand for? I'm unfamiliar with those abbreviations, excuse me.

Just to add something to what's already been said.
Based on the numbers you provided, your blood pressure regulation looks satisfactory, so it might actually be time to start thinking about tapering off the antihypertensive therapy.
As for the liver—you probably heard about portal hypertension, which is an entirely different beast altogether. That's not what we're dealing with here.
The culprit is exactly what you suspected: the inactivity and the weight.
Whatever you do, keep monitoring that BP. If the readings spike again, the doctor might consider switching things up to just an ACE inhibitor—like Irezex, Ramipril, or perhaps a combination with a diuretic like Irezex or Ramipril.

Greetings.
I’ve returned from my annual checkup and completed my blood work.
I received the results yesterday, and here is where things stand:
AST-17
ALT-30
GGT-22
Cholesterol-5.3
HDL-1.24
LDL-3.44
Triglycerides-1.3
On a positive note, I have lost 29 kg in just 7 months. I went from 114 kg down to 85 kg.
Here is a photo showing the blood pressure readings I recorded about a month and a half ago, at most.
http://imageshack.us/photo/my-images...120921234.jpg/
I actually stopped tracking them because I was starting to get on my mother's nerves with all the measuring, but there it is.
Please excuse the messy handwriting; I write as best as I can.😢
I saw my doctor yesterday, and he said my blood and urine results look fine. Regarding medication, he suggested I continue taking the Amlodipine/Hydrochlorothiazide. I told him I would like to stop, as it feels pointless to keep medicating myself. He countered by asking if my blood pressure would spike if I quit. After a few minutes of discussion, his stance changed slightly. Since I had already taken the pills a few days ago, he told me to finish those and then remind him to switch me to something else.
He mentioned he might prescribe me either Ramipril 2.5 mg or Hydrochlorothiazide. I am not entirely sure which one, but it will likely be just one of the components found in the Amlodipine/Hydrochlorothiazide blend. I am supposed to take this for one more month, and then that should be the end of it. During our talk, I also brought up an issue I've had since starting these pills: a sense of constant anxiety and a sort of depression since I began taking the Amlodipine. He insists it isn't the medication, but rather psychological. And there is something else...
Occasionally, I feel an uncomfortable sensation on the left side of my chest, near the nipple, which bothers me and leads me to imagine the worst possible outcomes. There is also an intermittent stinging sensation, almost like being pricked by a needle through my spine, though that is extremely rare (though it did happen for the first time yesterday, two or three times in one day). I had an ECG four or five months ago and everything was normal. It simply feels as though I am terrified of everything, and this fear torments me more than the actual physical condition. He told me that when these moments occur, I should take some Normabel to calm down and stop dwelling on such thoughts.

I am interested in your opinions. Thank you in advance.

Is there no response at all? 😢