High Blood Pressure

Guidance : BP Medication

03/25/2005

Question:

I am male aged 48 years with hypertension since 1979. I was put on Atenolol 100 and subsequently Amlodipine 10 added in year 2000. Again last year Losartan-100+HCTZ 12.5was added. Recently I had pitting edema over right leg. Hence internist advised Spironolactone-50 with Frusimide 20 which I started but with no relief. While advising for this medicine, my internist asked to remove HCTZ-12.5 from my regimen. It so happened that my relative doctor asked me to go for Right Leg Lower Limb colour Doppler since the edema was unilateral. The colour doppler findings were that there was no thrombosis in venous system but MILD INCMPETENT LT SAPHENO FEMORAL JUNCTION TWO INCOMPETENT PERFORATORS SEEN IN LEG. As the edema was relating to vascular, he asked me for stocking and elevated leg while sleeping and not to stand for long not to sit with legs swinging etc. He asked to stop Frusemide+Spironolactone. My internist has now put me to INDAPAMIDE SR 1.5 Once along with the drugs I am already taking. Is it ok ? Further in view of lacunar infarction and Mild Cerebral Atrophy ( MRI Brain due to postural vertigo in Jan-05 ), he advised for COPEDOGREL 75 OR ASPIRIN 162.5. Which one will be better for me ? I am otherwise healthy individual with all normal reports except that My Homocystein was 16 and Lp(a) was 55 and hence I am on Attorvastatin-10 mg. My S Cholestrol-115 TG 135 LDL 49 HDL 42. My S Creatinine is 1.52 and Uric Acid is 9 for which I take Allpurinol-100 twice. I also take Folic Acid 5 mg. My weight is 105 despite strict dieting brisk walk for 60 minutes. My 2D Echo is normal with 0.65 LVEF and Concentric LVH without cavity dilatation. Please asvise me precisely on following: 1. Indapamide 1.5 SR better than earlier HCTZ 12.5 taken by me. Is it necessary to take diuruitic. My BP is well controlled. 2. Should I take Clopidogrel-75 or aspirin 162.5 and which one better ? 3. Any other suggestion. Sir, we are staying in remote place. I shall discuss with my internist as soon as I receive response from me. You are doing excellent service for patient community at large. It is not my intention to procure prescription or online consultation. My object is to have your expert advices which I shall discuss with my doctor so as to have error free treatment. THANKS AND REGARDS HIGHLY OBLIGED

Answer:

Edema that is unilateral is generally due to a local problem in the leg and not due to salt and water retention. It is therefore not likely to respond well to diuretics, whether it be HCTZ, Lasix or indapamide. If your blood pressure is well controlled, it does not seem necessary to add more diuretics to your regimen.

Regarding your questions:

1) Indapamide is very similar to HCTZ. No good head-to-head comparisons exist. Indapamide has been shown to protect from a recurrent stroke. HCTZ is much less expensive, and has been shown in many studies to reduce the risk of a first stroke.

2) Aspirin has been shown to protect individuals at high risk or who had a stroke from a second stroke (secondary prevention). The optimal dose is not known, but many experts recommend at least 50 or 81 mg per day. Clopidogrel has been shown to be slightly better than aspirin, but the difference is small, and clopidogrel is much more expensive.

3) The best way to prevent a stroke is to control blood pressure, sugar levels (in diabetics), lipid levels, supplementation of vitamin B6, B12 and folic acid, aspirin or clopidogrel and treatment of existing carotid artery stenosis. Of course, smoking cessation, a reasonable diet and exercise regimen and weight loss (for people who are overweight) should always be part of a healthy lifestyle.

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Response by:

Max C. Reif, MD
Director, Hypertension Section
Division of Nephrology & Hypertension
Department of Internal Medicine
College of Medicine
University of Cincinnati