Calcium Channel Blockers

[Cody]

Dear CCF Physicians,

In order to control blood pressue can a calcium channel blocker such as Norvasc also be added to the following daily medications:
Altace(10mg), Atenolol(50mg), Hydrochlorothiazide(25mg), Imdur(30mg), Lipitor(20mg), and Aspirin(81mg)?  Or, is the calcium channel blocker taken instead of one of the above medications?  Would changing the time of day a person takes their medication have any effect on blood pressure control?  For example would it be better to take the altace(10mg), atenolol(50mg), and hydrochlorothiazide(25mg) all in the morning or would it better to take only the beta blocker and diuretic in the morning then take the ace inhibitor at bed time?  I am just looking for different ways to better control my blood pressure.  It seems I am at the target dose of the initially mentioned medications: beta blocker, ace inhibitor, and diuretic and still are somewhat hypertensive at times.  Thus wondering what effect adding a calcium channel blocker, such as Norvasc, may accomplish.  The rise in blood pressure, the systolic, is of concern.  What typically used to be 120-125/70-72 has started to creep up to systolic pressures in the 145-155 range with little or no change of the diastolic pressure.  It seems as I age, presently 64, isolated systolic hypertension is beginning to appear as it did with my parents.

Thanks,
Cody

[CCF-M.D.-MJM]

cody,

glad to see you are trying to control your risk factors.  regarding blood pressure control, for most patients, I start with an ACEI like Altace.   You are the appropriate (maximum) dose of the Altace.  I will very often add a calcium channel blocker like norvasc second and maximize that dose -- norvasc 10 mg once per day.  If this does not control blood pressure, I would next add HCTZ at 12.5 mg and increase to 25 mg if necessary.  Beta blockers are not great blood pressure medications, but it is a reasonable addition.  The dose can be increased if you have normal kidneys.

Based on your current meds, adding norvasc is a very reasonable next step. I would probably start with 5 mg and increase to 10 mg if you blood pressure is not improved in 2-4 weeks.

If you tolerate all the medications at one time, it is reasonable to take them in the morning.  Your blood pressure will typically be higher during the day.

If you are tolerating the atenolol without side effects, that can also be increased, but starting norvasc sounds like a good first option.  If you do not have coronary artery disease or another indication for a beta blocker, you could probably try stopping the beta blocker and starting norvasc and only add the beta blocker back if you need it.

You are probably right -- isolated systolic hypertension is sneaking up on you.

I hope this answers your questions.  good luck and thanks for posting.

[tickertock]

3 Questions posted within the last 15 days, basically redundant ?s at that. Just a friendly reminder that the limit is 2 questions within a 6 month period. It is best work with your doc/cardio and see how you respond to different B/P medications, it's all trial and error, what works for one person might not work another , sometime it can take quite a few months or longer to find the right medications. Good luck.

[Renominator]

I've noticed this same person has posted several times here.  Given that the ability to post is re-set at a different time each day, I'm assuming there's a lot of time dedicated to this task.  Probably better to let others have a chance at asking a question than to ask the same question over and over?

[june55]

A related discussion, blood pressure was started.