HBP/Meds/Women/Menopause

[Catchy]

Dear Dr.
I am female, 45, 5'11" 300lb, strong/not aerobic, drink alot of caffeine every day, take quite a bit of ibuprofen monthly,never smoked,no alchohol.

Paternal Family Hx: obesity, arteriosclerosis, hypertension, DMII, colon ca, stroke, mci, bypasses.

Maternal Family Hx: breast ca, prostate ca.
Childhood hx: scarletina, recurr. ear inf.

Events:
age 29, orthonovum 1/35 for dysmenorrhea, sudden loss of vision in left half of left eye at work in am-blood pressure high, no hx of migraine, vision faded back in within the hour. No headache till after vision restored, then headache grew to disorienting proportions by night. Discontinued bcp's. Never recurred.

age 35, referred by gyn to renal/hypertension dr-good workup, hbp, prescribed Procardia-I didn't like what I read about it, never started meds, never rtnd, no symptoms at the time. Renal clearance/labs wnl. Cholesterol ~220. (Hx recurrent UTI's once a year over 10yr period, culminated in passing of "grit" with ultrasound showing renal ?pyramids? and mildly fatty liver. UTI's never recurred after "grit" episode. Ouch.)

age 40, heart ct for a study showed arteriosclerosis-80% of my age group better than I.

age ~41, allergies started after severe exposure to kitty litter dust and a throat sinus ear infection that went untreated too long. Since then tb test +, chest xray neg, possible latex allergy, cat/dog/horse/maple tree allergy, flu shot reaction, mosquito bite reaction, peanut butter reaction, severe reaction to bactrim and balloons-both prev no problem-face like blowfish w balloons, large hives and tiny blood blisters w Bactrim. Lived on benadryl for next couple yrs. NEVER HAD ALLERGIES PRIOR TO THIS.

age ~42, headaches waking me at 4-5am daily-went to a cardiologist. Placed on Hyzaar 50-12.5 Had one of those suction cup upper arm tests at a heath fair that said I was 50% water, so I was pleased with Hyzaar's diuretic component. Little did I know....once you start it you can't get off it. Tried twice and within 36hrs ankles looked like the skin was going to pop open. Had not had this problem prior to Hyzaar. Try sleeping with your feet up on the wall. However, headaches gone and bp normal when taking Hyzaar. But now...blood sugar which had always been 100 increased to ~130.

age 43, finally went to allergist, prescribed Allegra, Albuterol. Allegra instantly felt like a head cold. Stopped taking it, never filled the Albuterol.

age 44, allergies worse, now experiencing episodes after moving furniture of shortness of breath/coughing attacks. Mother, retired nurse, asks if she should call 911, only half jokingly. Also now getting completely random infrequent zaps of pain with a branchlike pattern in left chest/breast/under arm-split second in nature-rarely also get one at bottom of front of neck. Normal EKG and treadmill stress test which were done by phys ther in a early diabetes prevention study I volunteered for-did quite well for awhile till work sabotaged it-lots of job stress :-)

age 45, went back to allergist, "crossed the border to mild asthma" left with Zyrtec, Flonase, Albuterol, Epipen...overkill. Forget Flonase, tried Albuterol couple episodes, with no noticeable increase in depth of breath. However, Zyrtec is a miracle allergy drug....on a humerous side note, I had so much drainage from allergies that I hadn't had flu since allergies started. Two weeks of Zyrtec and I was a new woman, and promptly caught the flu from coworkers.

age 45, 6wks after starting Zyrtec-sudden severe headache front left side of head...scary! It was a Fri at work ~11am, nauseous, tears, had nurses where I work take bp- 198/126. Called cardiolgist office, there is definitely a problem these days with voicemail/response time. 4hrs later heard from the office nurse. By then I had been taking aspirin (I know, not the treatment of choice for stroke...) and my headache had improved some, However, by late afternoon it began again. Mom looked up Hyzaar and advised me to take another Hyzaar. So that weekend I discontinued Zyrtec, took Hyzaar twice a day, and on Monday bp was 126/79. I then rtnd to Hyzaar once a day. A week later I somewhat cautiously began taking Zyrtec once every 3days. (p.s. it wasnt the Zyrtec with the extra something.) I also went back to the allergist for my 2mos fu and everything looked like before the allergies, the pft's were improved, and I left with a script for a half dose daily of Zyrtec-which they insist does not raise BP, but I had normal bp for three years on Hyzaar, normal bp week before Zyrtec started, and today I had my gyn checkup (3yrs) and bp is still higher than before Zyrtec. But Zyrtec is a miracle so as long as no headaches I will keep with it.

By now your eyes are glazed over-I really do have two questions. You should also know that in 3yrs I have seen the cardiologist 4times and called once-the day of the "stroke." I have seen the allergist 3 times in 2yrs and called once-when I finally caught the flu I wanted to ask if the Albuterol would help with that congestion. My "chart" is 1/2" thick and it contains my entire healthcare records including gyn and dental for the last 23yrs.

Question 1: My insurance does not consider Hyzaar a preferred drug, and since I am no longer happy with it, are there a few bp meds you would recommend that I could compare against the ins list and then when I go see the cardiologist again I can discuss being switched to one of them?

Question #2: I am heading towards those menopausal years when women catch up to men in heart attack statistics. Because of that heart ct, I am thinking ahead. I do not agree with the hormone therapy for menopausal women-but I know it offers some cardiovascular protection? Here comes the wacko question-is anyone in the medical field currently prescribing bloodletting for menopausal women?

Thanks-these forums are excellent because focus is on the details, not the first impressions.

[hbp702]

I know beta blockers and diuretics are popular (partially due to
low cost), but why are they first line therapy for
high blood pressure?

Beta blockers impair exercise tolerance, can worsen asthma, can cause impotence and turned me in to a walking zombie while I was taking them.

Diuretics cause inconvenience (due to urination) and also cut my energy levels significantly.

A2 inhibitors (which I'm on), ACE inhibitors, and calcium channel blockers (which I'm on), seem to have far less side effects.

But they are more expensive.

[Ravae]

I at 41 in September of 2001 suffered two strokes, a heart attack, and lost my vision within a thirty day span. I had been on hormone replacement for ninty days. While hospitalized from the heart attack I was diagnosed with a clotting disorder that was evedently brought out by the hormones. I cannot get anyone to explain to me what my disorder is. I am told there are not many people with Phosphatidyl Serine, but I was not screened before I was put on the hormones. I just turned 42 last year and quite honestly never thought I see it. I am hospitalized about every other month, due to clots. But my life has totally changed due to menopause!

[CCF-M.D.-KE]

Your medical history is quite complex. However, I will direct my response to your final 2 questions.
Hypertension is a common condition which affects approximately 33% of the population. First line therapy for hypertension is diuretics. Hydrochlorothiazide is commonly used which is cheap and effective. Beta blockers are used as second line therapy, atenolol and metoprolol are some common names.

Hormone replacement therapy is not felt be effective in preventing cardiovascular disease in women. I am also not familiar with bloodletting therapy, but it is not used in the treatment of menopause.  

Thanks for your question,


CCF-MD-KE