Which med is best?

[MistyEve]

Female 48.Diagnosed w hypertension. Taking HCTZ only at this time, but need more medication to get readings down. Tried ACE inhibitor Altace. It raised creatinine levels. Tried Inderal. It interferred w thyroid meds. Looking for BP med that will do the job but not interfer with thyroid meds. Would like to try angiotensin II receptor antagonists.Research reports favour different ones and contradict each other. Some favour Candesartan, others Losartan; and still others Valsartan. They all have slightly different modes of action. Which would you choose? OR - would you favour a different class of BP meds?  CNS; vasodilators; calcium channel blockers etc. Since I had a problem with ACE inhibitor, would I also have a problem with ARBs, given that their modes of action is similar? Also - would it be wise to try to go back on Inderal and try to increase thyroid meds to counteract Inderal's propensity to interfer with T4-T3 conversion(thus decreasing available thyroid hormone in blood)? (I've had difficulty getting my thyroid meds optimized, and have just done so recently.)I've read that beta blockers can cause sudden death. How common is this? I take a baby aspirin every day. Does aspriin raise BP? Should I continue? Pros and cons?
Thank you sincerely,
little

[CCF-M.D.-RCJ]

Little,

Thanks for your question. I believe you posted a similiar question 2-3 months ago?

First, a good internist can help you make this decision.  This is not the type of decision that should be made "over the internet", however, I will be happy to provide some general guidance.

(1) It will be impossible to predict a priori which of the ARBs will suit you best.  If you wish to use these agents, which makes some sense, trial and error will have to be your guide.

(2) The theoretical blockade of t4-t3 is not likely to have been the culprit for your fluctuating hormone levels.  The most likely cause was variance in the thyroxin drug you received -- Synthroid in particular has been associated with inconsistencies in drug strength as compared to the label.

(3) I have never read or heard, and I do not believe, that beta-blockers are associated with sudden death.  In fact, this class of drugs is used to prevent sudden cardiac death.  If you found something to the contrary, please post it and I'll review.

(4) To my knowledge, low-dose aspirin has not been associated with elevated blood pressure.

Hope that helps.

[MistyEve]

Thank you for the response.

2 or 3 months ago I had similar question about beta-blockers. It was at that time that I had been given Inderal, and started having all kinds of problems with a recurrance of hypothyroid symptoms.

In the thyroid literature (www.thyroidmanager.org -- written by drs for drs) - it says that propranolol is used to dampen the effects of thyroid hormone in cases of hyperthyroid.

Happy to know that beta blockers don't cause sudden death. (I will look again for the info saying it did - I could have just read it wrong).

Could you tell me what class of hypertension med you favour as a first and second line of defense?

Thanks sincerely,
little

[TimL]

I have recently been prescibed with the ARB Losartan, after experiencing side effects with Ramipril (ACE inhibitor) and prior to that side effects with calcium channel blockers.  Ramipril knocked me sideways - dizziness, loss of libido, muscle fatigue - while calcium channel blockers left me with swollen ankles and enlargement of the gums(!).  Losaratan has had no discernible side effects and has proven v effective in controlling my BP.  I take  a half dose (25mg) along with 600mcg of Monoxidine (a centrally acting drug - another one which I have found has no side effects although it is not as good at controlling BP).