Withholding medication to elevate blood pressure

[Victor-Berger]

  My 92 year old father who had been in perfect health up untill a few years ago, now has congestive heart failure, atrial fib, a heart murmur and a blood clot in the lower part of each leg, one of which is calcified. He is on Vasotec, 2.5mg, 2x/day, Furosemide 40 mg, 1x/day, Lanoxin .625mg, 1x/day, and Cumodin 2.5mg, 1x/day. Over the past three or four months we have seen him deteriorate very much, he says he never knows whether he is going to wake up in the morning and the general feeling in my family is that he is very close to the end, although I sometimes wonder whether all this won't pass and he will live another 10 years. I realize he is old but I just want to understand his medical problems and do whatever I can to make him the most comfortable.
  Our main concern now is his low blood pressure which lately has been around 80/50 and today is 70/50. Normally he had low blood pressure when he was healthy, around 110/65. Since I know that Vasotec and Furosemide both contribute to lowering blood pressure, I was wondering whether he should skip taking the Vasotec or the Furosemide or both and for what period of time would it be safe to withhold it. Any suggestions would be greatly appreciated. I would also like to know if this combination of drugs is a common one and how safe it is.

[CCF CARDIO MD DLB]

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Dear Victor
The combination of drugs is common and safe. Your father's blood pressure is quite low. You should definitely call his doctors and inform them of this and let them make the necessary medication changes. In general, a blood pressure this low is unsafe. However, with end-stage heart failure, sometimes cardiologists will try to lower the blood pressure to ease the work of the heart. I don't know if this is the case with your father. You should call the doctor right away and figure this out.
No one can say how long your father will be around. However, in general, for someone in their 90s with heart failure, the life expectancy is very short.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.