General

First line drugs for mild or borderline hypertension

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29 Jun 2016 - General
 

In some patients with mild or  borderline hypertension,  I could not avoid but prescribe low dose antihypertensive medications because they could not adhere to lifestyle changes. If the pulse rate of the patient is quite fast, 80 per minute and over, I  usually  give  bisoprolol 2.5 mg, 1 tablet once a day. If at the same time I see that the diastolic blood pressure is 90 and over, I usually add 6.25 mg of hydrochlorothiazide. There are drug preparations which contain the combination of bisoprolol and hydrochlorothiazide. These preparations could very well serve as initial drugs for borderline hypertension with fast heart rate and elevated diastolic pressure. Advise patients to take them after breakfast.        

In pregnant ladies, methyldopa, hydralazine would be used instead. For patients who has IHD or post open heart surgery, being on ACE-i or ARB + beta blockers are essential unless they have contraindications. These are my 2 cents worth. Thus even from a simple condition, hypertension, we know that there are many ways to skin a cat, it is like cooking as well, as long as it is safe and the effect is seen and beneficial to patients, then it is ok, although there's always a clinical practice gu...
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Hi, Ziwei! I wrote the article on the premise that the patient has only borderline hypertension, without any co-morbid problems. I did this so that the presentation will not be so complicated, and our younger colleagues who have just started practicing medicine will be able to follow. While I was initially inviting reactions to the post, I really expected that the discussion will go deeper as shown by your reactions. Now, you would like to inject concomitant problems, such as diabetes mellitus...
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HI Jose. I usually choose my medications base on patient's comorbidities. In a young obsese individual, I will tend to avoid 1st or 2nd generation beta blocker because of the small increase risk of diabetes mellitus. I prefer ARB if they patient can afford it as it has relatively less side effect and has renal protective effect. I prefer ARB over ACEI as I do not want to deal with ACEI- cough which as be as high as 10% in ladies. If patient is unable to afford ARD, i prefer calcium channel b...
 (Total 135 words)