BP 210/160 help or assist!

[273]

At my father very high BP 210/160.
Already in current of month prinimat Betalok 30 on 100 in day.
BP was within the limits of 170/100, and last night skachyok up to 220/180 and today too snizhatsja does not want.

Advise as it is possible, more quickly to lower a BP hotjaby up to 170.

About the father: 1948 g.r., in January s.g. Has transferred or carried mikro an insult and a myocardial infarction without Q.
And more: constantly complains on prifkus salts on labiums.

Yours faithfully, Igor.

[Aritmolog]

At such digits of pressure of one preparation it is not enough!
It is meaningful to metoprololu (betalok) to add:
- Enalapril of 10 mg h 2 times day,
- Hypothiazidum of 25 mg h 2 times day.

Quickly to reduce pressure it is impossible is can cause or call an insult!
It is necessary normalizovyvat it or him within a week, and then constantly to supervise.

[Aritmolog]

In parallel it would be not bad to look for the reason of so high BP:
- The endocrine reasons (a blood on a hydrocortisone, a potassium, a calcium, urine on 17-, VMK, fibers of a blood and urine, etc.)
- The renal reasons (the analysis wet, assays Zimnitskogo, addis-ao?u, Reberga, US of kidneys and vessels of kidneys)

[273]

Thanks for advice or council, has already sent the wife in a drugstore.
It is possible one more question?
Together with Betalok 30 following preparations have been appointed or nominated:
1. preduktal MV on 35 2 times day;
2. Indapamid on 2,5 in the morning;
3. Captoprilum on 25 2 times day;
4. Kardiket retard on 40 2 times day;
5. Sydnopharmum on 2 2 times day.

Whether it is possible to accept all these preparations simultaneously?

Yours faithfully, Igor.

[Aritmolog]

And what you at once preparations have not listed all???
He accepted all of them? Or it was limited to a self-choice of one betaloka?
Well good...

2. Indapamid on 2,5 in the morning; - weak diuretic, Hypothiazidum is stronger.
3. Captoprilum on 25 2 times day; - the dose and frequency rate of reception are small, enalapril is better.
4. Kardiket retard on 40 2 times day; - I do not mind.

5. Sydnopharmum on 2 2 times day.
1. preduktal MV on 35 2 times day;
These or It it is possible to not accept - weak and ineffective medicines. It is amusing, that preduktal have put on 1 place.

Write, how will operate or work ++. Can it is necessary will vary doses, replace with other medicines or add still something.

[273]

The order of preparations absolutely casual.

If you not against, I can send you on E-mail an extract from a case history in format PDF (I now scan it or her).

I look forward to hearing on LLL273@mail.ru

Yours faithfully, Igor.

[Aritmolog]

The photo can be attached directly here at a forum.
Forgive or Excuse, but on E-mail I try to not communicate with patients.

[Aritmolog]

On extracts.
Kidneys. In urine fiber and erythrocytes. On US - it is condensed and deformed. It is necessary to visit or attend the urologist and to be treated!

EhoKG: FV 45 %. Edemas of legs or foots are? A trace from elastic noska?
To that I have listed it is necessary to add veroshpiron 100 mg daily.

Saccharum 6,1. It is necessary to make the -tolerant test for exception of Diabetum.

Cholesterin 5,5 - to that has listed to add simvastatin 10 mg for the night.

In a hospital to pressure battled Nifedipinum and Clophelinum. I.e. the hypertensia badly gave in to treatment. What, except for betaloka your father accepted yesterday, the day before yesterday, today? Let's begin all that I have listed. And tomorrow we shall try to strengthen therapy if it is required.
In treatment of a hypertensia continuousness and duration are important.

[273]

Edemas of legs or foots are, and as it seems to me strong - shchikolotku practically it is not visible. At pressing the trace remains about one minute.
One more question.
How often it is necessary to measure a BP?

Yours faithfully, Igor.

[273]

BP 250/170
At 16:30 has given
Enalapril of 10 mg
Hypothiazidum of 25 mg
veroshpiron 50 mg

What to do or make?

Whether it is possible to accept Spazmalgon at a high BP, the father is excruciated very much with a headache? If there is no that that is possible?

[Aritmolog]

In view of otekov-a dose of Hypothiazidum it is possible to increase about 50 mg.
Watch or Keep up that how much he drinks and how much pisaet. Periodically weigh.

Spazmalgon - it is possible.

BP measure not less than 2 times day. If necessary it is possible to measure each 1/2 hours.

For the period of a convergence of edemas it is necessary to give for the night 250 - 325 mg of Aspirinum if there is no stomach ulcer.

Tomorrow it is meaningful to give 40 mg of Furosemidum (Lasixum) in the morning.

[273]

Today at 9.00 a BP 150/100; at 16.00 180/130.

The report has read through just now.

Whether it is possible to give UPSARIN UPSA (200 Aspirinum 330 askorbinki)

[Aritmolog]

It is necessary to aspire to 140 and 90 mm hg
Askorbinka - to what! Better simply Aspirinum (even Soviet - Acidum acetylsalicylicum).

[273]

There are some problems with a stomach.
If I have correctly understood Aspirinum and quality of anticoagulant.
Whether replacement by Warfarin is possible or probable?

I accept Varfari 5 in day PTI of 65-70 %.

If only Aspirinum that mozhnoli even sparkling?

[Aritmolog]

If can check often PTI warfarin it is possible. PTI it is necessary 50 - 60. But then any Aspirinum!

What to you it was gave sparkling? Think less stomach will touch - so it not so. Action of Aspirinum and others NPVS on a stomach - systemic, i.e. through a blood!!! Instead of in a place of contact are household conjectures:) But if want it is possible also sparkling. And here askorbinka to what, by the way she not less Aspirinum influences a stomach.

And what with a stomach? Something can it or him podstrahuem?

[273]

Medical obsledvany in occasion of a stomach was not.
Sometimes complains of a heartburn. Here also I am afraid.

With control PTI perhaps there will be problems, the house will be not not checked up, and in an out-patient department record for 2-3 weeks forward.
Last time 2 months ago checked that, and owes each 2 weeks, at least.

[Aritmolog]

Warfarin without the control - is impossible!!!
Then Aspirinum + ranitidin (zantak, gistak, etc.). Ranitidin - prikryshka from a stomach (heartburn).

PTI (it is better MNO) at stably picked up dose of warfarin it is possible to measure once a month series of packing of a preparation. Less often - it is very dangerous!

[273]

Very dangerously! On how much?

MNO it is certainly good, but do or make only in OKD and that for money (500).

[Aritmolog]

On how much? It is complex or difficult to tell or say, the risk of a bleeding is simply great at uncontrolled reception of warfarin (and less often than 1 time a month is uncontrolled).

MNO can consider or count. It is necessary to know PTI and an index of sensitivity of a solution (to ask in laboratory). MNO = (PTI yours/O? of control plasma) in degree MICH. MNO does not depend on properties of a solution, unlike PTI.

[273]

At 21:00 the BP of 190/130 tablets has given at 18:00

All has understood I shall supervise MNO in OKD.

By the way level PTI keeps since August of that year approximately 60-70 %.

It is possible to consult at you as at kariologa, to open a new subject or it is possible here?

[273]

AT 9:00 A BP 160/120

[Aritmolog]

It is possible to increase still a dose of Hypothiazidum - up to 100 mg (but only for some time), and enalapril up to 20 mg h 2 times.
Even day is observable, if it is not enough, it will be possible to add amlodipin 5 mg h 1 time.
What with edemas of legs or foots? And how much he is wetted for a day?
The level of its or his hemoglobin, if low iron preparations are necessary, Acidum folicum and cyancobalamine is important also.

Question as to the cardiologist, set at the next forum is better
http: // forum.nedug.ru/forumdisplay.php? s = and forumid=14
And only in a new subject to mix:)

[273]

AT 17:00 A BP 170/130

With edemas of legs or foots, on mine, normally, a trace from elastic noska practically it is not visible.

Level of a hemoglobin while I can not tell or say. The father is still weak and in an out-patient department will reach to him tjazhelovato, but we shall try to make the analysis more quickly.

How much he is wetted for a day precisely (in times) I can not tell or say, but obviously more often than earlier, even swears " that for chemical has palmed off ".

Tonight ladies of enalapril of 20 mg.

[Aritmolog]

Then do not hurry up to increase or enlarge Hypothiazidum, time edemas descend or go.
Hemoglobin can define or determine and domiciliary if to cause or call.

Measure the allocated and absorbed liquid! It is a lot of to allocate too it is not good, since there is a risk of disturbances of the coagulative cascade!

[273]

Today has given already 50 Hypothiazidum in the morning, it is necessary to reduce up to 25?
Hemoglobin on Monday we shall define or determine.

There is a cardiogram of approximately monthly prescription (was together with an extract), it is necessary to send?