Should I Switch My Blood Pressure Medication After Surgery?

Do I need to change my medication?

Hello Dr.
Lee, I was involved in a car accident on December 4th, resulting in an open fracture of my lower limbs, and I underwent surgery.
After the surgery, I was moved to the recovery room, where my blood pressure was 180/120.
Due to the persistently high blood pressure, I was monitored for 2 to 3 hours.
During my hospital stay, the doctor prescribed Amlodipine 5/160 mg as an antihypertensive medication, which I took every morning.
My systolic blood pressure ranged from 140 to 160.
Two weeks after being discharged, I continued taking the antihypertensive medication.
During this time, I occasionally experienced insomnia, with some nights of no sleep, and my blood pressure sometimes reached 170, but I did not experience headaches.
Due to necrosis at the surgical site, I underwent two debridement surgeries and received negative pressure wound therapy, requiring an additional 10 days of hospitalization.
Now, since the epidermis has not yet healed, I need to continue applying medication at home.
A few days ago, I visited the cardiology outpatient clinic, and after blood tests, the doctor indicated that all my indices were normal.
My systolic blood pressure has been fluctuating between 145 and 155, with diastolic pressure around 100.
The doctor recommended switching to Lercanidipine 10/160/25, stating that it is slightly stronger than Amlodipine.
However, I have not yet switched medications and am still taking Amlodipine.

Could you please explain the difference between Amlodipine 5/160 and Lercanidipine 10/160/25? I read online that Amlodipine can affect erectile function; does Lercanidipine have other side effects? Over the past few days, my systolic blood pressure has been between 135 and 145, diastolic pressure between 97 and 107, and my pulse has ranged from 68 to 85.
I compared my home blood pressure monitor with the one from the hospital, and I found that my home readings for both systolic and diastolic pressures were each about 10 mmHg higher.

max, 40~49 year old female. Ask Date: 2022/02/23

Dr. Li Shengkai reply Cardiology

(1) Eyanwen (5/160) is a combination antihypertensive medication that contains two components: a calcium channel blocker and an angiotensin receptor antagonist.
Liyanwen (5/160/25) is also a combination antihypertensive medication, but it includes a diuretic, making it more potent, with an approximate additional reduction of 10 mmHg in systolic blood pressure.
(2) In fact, all types of antihypertensive medications can affect sexual function to some extent.
If one experiences adverse effects, it is advisable to seek assistance from a urologist.
All medications have potential side effects, but Liyanwen has been in use for a long time, suggesting that its side effects are likely manageable; if there were severe side effects, it would have been withdrawn from the market long ago.
(3) Blood pressure readings taken at home and in a hospital may differ slightly.
In a hospital setting, the unfamiliar and often noisy environment can inadvertently cause tension, leading to elevated blood pressure.
Different blood pressure monitors may have slight measurement discrepancies, so it is recommended to take multiple readings for accuracy; additionally, blood pressure monitors should be calibrated regularly to maintain their functionality.
(4) Generally, home blood pressure should not exceed 130/80 mmHg; besides medication, lifestyle modifications following the SABCDE approach should be actively pursued to help control blood pressure: S (sodium-restricted diet), A (moderate alcohol consumption), B (weight loss), C (smoking cessation), D (DASH diet), E (regular exercise).

Reply Date: 2022/02/23

More Info

After surgery, managing blood pressure is crucial, especially for patients with a history of hypertension and those who have undergone significant medical procedures, such as your case following a car accident and subsequent surgeries. It’s understandable to have concerns about whether to switch medications, especially when considering the differences between the medications prescribed.

The two medications you mentioned, 易安穩 (Amlodipine/Benazepril) and 力安穩 (Amlodipine/Benazepril/Hydrochlorothiazide), are both antihypertensive agents but differ in their composition and mechanism of action. The primary difference lies in the addition of a diuretic (Hydrochlorothiazide) in 力安穩, which can enhance blood pressure control, particularly in patients who may have fluid retention or additional cardiovascular risk factors.

1. Effectiveness: 力安穩 is generally considered more potent due to the diuretic component, which helps to reduce blood volume and, consequently, blood pressure. If your blood pressure readings remain elevated (145-155 systolic and around 100 diastolic), switching to 力安穩 may provide better control. The goal is to maintain blood pressure below 130/80 mmHg, especially after surgery, to reduce the risk of complications.

2. Side Effects: As with any medication, both drugs can have side effects. Amlodipine, a calcium channel blocker, can cause peripheral edema (swelling), dizziness, and in some cases, sexual dysfunction. Hydrochlorothiazide, the diuretic in 力安穩, may lead to electrolyte imbalances, dehydration, and increased urination. It’s essential to monitor for these side effects, especially after surgery when your body is healing.

3. Monitoring: After surgery, it’s vital to keep a close eye on your blood pressure and any side effects you may experience. Regular follow-ups with your healthcare provider are essential to adjust medications as needed. If you notice significant fluctuations in your blood pressure or experience side effects, communicate these with your doctor.

4. Lifestyle Modifications: In addition to medication, lifestyle changes can significantly impact blood pressure management. Following the SABCDE approach (Sodium restriction, Alcohol moderation, Body weight management, Cessation of smoking, Dietary changes, and Exercise) can help in controlling blood pressure effectively.
5. Consultation with Your Doctor: Since your doctor has recommended switching to 力安穩, it’s likely they have assessed your current blood pressure readings and determined that a stronger medication may be necessary. However, if you have concerns about switching medications or potential side effects, it’s crucial to discuss these with your healthcare provider. They can provide personalized advice based on your medical history and current condition.

In conclusion, switching your blood pressure medication after surgery can be beneficial, especially if your current medication is not adequately controlling your blood pressure. 力安穩 may offer improved control due to its additional diuretic component. Always consult with your healthcare provider before making any changes to your medication regimen, and ensure you are monitoring your blood pressure regularly to assess the effectiveness of the treatment.

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