Consultation on Medication Concerns for Hypertension Management

Medication Inquiry Consultation

Dear Dr.
He,
Hello.
I am inquiring on behalf of my mother, who is 68 years old and does not use the internet.
Recently, she has been experiencing high blood pressure (systolic pressure exceeding 200 mmHg).
After visiting a cardiologist, she was prescribed "Diovan" (160 mg).
However, after taking it, she experienced low blood pressure (90/60 mmHg) and felt fatigued, weak, and slightly dizzy, which are uncomfortable side effects.
During her follow-up appointment today, she reported these issues to her doctor, but the physician advised her to continue taking "Diovan" (160 mg) regularly and not to reduce or stop the medication on her own to avoid hypertension.
I would like to ask Dr.
He the following questions:
Q1.
Will the side effects of low blood pressure, dizziness, and fatigue caused by taking "Diovan" (160 mg) diminish over time as my mother continues to take the medication and her body adjusts to it?
Q2.
Based on your opinion, should my mother continue taking "Diovan" (160 mg), or should she not have to endure these side effects and instead ask her doctor to adjust or change her medication?
Thank you, Dr.
He.

Axiang, 40~49 year old female. Ask Date: 2023/03/24

Dr. He Dongjin reply Cardiology

Hello, my opinion is that if the systolic blood pressure exceeds 200, the focus should not be solely on treatment.
It is important to first understand what the average blood pressure is.
Diovan 160mg is not that strong and is unlikely to reduce blood pressure from 200 to 90.
I would recommend stopping the medication first and observing the changes in blood pressure, then starting with half a dose to monitor the blood pressure changes accordingly.
Peace and care from Changhua Hospital.

Reply Date: 2023/03/24

More Info

Managing hypertension, especially in older adults, can be quite challenging, particularly when patients experience side effects from their medications. In your mother's case, she is experiencing significant fluctuations in blood pressure, with episodes of very high readings (over 200 mmHg) and low readings (90/60 mmHg) after taking Diovan (Valsartan). This situation raises important questions about the appropriateness of her current treatment regimen.

Q1: Will the side effects of Diovan (low blood pressure, fatigue, dizziness) diminish over time?
In many cases, patients may adapt to the side effects of medications over time. However, this is not guaranteed, and the experience can vary significantly from person to person. Some individuals may find that their bodies adjust to the medication, leading to a reduction in side effects, while others may continue to experience discomfort.
It's also important to consider that the low blood pressure readings your mother is experiencing could be a direct result of the medication. Diovan is an angiotensin receptor blocker (ARB) that is effective in lowering blood pressure, but it can lead to hypotension (low blood pressure) in some patients, especially if they are sensitive to its effects or if they are taking other medications that also lower blood pressure.

Q2: Should your mother continue taking Diovan despite the side effects?
Given the side effects your mother is experiencing, it is crucial to have an open dialogue with her healthcare provider. While it is essential to manage her hypertension to prevent complications such as stroke or heart attack, the quality of life and the patient's comfort are equally important. If the side effects are significantly impacting her daily life, it may be worth discussing alternative treatment options or adjusting the dosage with her physician.

Here are some considerations:
1. Medication Review: It may be beneficial for her doctor to review all of her current medications. Sometimes, interactions between different medications can exacerbate side effects.
2. Alternative Medications: If Diovan is causing unacceptable side effects, her doctor might consider switching her to a different antihypertensive medication. There are various classes of antihypertensive drugs, including diuretics, calcium channel blockers, and other ARBs, which may be better tolerated.

3. Lifestyle Modifications: Alongside medication, lifestyle changes can significantly impact blood pressure management. Encouraging a heart-healthy diet (such as the DASH diet), regular physical activity, weight management, and stress reduction techniques can help stabilize blood pressure.

4. Monitoring: Regular monitoring of blood pressure at home can provide valuable information to her healthcare provider. Keeping a log of her blood pressure readings can help identify patterns and inform treatment decisions.

5. Follow-Up Appointments: Regular follow-up appointments are crucial for adjusting treatment plans based on her response to medications and any side effects she experiences.

In conclusion, while Diovan can be an effective medication for managing hypertension, the side effects your mother is experiencing warrant a thorough discussion with her healthcare provider. It is essential to balance the need for effective blood pressure control with the importance of maintaining her quality of life. If the side effects do not improve or worsen, seeking a second opinion or exploring alternative treatment options may be necessary.

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