Addressing Cardiovascular Medication Concerns for Elderly Patients - Cardiology

Questions regarding cardiovascular medications for my father?

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Hello, Director He.
I would like to ask you about my father's cardiovascular medication issues.
My father is 78 years old.
In mid-August last year, he experienced two episodes of syncope.
The first time, he fainted in the bathroom and described waking up about five minutes later, finding himself sitting on the bathroom floor.
Two days later, he fainted again at his desk, and we called an ambulance to take him to the emergency room.
After relevant examinations in the emergency department, he waited for two weeks until a hospital bed was available, during which he underwent cardiovascular examinations including echocardiogram, tilt table test, carotid ultrasound, brain MRI, and cardiac catheterization.
The results were generally okay, with no serious issues found.
The doctor attributed the syncope to my father's hypertension, hyperlipidemia, and diabetes, and recommended that he get a pacemaker to monitor his heart rhythm.
However, my father felt that this was an invasive treatment and preferred to manage his condition with medication.
From October last year until now, he has been taking the following medications:
1.
Datan (Atenolol) 160 mg
2.
Metformin 850 mg (stopped in January this year)
3.
Clopidogrel 75 mg
4.
Rosuvastatin 10 mg
5.
Bisoprolol 5 mg (stopped in March this year)
6.
Glimepiride 25 mg
7.
Candesartan 4 mg (newly prescribed in April, but stopped on July 24)
8.
Metformin extended-release 500 mg (newly prescribed in April)
He has had regular follow-ups, totaling four visits, and has undergone blood tests before each visit.
As of the July 24 visit, his HbA1c has decreased from 8.1% to 6.4%.
During the April 25 visit, his cholesterol levels also improved.
However, my father felt dizzy from the medications, leading the doctor to stop Rosuvastatin.
At the July 24 visit, due to a rise in cholesterol levels, the doctor advised him to take Rosuvastatin every other day.
Since my father still frequently felt dizzy, the doctor discontinued Candesartan and adjusted Datan to half a dose taken twice daily.
After the July 24 visit, my father felt that his HbA1c had decreased, cholesterol levels had not risen significantly, and his blood pressure readings were between 130-140 systolic and 80-90 diastolic.
However, he secretly stopped all medications, feeling that the dizziness made him reluctant to continue.
We discovered this on August 10 and forced him to resume his medications.
I would like to ask the doctor:
1.
After stopping medications for about three weeks, will resuming them have any effects on his health?
2.
Recently, I have observed that his blood pressure sometimes exceeds 140 systolic after resuming medications.
Could this be a reaction due to the prolonged cessation of medication?
3.
After my father was hospitalized last year, he was diagnosed with COVID-19 upon returning home.
Could this be a reason for his frequent dizziness and lack of energy while taking medications?
4.
I found online that many antihypertensive medications have dizziness as a side effect.
How can this be addressed? Should we consider changing medications?
5.
Since Candesartan was discontinued during this visit and my father has prostate issues, causing him to frequently wake up at night to urinate, should we consult the doctor about possibly resuming Candesartan?
Thank you very much, Director He.
I appreciate your assistance in answering these questions.
Thank you.

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Ms. Zhang, 40~49 year old female. Ask Date: 2023/08/13