Blood Pressure Medication

[Jingthing]

1 minute ago, Pottinger said:

He may also self-medicate for quite the wrong underlying ailment, which a doctor could pick up.

That's why I said yes and no.

[Pottinger]

4 minutes ago, Jingthing said:

That's why I said yes and no.

Well, personally I would not equivocate; the heart and its condition are of fundamental importance to men in middle age and beyond, and in my opinion not to be fooled around with in asking questions of anonymous people on an internet forum such as this - particularly not just for the sake of lowering his insurance premium.

[Jingthing]

Just now, Pottinger said:

Well, personally I would not equivocate; the heart and its condition are of fundamental importance to men in middle age and beyond, and in my opinion not to be fooled around with in asking questions of anonymous people on an internet forum such as this - particularly not just for the sake of lowering his insurance premium.

Well Sheryl isn't anonymous. I'm sure she would recommend consulting a competent doctor before starting a BP med but in that context she did mention ace inhibitors. I'm assuming as a way of acknowledging that in Thailand many people do self prescribe because most meds don't require a scip here.

Just keeping it real.

[BigStar]

8 hours ago, Jingthing said:

Well Sheryl isn't anonymous. I'm sure she would recommend consulting a competent doctor before starting a BP med . . . .

And so she did ask, Have you had a full cardiac assessment? (Inc. stress test)?

 

The OP's also taking a statin, so his health's probably just degenerating into the usual metabolic syndrome. In the absence of any successful attempt to diet and exercise, chasing after docs is his only realistic course of action. That is, he should get this year's full cardiac assessment out of the way ASAP, not self-medicate and foolishly attempt to defraud his insurance company.

[Jingthing]

8 minutes ago, BigStar said:

And so she did ask, Have you had a full cardiac assessment? (Inc. stress test)?

 

The OP's also taking a statin, so his health's probably just degenerating into the usual metabolic syndrome. In the absence of any successful attempt to diet and exercise, chasing after docs is his only realistic course of action. That is, he should get this year's full cardiac assessment out of the way ASAP, not self-medicate and foolishly attempt to defraud his insurance company.

Not interested in arguing with you. Just saying that IF some people are going to self prescribe and some people definitely will, they may as well make the best possible decision on choice of meds. This is Thailand. You can lecture people all you want but you can go into any drugstore and buy most anything. 

[steve187]

19 hours ago, Pottinger said:

You're mad to ask such advice on ThaiVisa - see a shrink.

helpful post

[Banana7]

A friend who went to Bang Lamung hospital with hypertension BP 180/105 was prescribed:

Manidipine 20 mg, after morning meal

Apresoline (hydralazine) 25 mg, 1 tablet after morning meal, 1 tablet after evening meal

For high HDL cholesterol, half of one 40mg tablet after evening meal, chlovas-40, atorvastatin 40mg tablet

Now his BP average 120/85 pulse ranges 70-90.

 

[norbra]

On 3/3/2021 at 8:11 PM, Sheryl said:

Have you had a full cardiac assessment? (Inc. stress test)? As presence/an]bsence of carduac disease is a factor in selecting best approach to managing hypertension.

 

Assuming no cardiac issue, the most common first line drugs for someone with no special other conditions and assuming not of African descent would be an ACE inhibitor or an Angiotensisin II Receptor Blocker.

 

Least expensive forms of these in Thailand are Enalapril and Losartan respectively. ARBs (Losaratan) as less likely to cause dry cought than ACE inhibitor (though sometimes do).

 

People of of African descent respond better to calcium channel blockers.

 

With any drug, you want the lowest dose that achieves good control so need to monitor at home.

 

Be sure to read up on contraindications, side effects and interactions.

 

 

Could a Thaizide diuretic be used in combination with ace/arbs doses.

Could this also reduce BP further?

Edited August 21 by norbra

[orang37]

For a first step, you might want to look into ACE inhibitors like lisinopril or ARBs like losartan. They're pretty common and have fewer side effects. You can usually find them at local pharmacies without a prescription in Thailand. 

[Sheryl]

8 hours ago, norbra said:

Could a Thaizide diuretic be used in combination with ace/arbs doses.

Could this also reduce BP further?

 

This is often prescribed, yes. Usually in a low dose, lower than if diuretic used alone. 

[newbee2022]

On 3/3/2021 at 4:49 PM, myprivate said:

"go to see a Doctor" 

Follow this! And don't listen to all these wannabe Doctors here.👍

No diagnosis here, no anamnesis either.😶

[norbra]

18 minutes ago, newbee2022 said:

Follow this! And don't listen to all these wannabe Doctors here.👍

No diagnosis here, no anamnesis either.😶

I was asking for information about diuretics,I received an excellent reply from @Sheryl.

[crobertsjr]

I am a retired RN. I would not start with Amlodipine. There are many other safer medications out there. Perhaps do a search on Google for the safest blood pressure medications. Then use Drugs.com to look at dosing, interactions, side effects, etc. Only you know your other health issues, if any, and your personal lifestyle. These things will effect what your best choice of medication will be.

[crobertsjr]

Be careful self prescribing loop diuretics. They can have negative effects on electrolyte levels, which will create additional problems.

[norbra]

1 minute ago, crobertsjr said:

I am a retired RN. I would not start with Amlodipine. There are many other safer medications out there. Perhaps do a search on Google for the safest blood pressure medications. Then use Drugs.com to look at dosing, interactions, side effects, etc. Only you know your other health issues, if any, and your personal lifestyle. These things will effect what your best choice of medication will be.

Before coming to Thailand I was on Exforge HCT,in Thailand 3000baht per month.

I switched to adlodipine and losarten equivalents,for 20 years now my BP has been mid 120's/70,now up 12% so I was looking at adding the diuretic I was taking in the Exforge HCT combo.

[newbee2022]

20 minutes ago, norbra said:

I was asking for information about diuretics,I received an excellent reply from @Sheryl.

Perfect that she could give diagnosis on internet plus doing anamnesis. Congrats.🤣

[norbra]

Just now, newbee2022 said:

Perfect that she could give diagnosis on internet plus doing anamnesis. Congrats.🤣

Bye'

[newbee2022]

On 3/3/2021 at 10:16 PM, Lazy Sod said:

Good info

A very inappropriate advice.

A responsible doctor would do anamnesis first, then diagnosis, then medication if necessary.

[Burma Bill]

On 3/3/2021 at 4:49 PM, myprivate said:

I'm in my late 50's, blood pressure has been steadily rising the last couple of years, now it's often in the range 130-150, rarely below 130. Tried losing weight and exercising, etc., not much difference. My mother, father and brother all needed blood pressure meds once they hit 60.

 

What would be the first drug to try for somebody based in Thailand? People may say "go to see a Doctor" but once 'high blood pressure' is diagnosed it seriously affects health insurance, for example exclusions for cardio-vascular conditions, or a much higher premium. I don't want that on my record at this stage. Prefer to manage it myself, at least in the early stage, using blood pressure monitor and locally purchased meds.

 

No other health issues except high cholesterol (which is controlled by statins), taking no other meds at this stage.

 

When I lived in Thailand almost 5 years ago, and being an insulin dependent Type 2 diabetic, my Thai doctor prescribed - 

Amlopin 5mg (2x daily, am/pm) and Angilock 50mg (one daily am). This is approved by my Khmer doctor and I continue with the same prescription.

[sandyf]

2 hours ago, crobertsjr said:

I am a retired RN. I would not start with Amlodipine. There are many other safer medications out there. Perhaps do a search on Google for the safest blood pressure medications. Then use Drugs.com to look at dosing, interactions, side effects, etc. Only you know your other health issues, if any, and your personal lifestyle. These things will effect what your best choice of medication will be.

That was my experience in the UK. When first diagnosed, over 45 years ago now, I was prescribed a beta blocker, some years later that was changed to an ace inhibitor and it was some time after that the doctor added Amlodipine. Been the same prescription now for about 20 years.

[GordonP]

I've been on Ramipril 10mg and Lercandipine 10 mg many years (I was diagnosed at age 24, now aged 68). Recently the latter has been increased to 20 mg. 

[sandyf]

On a slightly related issue, does anyone know if generic apixaban can be sourced in Thailand.

[sandyf]

4 minutes ago, GordonP said:

I've been on Ramipril 10mg and Lercandipine 10 mg many years (I was diagnosed at age 24, now aged 68). Recently the latter has been increased to 20 mg. 

Indeed, many seem to think it is an old age problem. I was first diagnosed just over 30 but think it was there before that.

When I was discharged from the RAF at age 30 the MO made me wait half an hour and checked again, frowned a bit but signed the papers, never thought anything of it till I started seeing a GP.

[Letseng]

Every type has a side effect. Most give you swollen ankles.

There is not "a one fits all" BP pill. Plus your underlying condition which causes the rising BP needs to be considered (e.g. kidneys?). Start of by reducing salt & see what happens.

My doc would not put you on BP drug with a BP of 130 or 140/...? Go & see somebody. 

 

 

[Globalres]

On 3/3/2021 at 4:49 PM, myprivate said:

I'm in my late 50's, blood pressure has been steadily rising the last couple of years, now it's often in the range 130-150, rarely below 130. Tried losing weight and exercising, etc., not much difference. My mother, father and brother all needed blood pressure meds once they hit 60.

 

What would be the first drug to try for somebody based in Thailand? People may say "go to see a Doctor" but once 'high blood pressure' is diagnosed it seriously affects health insurance, for example exclusions for cardio-vascular conditions, or a much higher premium. I don't want that on my record at this stage. Prefer to manage it myself, at least in the early stage, using blood pressure monitor and locally purchased meds.

 

No other health issues except high cholesterol (which is controlled by statins), taking no other meds at this stage.

For many years I was 145/85 - 160/85 at home.  At hospital it shot up much higher. Since a few years I have taking L-arginine a simple amino acid (L-Citrulline is also considered good).  It increases production of the “good” nitric oxide as well as widens your veins and makes them more permeable.  My blood pressure at home is now in the range of 110-118/80 and has been since some months after starting the L-arginine.  
You can google L-arginine and read for yourself.  It helps many people but not all.  This way I have been able to stay away from drugs which ALWAYS have side effects.  FYI I am 75 yrs old.

[Irish star]

On 3/3/2021 at 7:31 PM, BritManToo said:

I went to the hospital and used the machine 86/60.

Nurse says 'that's no good at all, do it again'

We settled on 96/60.

Mine is 96 over 64 

[loong]

On 3/3/2021 at 4:52 PM, KannikaP said:

Amlodepine, start with 5mg then up to 10mg if no change. Bht 240 for box of 100.

Amlodepine when taken with some statins can lead to serious side effects including liver problems!

I used to take Amlodepine but when I had to start to take statins, the doc changed my BP drug to Anapril.

Self-medication can be a really bad idea as well as risky.

[BusyB]

On 3/3/2021 at 10:52 AM, KannikaP said:

Amlodepine, start with 5mg then up to 10mg if no change. Bht 240 for box of 100.

 

There are so many potential causes of high blood pressure that s/he should see a doctor. It's not good enough to assume that a calcium antagonist might solve the issue. The situation can also become urgent very quickly. There's a multitude of potentially fatal issues could be behind the development. Could be anything from plaque to valve problems to nervous system signaling problems. Or psychosomatic.

 

A decent health insurance will probably apply a reasonable surcharge premium to an issue that is being properly managed.

 

OP see a doctor. Especially if your lower BP value (diastolic) is at 81 or above. The 130's (systolic) is not such a problem although 120 is better. Doctors worry more about the diastolic value. You need a thorough evaluation.

 

I've been through the process and actually take Amlodipin because calcium build up in my vascular system was constricting dilation and contraction and hence blood flow. Now they've found some plaque build up in my coronary blood vessels which is not threatening now, but is obviously a long term threat. I'll probably be on statins by year's end. That process is ongoing with a stress ECG coming up. I'm heading for 70.

 

As my heart specialist said, "It's quite normal as you age. All part of the dying process."

[sanabavy IV]

Can such a dated topic be listed in " featured topics"? Am I missing something here?

[Alidiver]

Suggest first get a blood test and look at LDL levels.
Depending on results, you may need either statins or a calcium channel blocker such as Amlodopine.