Medication For High Bp

[phutoie2]

Hello all, a few months ago I read several good posts on high blood pressure problems and there were some pretty well informed folk on TV giving good advice.

I was diagnosed with high blood pressure about 4 years ago after feeling quite unwell at work (In UK).

It is now fairly well under control but I have to take a mixed regime of medication to keep it that way.

Retiring to a more relaxed way of life in Thailand has really helped too by the way.

During my last 4 years I have had numerous tests and investigations done to find the cause of the high BP.

The last one being a coronary angiograph with the results revealing a clear set of arteries and no problems there.

A ct scan last year showed up a tumour on one of my adrenal glands and my physician has suggested a possibility of something called Conns syndrom with hypokalemia, but after some special blood tests for hormone/aldosterone levels another physician thinks the lump on my gland is just incidental.

Still do not know the cause of the high BP but as we have a history of this on my mothers side the physicians advice was "we are all a product of our parents" see you in two years time and in the meantime keep having regular BP and pottasium checks.

This I have been doing at a local poly-clinic in a nearby town.

The main problem as I see it in Thailand is to keep up a regular supply of medication.

In the UK I was on daily:- 50 mg Spironlactone

10 mg Amlodipine

20mg Lisinopril

10mg Amlodipine

20mg Olmersartan (similar to Valsartan but cheaper)

4 mg Doxazosin

I only started taking the spronlactone (potassium sparing diurectic) at the beginning of this year and this, drug has some unpleasant side effects ie developing boobs bigger than my wifes!!), however this is the one medication that really helped to lower my BP to a normal level (130/80 to 141/85) last 2 readings.

The other medications that I had been taking only had minimul effects in lowering my BP.

At my local clinic I can purchase a Thai version of Spironlactone and Amlodopine but they do not stock any of the others I have mentioned. I ran out of the alpha blocker - Doxerzosin some months ago and not noticed any side effects so far.

I have been told that after seeing a Thai consultant at my local big city hospital you can purchase medication at the hospital pharmacy. The hospital is a 270 km round trip and the medication is expensive but that does not really concern me, its much better than the alternative.

On my last trip to BKK (visa extension) I visited several drug stores/pharmacies and all my medication was available but again very pricey.

I have now started to build a new life in Thailand and despite having excellent treatment by the NHS I do not wish to return to the UK for some time. A long post!!! but if anyone has advice on purchase of BP medication, good hospitals/physicians (BKK/central Thailand), costs of CT scans etc - much appreciated.

PS joined BUPA but being an honest chap I declared everything under pre-existing conditions.

Edited October 13, 2007 by phutoie2

[Gary A]

When I moved over here, I was on four different types of medications. My blood pressure was NOT under control and I felt bad every day. A friend of mine took me to see his doctor. After a talk reviewing my medical history and what I was taking, the doctor recommended a 60 mg aspirin (Aspent) and a 20 mg Anapril every day and to come back to see him in a week. Anapril is an ACE inhibitor that is made in Thailand. Within two or three days I felt like a new man. Best of all my blood pressure is under control. I now take 10 mg (half a tablet) and everything is normal.

[Mobi]

There must be a decent drug store in -presumably? - Bangkok - which will have in stock, or order for you, a wide range of drugs.

Here in Pattaya I use Fascino, which has a massive range of drugs - just about everything that is available in Thailand, and all at decent prices, and a 5 % discount for frequent users. What they don't have in stock they will get within 48 hours.

I too suffer from high BP as well as being a insulin dependant diabetic, suffering from glaucoma, coronary disease, and a dodgy prostate and I take over 15 different meds a day for these conditions, and all are available at Fascinos.

There must be a similar place to Fascinos in BKK.

Maybe someone can recommend a place?

[Sheryl]

Lisonapril is an ACE inhibitor and readily available in Thailand under a variety of brand names, including Prinivil and Zesrtil, among others.

Doxazosin, the alpha blocker, is likewise available under many brand names; some of the local generic equivelents include Duracard, Pencor and Cazosin

Olmersartan, an Angiotensis II inhibitor is vailable too but only as brand name import and thus expensive. As far as I know this is still the case with all the Angiotensisn II inhibitors. So if it is possible to get your BP controlled without them that would be better for you economically...but of course, don't let the cost factor keep you from them if they are necessary (i.e. if cannot control BP otherwise). I think some of the earliest ones will be coming off patent and hence getting cheaper within a few years time.

It is, however, not usual to be one both an ACE inhibitor and an angiotensisn II inhibitor. Usually it is one or the other...an ACE inhibitor being tried first due to its lower cost, then an angiotensin II inhibitor if there are side effects (or to begin withm, if there were contraindications) to the ACE inhibitor. The mode of action of the 2 classes of drugs are similiar.

In short, except for the Angiotensin II Inhibitor, it sounds like your medication problem is just lack of good pharmacies in your area. Where exactly do you live?

Many pharmacies in Thailand are staffed by people who are not actual pharmacists and do not recognize drugs by generic name. However, there will be at least one bona fide pharmacy (as in, staffed by a licensed pharmacist) in every provincial capital or large town.

There is a Fascino's in Bangkok, it is across from Siriraj Hospital (Thonburi side of the river). I believe there is also one in Chiang Mai. And, of course, many other good pharmacies in Bkk and Chiang Mai as well.

Where I am puzzled and a bit concerned in your history is regarding the adrenal "tumor". Are you sure it was a tumor as opposed to a cyst? If so then was it biopsied? The fact that you respond so well to spironalactone (and only to spironalactone) makes me wonder if you may not in fact have Conn's disease. I think it would not hurt to consult a doctor specializing in adrenal disorders, but to reduce costs and simplify matters have with you a summary of your treatment and test results from the UK.

Could try one of these doctors at Bumrungrad who specialize in endocinology and hypertension:

Name: Dr. Poj Tannirandorn

Qualifications: Medical School: - M.D. Mahidol University, Siriraj Hospital, 1993

Board Certifications: - American Board of Internal Medicine, 1999

- American Board of Endocrinology, Diabetes and Metabolism, 2001

- Specialist in Clinical Hypertension, USA, 2001

- Internal Medicine, Thailand, 2002

- Endocrinology and Metabolism, Thailand, 2002

- Family Medicine, Thailand, 2002

Special Clinical Trainings (with Document) : Thyroid Diseases and Endocrine Disorders Special Clinical Interests: Diabetes, Endocrine Disorders, Internal Medicine & Hypertension

Day Time Location

Mon 16:30 PM - 19:00 PM Med/Surg NS 7

Wed 16:30 PM - 19:00 PM Med/Surg NS 7

Fri 16:30 PM - 19:00 PM Med/Surg NS 7

Sat 09:00 AM - 15:00 PM Med/Surg NS 7

Sun 09:00 AM - 11:30 AM Med/Surg NS 7

Name: Dr. Sarat Sunthornyothin

Qualifications: Medical School: Chulalongkorn University, 1990

Board Certifications: - American Board of Internal Medicine, 1996

- American Board of Internal Medicine, Subspecialty Endocrinology,

Diabetes & Metabolism, 1999

Special Clinical Interests: Endocrine Neoplasia, Lipid Metabolism, Osteoporosis and Hypertension

Day Time Location

Wed 17:00 PM - 20:00 PM Nurse Station 6

Fri 17:00 PM - 20:00 PM Nurse Station 6

Sat 09:00 AM - 12:00 PM Med/Surg NS 6

Good luck!

[phutoie2]

Thank you Sheryl for a very detailed reply. One of my worries of finally making that big "move" to Thailand was being able to access medication supplies especially as I was to live in the country without specialist pharmacies close by. Believe me I have visited many of the local chemist type shops in my area but apart from the local poly-clinic not much success.. I discussed this with my GP (doctor) before leaving UK and he recommended that it should 'nt deter me from going to Thailand.

I live about 250 km's north of Bangkok, up the highway 21 in a small town. The big cities of Sara Buri/Lop Buri and Nakhon Sawan are all about a 2-3 hour drive away. Some ex-pats I have spoken to attend the Sara Buri - Mittaparp Memorial Hospital and a consultant comes up from Bangkok on Saturdays. I think its just a matter of turning up, not too sure if there is an appointment system. I plan to go within the next few weeks and if not successful will try the Bangkok hospital and doctors you have recommended.

My physician in UK has posted on to me all my medical history notes since I first developed hypertension.

Having re-read them I notice I have been on Spironolactone for over 2 years now, and I am of the opinion that this one medication has been able to stabilise my very difficult to treat hypertension.

The physician also mentions that I have to have another CT scan in March 08 to monitor the lump on my left adrenal gland. No tests have been done on this lump as of yet, but as I said before one consultant says the results of the CT scan should not be dismissed entirely due to the findings of my hormone and plasma renin activity/Aldosterone tests. The other physician says I may have this Conn's syndrome due to my low pottasium and reaction to spironolactone together with this lump.

In December last year in UK I had ECG and exercise ECG tests, and I was referred for angiograpy. The angiograph revealed clear arteries. I asked the consultant if I should take an asprin a day for high BP etc and he told me "not neccessary"

Finally Sheryl if I cannot get hold of Lisinopril can I take another ACE inhibitor such as suggested by "Garry A" - Anapril for example?, which I can get locally. Is that the same as Enapril? I did read on the net about spironolactone and certain ACE inhibitors not being compatible.

I notice that you are from Prachinburi, my wife is from nearby Kabinburi.

I have driven down the 33 many times now.

Edited October 14, 2007 by phutoie2

[Gary A]

Thank you Sheryl for a very detailed reply. One of my worries of finally making that big "move" to Thailand was being able to access medication supplies especially as I was to live in the country without specialist pharmacies close by. Believe me I have visited many of the local chemist type shops in my area but apart from the local poly-clinic not much success.. I discussed this with my GP (doctor) before leaving UK and he recommended that it should 'nt deter me from going to Thailand.

I live about 250 km's north of Bangkok, up the highway 21 in a small town. The big cities of Sara Buri/Lop Buri and Nakhon Sawan are all about a 2-3 hour drive away. Some ex-pats I have spoken to attend the Sara Buri - Mittaparp Memorial Hospital and a consultant comes up from Bangkok on Saturdays. I think its just a matter of turning up, not too sure if there is an appointment system. I plan to go within the next few weeks and if not successful will try the Bangkok hospital and doctors you have recommended.

My physician in UK has posted on to me all my medical history notes since I first developed hypertension.

Having re-read them I notice I have been on Spironolactone for over 2 years now, and I am of the opinion that this one medication has been able to stabilise my very difficult to treat hypertension.

The physician also mentions that I have to have another CT scan in March 08 to monitor the lump on my left adrenal gland. No tests have been done on this lump as of yet, but as I said before one consultant says the results of the CT scan should not be dismissed entirely due to the findings of my hormone and plasma renin activity/Aldosterone tests. The other physician says I may have this Conn's syndrome due to my low pottasium and reaction to spironolactone together with this lump.

In December last year in UK I had ECG and exercise ECG tests, and I was referred for angiograpy. The angiograph revealed clear arteries. I asked the consultant if I should take an asprin a day for high BP etc and he told me "not neccessary"

Finally Sheryl if I cannot get hold of Lisinopril can I take another ACE inhibitor such as suggested by "Garry A" - Anapril for example?, which I can get locally. Is that the same as Enapril? I did read on the net about spironolactone and certain ACE inhibitors not being compatible.

I notice that you are from Prachinburi, my wife is from nearby Kabinburi.

I have driven down the 33 many times now.

Actually Enaril was the first one I was on and our village pharmacy suggested Anapril instead. My doctor said that either can be used as they are nearly identical. In this area Anapril is more widely available so that's what I take. I monitor my own blood pressure and can see no difference between the two. The last box of 100 20 mg foil wrapped Anapril I bought was 300 baht. I now only use a half tablet a day but they don't stock 10 mg tablets.

[phutoie2]

Thanks Garry A, for that, I too can purchase my main two medication tablets for 3 baht per tablet. (Spironolactone - made in Thailand) and Amlodopine (made in India) from my local clinic. Its only when I visited Boots the chemist in Silom that they wanted 54 baht per tablet.! Incidentally I use the website - drugs.com for some useful info.

[flyer]

Hi Phutoie,

Not sure it could help, or maybe you already tried that, but several of my friends who had more or less severe BP problems got very significant improvements or even complete remission with switching their eating habits to Thai food only (instead of English/european). Also make sure to get to your normal weight if you are overweight, no matter what that takes, but there also eating Thai food only will help a lot.

Good luck

[themuse1969]

Sir, here comes contrarian advice. If you are open to pursue it, good on ya, if not, so be it.

Don't cease your meds immediately, but do immediately find an herbal or nutrition-oriented practitioner and wean yourself of all those toxic meds ASAP. Again, do not switch cold turkey!....but do so gradually. Once you've made the switch, after 3-4 months, begin a gentle detox program under the guidance of that same practitioner. When it comes to functional medicine, allopathic medicine is macabre! The patient is killed slowly....slowly enough to fork over a bundle of cashola.

By what authority do I speak? The files of many patients' dreadful accounts of medical intervention, when all they needed was a loving tweak from the earth's garden. Also, my many years of loving service in this field. I'm retired now....as much as I can be, anyway.

Cheers

Hello all, a few months ago I read several good posts on high blood pressure problems and there were some pretty well informed folk on TV giving good advice.

I was diagnosed with high blood pressure about 4 years ago after feeling quite unwell at work (In UK).

It is now fairly well under control but I have to take a mixed regime of medication to keep it that way.

Retiring to a more relaxed way of life in Thailand has really helped too by the way.

During my last 4 years I have had numerous tests and investigations done to find the cause of the high BP.

The last one being a coronary angiograph with the results revealing a clear set of arteries and no problems there.

A ct scan last year showed up a tumour on one of my adrenal glands and my physician has suggested a possibility of something called Conns syndrom with hypokalemia, but after some special blood tests for hormone/aldosterone levels another physician thinks the lump on my gland is just incidental.

Still do not know the cause of the high BP but as we have a history of this on my mothers side the physicians advice was "we are all a product of our parents" see you in two years time and in the meantime keep having regular BP and pottasium checks.

This I have been doing at a local poly-clinic in a nearby town.

The main problem as I see it in Thailand is to keep up a regular supply of medication.

In the UK I was on daily:- 50 mg Spironlactone

10 mg Amlodipine

20mg Lisinopril

10mg Amlodipine

20mg Olmersartan (similar to Valsartan but cheaper)

4 mg Doxazosin

I only started taking the spronlactone (potassium sparing diurectic) at the beginning of this year and this, drug has some unpleasant side effects ie developing boobs bigger than my wifes!!), however this is the one medication that really helped to lower my BP to a normal level (130/80 to 141/85) last 2 readings.

The other medications that I had been taking only had minimul effects in lowering my BP.

At my local clinic I can purchase a Thai version of Spironlactone and Amlodopine but they do not stock any of the others I have mentioned. I ran out of the alpha blocker - Doxerzosin some months ago and not noticed any side effects so far.

I have been told that after seeing a Thai consultant at my local big city hospital you can purchase medication at the hospital pharmacy. The hospital is a 270 km round trip and the medication is expensive but that does not really concern me, its much better than the alternative.

On my last trip to BKK (visa extension) I visited several drug stores/pharmacies and all my medication was available but again very pricey.

I have now started to build a new life in Thailand and despite having excellent treatment by the NHS I do not wish to return to the UK for some time. A long post!!! but if anyone has advice on purchase of BP medication, good hospitals/physicians (BKK/central Thailand), costs of CT scans etc - much appreciated.

PS joined BUPA but being an honest chap I declared everything under pre-existing conditions.

[Sheryl]

I live about 250 km's north of Bangkok, up the highway 21 in a small town. The big cities of Sara Buri/Lop Buri and Nakhon Sawan are all about a 2-3 hour drive away. Some ex-pats I have spoken to attend the Sara Buri - Mittaparp Memorial Hospital and a consultant comes up from Bangkok on Saturdays. I think its just a matter of turning up, not too sure if there is an appointment system. I plan to go within the next few weeks and if not successful will try the Bangkok hospital and doctors you have recommended.

My physician in UK has posted on to me all my medical history notes since I first developed hypertension.

Having re-read them I notice I have been on Spironolactone for over 2 years now, and I am of the opinion that this one medication has been able to stabilise my very difficult to treat hypertension.

The physician also mentions that I have to have another CT scan in March 08 to monitor the lump on my left adrenal gland. No tests have been done on this lump as of yet, but as I said before one consultant says the results of the CT scan should not be dismissed entirely due to the findings of my hormone and plasma renin activity/Aldosterone tests. The other physician says I may have this Conn's syndrome due to my low pottasium and reaction to spironolactone together with this lump.

Finally Sheryl if I cannot get hold of Lisinopril can I take another ACE inhibitor such as suggested by "Garry A" - Anapril for example?, which I can get locally. Is that the same as Enapril? I did read on the net about spironolactone and certain ACE inhibitors not being compatible.

I notice that you are from Prachinburi, my wife is from nearby Kabinburi.

I have driven down the 33 many times now.

I'm sure that you will be able to locate a good pharmacy in Saraburi, Lopburi and/or Nakhon Sawan. If any readers know names/locations maybe they can advise...also you might post an inquery on the Central Thailand forum.

There is an excellent pharmacy in Prachinburi town, right next the red light, with a very helpful English-speaking pharmacist, if you have occasion to get down that way.

I don't think you will have any diffiuclty finding lisinopril at any of these places, but if you do then yes, could substitute another ACE inhibitor -- IF you need to be on an ACE inhbitor (which is open to some doubt, see below) , and also yes, anapril and enapril are the same thing. Both are just local brands of enalapril...as is Enaril.

The cautions regarding ACE inhibitors and Spironolactone are generic to ACE inhibitors as a group. regardless of whether you use lisinopril or enalapril. The problem is that the risk of a high potassium level is increased. Same is also true of Angiotensin II inhibitors and spirololactone together, much less all 3. (As I mentioned it is very unusual to be on both an ACE inhibitor and an Angiotensin II inhibitor and I question the need for it). Anyhow if it is necessary then the precautions would be (1) maintain adequate fluid intake (from sources not containing potassium, i.e. plain water) and (2) regular serum potassium measures. Another good precaution which can be done at home is to monitor your pulse for any irregularities, as the most dangerous effect of a high potassium aare abnormalities in the heart rhythm. If you detect any abnormal beats or apparent irregular spaces between beats, see a doctor promptly and omit further doses of meds until you do.

At Mittapheab Hospital you will certainly be able to get serum potassium checks and ought to be able to have consultation regarding your BP and BP meds, but will not be able to get what you need in terms of ruling out Conn's disease. Not sure if you can get the CT there or not but for sure cannot get the CT read by a specialist in adrenal disorders. So for that you really, really should go into Bangkok. This calls for very specialized knowledge and there are only a handful of specialists with what I would consider adequate qualifications.

I think it is well worth some extra travel to get the adrenal issue sorted out as you might potentially be able to greatly reduce or altogether come off your meds. In addition to the hassles and cost of getting them, you will need serum potassium levels checked regulalry for as long as you are on them. It is possiblethat a simple laparoscopic surgery to remove the adrenal mass would completely cure your condition...or that you need no meds other than spironolasctone.

Although you should be able to get a consultation with a specilist in hypertension at Mittapheab he may not be comfortable dealing with a possible adrenal problem.

If I were you, I'd see an endocrinologist with experience in adrenal disorders and special interest in hypertension as soon as possible to get things sorted out. Once they are, any needed long-term follow up can probably be handled at Mittapheab. But first priority is determining whether or not the adrenal mass is the cause of your hypertension (and if so whether surgical removal is indicated) and secondarily what if any meds are optimal.

Good luck

[wca01]

Anapril (for 100 20mg tablets I paid 350 Baht) has worked extremely well for me. In a short time my blood pressure has going down from 188 to 120 and is now very stable. My daily headache is gone.

WCA

[phutoie2]

Sheryl - thank you for your advice, lots for me to think about and I will be making plans soon.

WCA, If your systolic pressure has gone down from 188 to 120 that really good for one type of tablet, unfortunately mine is still above 140, however I think that may be caused by my liking for Leo beer!

[flyer]

Phu, get on thai food diet and without the singha..... but if you can keep BP at 140 maximum you are ok. Serious risk starts at around 160 and over....