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NFT: To any cardiologist out there

blueblood'11 : 2/6/2023 7:44 am
I need an opinion. I am an avid runner 68 yerars old. Been running for over 40 years. My doctor recently upped my Telmisartan BP meds from 40mg to 80mg along with the addition of 25mg of Hydrachlorithiazide simply because the additional 40mgs of telmisartan didn't lower my BP to an acceptable range. Now my readings are great however, for years I have always taken my meds in the morning. Now he's instructed me to take the BP meds at night. As active a person as I am does this make sense. So much of what I've read on line suggests this is not an exact concluusion. It states a lot depends on your life style. It also talks about dipping and people ovwer 55 and why it may be better to take it at night. I just would like an opinion from someone who works in that field. Thanks.
Not a cardiologist….  
Ryan : 2/6/2023 8:45 am : link
….but is it because of potential drowsiness with the higher dose? I know BP meds like Guanfacine are prescribed in very low doses for kids with aggressive manifestations of behavioral/mood disorders to help keep a lid on tantrums because it has a slight “deflating” effect.
There are a few guys that really know their stuff  
lono801 : 2/6/2023 8:51 am : link
Hope they see this.

I’m not familiar with the meds you are taking…but I take BP meds in the evening as well
Also not a cardiologist, however  
Ron from Ninerland : 2/6/2023 9:31 am : link
Hydrachlorithiazide for a runner seems like a bad idea. It’s a diuretic that could throw your sodium/potassium balance off, which is dangerous should you become dehydrated. There are tons of blood pressure meds out there. Why use Hydrachlorithiazide unless nothing else works.
Going to a football message board  
PEEJ : 2/6/2023 9:34 am : link
for medical advice.

Sounds like a good idea. smh
I'm an anesthesiologist and a runner  
Rico : 2/6/2023 9:43 am : link
I deal with BP meds all the time in my practice.

First line for HTN is ACE/ARB as you are doing.

Second line would be a Ca Channel Blocker like amlopidine, so I would add that before a diuretic.

Agree with Ron, you want no part of HCTZ. It will leave you dehydrated and hypokalemic.

Also agree with taking in AM, not PM.

Is your doc a runner? Seriously, I would recommend only seeing docs who are runners. You can find them as medical directors of local races.

Good luck!
I'm not a doctor  
Lafferty, Daniel : 2/6/2023 10:19 am : link
but I did stay at a Holiday Inn Express last night...
Rico  
blueblood'11 : 2/6/2023 11:08 am : link
totally confused by my doctor. For years I've taken those meds in the morning and why he suddenly had me switch direction confused me. So I decided to keep taking it in the morning. My wife even said why is he putting me on a Diuretic. I guess I have to make an appointment to discuss it with him. thanks for the information.
lono801  
blueblood'11 : 2/6/2023 11:09 am : link
Have you always taken them at night
Advice  
Hilary : 2/6/2023 11:22 am : link
Hydrochlorothiazide some
patients have a problem with
Potassium at low dose most
Do not and this is easy to check

There is data that risk of stroke
correlated with over night BP.

There are 3 first line drugs for HTM
diuretics arb calcium channel blockers
all are safe if monitored
RE: Going to a football message board  
mitch300 : 2/6/2023 11:42 am : link
In comment 16025616 PEEJ said:
Quote:
for medical advice.

Sounds like a good idea. smh

You mean a football message board that has doctors on it.
Doesn't really matter as far as blood pressure control is concerned  
Remdad : 2/6/2023 12:08 pm : link
And there are no reliable data that show superiority of nighttime to daytime administration.

The change is usually made to reduce symptoms. It doesn't sound like that is a problem for you.

I agree that advice on the internet is often worth as much as you are paying for it. But I do have the credentials you were looking for ...

Stay well
RE: RE: Going to a football message board  
PEEJ : 2/6/2023 12:20 pm : link
In comment 16025704 mitch300 said:
Quote:
In comment 16025616 PEEJ said:


Quote:


for medical advice.

Sounds like a good idea. smh


You mean a football message board that has doctors on it.


Doctor might give some info, but would never give treatment advice without a visit
I have  
lono801 : 2/6/2023 12:21 pm : link
But they have changed my meds and doses many times. They cut me way back on all of them.

I take a small amount in the evening.
RE: RE: Going to a football message board  
RicFlair : 2/6/2023 12:22 pm : link
In comment 16025704 mitch300 said:
Quote:
In comment 16025616 PEEJ said:


Quote:


for medical advice.

Sounds like a good idea. smh


You mean a football message board that has doctors on it.



Anyone can say they are a doctor on a message board.
You guys are ridiculous  
UConn4523 : 2/6/2023 12:26 pm : link
the OP was looking to share his experience and see how it sounded compared to others that might have gone through it (or have treated it). No where does he say he’s going to do what the guy on BBI said instead of his doctor.

I’ve had plenty of health things pop up over the years and since most of them my friends/family haven’t gone through, I researched online for opinions. Never once did I go do what the random guy online said to do without consulting with a doc first.

The OP asked for an opinion, not a diagnosis and treatment plan.
BBI is actually a good place for medical advice  
Ron from Ninerland : 2/6/2023 12:37 pm : link
1. Giant fans tend to be older than fans of other teams. As a result it has older posters than many other message boards. A higher proportion of us have experienced age related medical problems. We have consulted our own doctors, done our own research and have our own body of knowledge.

2. Anybody who spends decades watching the Giants is more likely to have high blood pressure and cardiac problems than any other subgroup of people I can imagine.
RE: You guys are ridiculous  
RicFlair : 2/6/2023 12:52 pm : link
In comment 16025748 UConn4523 said:
Quote:
the OP was looking to share his experience and see how it sounded compared to others that might have gone through it (or have treated it). No where does he say he’s going to do what the guy on BBI said instead of his doctor.

I’ve had plenty of health things pop up over the years and since most of them my friends/family haven’t gone through, I researched online for opinions. Never once did I go do what the random guy online said to do without consulting with a doc first.

The OP asked for an opinion, not a diagnosis and treatment plan.



He specifically asked for advice from a cardiologist. That’s a different scenario than what you’re describing.
The best data on this come from the TIME trial  
Remdad : 2/6/2023 12:55 pm : link
The TIME (Treatment In Morning versus Evening) trial - (Cardiovascular Outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomized open-label blinded-endpoint clinical trial. Lancet 2022; 400:1417 compared morning to evening dosing in 21,000 patients, mean age 65, 60% men, 90% white, only 13% with previous cardiovascular disease.

The primary endpoint (a composite of cardiovascular death, non-fatal heart attack, and non-fatal stroke) was not different (the hazard ratio, with 1 being no difference, was 0.95 with a 95% confidence interval 0.83 to 1.10; a confidence interval that includes 1 is not statistically significant by definition). There were no subgroups that suggested benefit of one strategy over another.

You can find smaller and less rigorous trials that suggest that evening administration might be better, but this one is much larger and more definitive, at least as far as I am concerned.

FWIW diuretics are usually given in the morning since people don't like to be up all night peeing. In this trial, patients were asked to try to take diuretics at night, but could change to the morning if they had nocturia. 5% of patients did that.
RE: BBI is actually a good place for medical advice  
DC Gmen Fan : 2/6/2023 12:57 pm : link
In comment 16025761 Ron from Ninerland said:
Quote:
1. Giant fans tend to be older than fans of other teams. As a result it has older posters than many other message boards. A higher proportion of us have experienced age related medical problems. We have consulted our own doctors, done our own research and have our own body of knowledge.

2. Anybody who spends decades watching the Giants is more likely to have high blood pressure and cardiac problems than any other subgroup of people I can imagine.



Genius!
RE: RE: You guys are ridiculous  
UConn4523 : 2/6/2023 12:58 pm : link
In comment 16025774 RicFlair said:
Quote:
In comment 16025748 UConn4523 said:


Quote:


the OP was looking to share his experience and see how it sounded compared to others that might have gone through it (or have treated it). No where does he say he’s going to do what the guy on BBI said instead of his doctor.

I’ve had plenty of health things pop up over the years and since most of them my friends/family haven’t gone through, I researched online for opinions. Never once did I go do what the random guy online said to do without consulting with a doc first.

The OP asked for an opinion, not a diagnosis and treatment plan.




He specifically asked for advice from a cardiologist. That’s a different scenario than what you’re describing.


“I just would like an opinion from someone who works in that field. Thanks”
RE: RE: RE: Going to a football message board  
SomeFan : 2/6/2023 1:01 pm : link
In comment 16025737 PEEJ said:
Quote:
In comment 16025704 mitch300 said:


Quote:


In comment 16025616 PEEJ said:


Quote:


for medical advice.

Sounds like a good idea. smh


You mean a football message board that has doctors on it.



Doctor might give some info, but would never give treatment advice without a visit
It is an huge understatement that medical advice on a football message board is not really the preferred way to decide how to take life-saving drugs even from physicians who have no idea of the medical history and have never seen the patient. Although, it does provide interesting commentary.
RE: The best data on this come from the TIME trial  
Jim in Fairfax : 2/6/2023 1:01 pm : link
In comment 16025775 Remdad said:
Quote:

FWIW diuretics are usually given in the morning since people don't like to be up all night peeing. In this trial, patients were asked to try to take diuretics at night, but could change to the morning if they had nocturia. 5% of patients did that.

This. I’d ask your doctor if it’s OK to take Telmisartan in the evening and the Hydrachlorithiazide in the morning.
RE: RE: RE: You guys are ridiculous  
RicFlair : 2/6/2023 1:02 pm : link
In comment 16025781 UConn4523 said:
Quote:
In comment 16025774 RicFlair said:


Quote:


In comment 16025748 UConn4523 said:


Quote:


the OP was looking to share his experience and see how it sounded compared to others that might have gone through it (or have treated it). No where does he say he’s going to do what the guy on BBI said instead of his doctor.

I’ve had plenty of health things pop up over the years and since most of them my friends/family haven’t gone through, I researched online for opinions. Never once did I go do what the random guy online said to do without consulting with a doc first.

The OP asked for an opinion, not a diagnosis and treatment plan.




He specifically asked for advice from a cardiologist. That’s a different scenario than what you’re describing.



“I just would like an opinion from someone who works in that field. Thanks”



“To any cardiologist out there”. Again much different than just asking people who may have had similar experiences.


Anyone can claim they are a cardiologist on message board.
It’s like you didn’t even read my post  
UConn4523 : 2/6/2023 1:08 pm : link
which specifically says “(or have treated it)”. He’s actually gotten some good feedback on here and nothing in the OP suggests he won’t now discuss alternative options with his doctor. In fact, his follow up post says his wife (who isn’t a doctor) is confused by it and will make a follow up appointment to talk to him about it.

I blew my back out years ago and posted on it here. Got some good advice that I discussed with many docs throughout my treatment process. Some interesting ideas that I never considered simply by asking a question. Common sense suggests I don’t just do it on a whim, and I didn’t.
I think the questions is reasonable  
upnyg : 2/6/2023 1:11 pm : link
Over the years, I learned that some Dr.s dont do a lot of their own research anymore.

Its good to hear what others are doing so that you can come back and ask questions to your providor. MY Dr. asks me the same questions every 6 months as if it the 1st time we met...pretty scary since he prescribes my meds.
RE: It’s like you didn’t even read my post  
RicFlair : 2/6/2023 2:11 pm : link
In comment 16025794 UConn4523 said:
Quote:
which specifically says “(or have treated it)”. He’s actually gotten some good feedback on here and nothing in the OP suggests he won’t now discuss alternative options with his doctor. In fact, his follow up post says his wife (who isn’t a doctor) is confused by it and will make a follow up appointment to talk to him about it.

I blew my back out years ago and posted on it here. Got some good advice that I discussed with many docs throughout my treatment process. Some interesting ideas that I never considered simply by asking a question. Common sense suggests I don’t just do it on a whim, and I didn’t.




And you continue to ignore the part where he specifically is asking for advice from cardiologists.
So the part where I actually address that  
UConn4523 : 2/6/2023 2:24 pm : link
is ignoring it? Weird hill to die on here especially since my post history is here for you to reflect on. “Or treated it” means exactly what you are describing.
RE: So the part where I actually address that  
RicFlair : 2/6/2023 2:30 pm : link
In comment 16025850 UConn4523 said:
Quote:
is ignoring it? Weird hill to die on here especially since my post history is here for you to reflect on. “Or treated it” means exactly what you are describing.



“Or have treated it”


So have any of the responses come from a cardiologist or from someone who has treated it?
Olive branch  
RicFlair : 2/6/2023 2:46 pm : link
Forget it. The only thing I wanted to say initially is that anyone can claim they are whatever on here. Specifically asking for advice from a cardiologist or someone who treated this (which would be cardiologists) is dangerous because anyone can claim they are one. Take the advice from randos who may have gone through it, but don’t seriously believe you’re getting advice from a doctor.


My bad for my half of the argument.
Rico is  
UConn4523 : 2/6/2023 2:57 pm : link
although I forget which kind
I think asking BBI for advice can be helpful  
Vanzetti : 2/7/2023 9:23 am : link
Ric Flair makes a good point but if you stick with posters who are longtime, I don't think you have to worry about fraud.

In regard to high blood pressure, my GP prescribed diuretic. I took them for a week and lost four pounds in water weight. Given that i bike ride and run, it did not seem like a good idea.

Good thing I did because it turns out I have afib and dehydration is one of the main triggers that sets it off.

I also have APCs (early heart beat) and was told by two different cardiologists that they were "benign" and "nothing to worry about." I finally went to the electro-physiologist and he told me that the APCs are likely triggering my afib.

So, with the complexity of medicine today and the role of insurance companies determining treatment protocols, I think consulting as many sources as possible is a good idea.

I also think the BBI community is likely to give you much better and informed answers than other online groups, where you don't know who the posters are and what agendas they have. A lot of crusaders out there who really have no idea what they are talking about.
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