Suggest treatment for high blood pressure
Patient: I had CABG 18 years aback. Nowadays when tested I am found to have Supra ventriculare Ectopics and Blood pressure in the range of 160/80. I am taking Cresar AM twice a day,  concor 1.25 mg daily. still i find my BP remains to be 160/70 most of the times. Please advice? Doctor: Hello and thank you for using HCM.I carefully read your question and i understand your concern.I will try to explain you something and give you my opinion.As you explain, you had CABG years ago. As you are diagnosed with ischemic heart disease, this means that we should be very careful with hypertension, because high blood pressure values slowly modifies your heart muscle.The ektopic  beats have to do with some electrical issues in the heart. Some electrical impulses that generate in a part of the heart different from normal sinusal rhythm cause a premature heart contraction that you feel like a skipped beat, because its not a normal one. There are different factors that might cause this skipped beats like emotional stress, excessive coffee consumption , coca-cola or energy drinks, so you have to avoid them.Pathology like anemia, hyperthyroidism or ischemic heart desease might be other causes. You explain that you still have high bllood pressure values despite your treatment. So, if you have mean values above 140/90 mmHg, than we should definitively correct your treatment.We can do this in two different ways. Raising the dosage of your existing medications or adding another drug. The goal is to have mean blood pressure below 140/90 mmHg. You don't mention the dosage of cresar. Concor can be taken up to 2.5,5 to 10 mg a day. It can better control your extra-sistolic beats and lower your blood pressure.But to decide this is important to know your frequencies and your heart function.So, if I was your treating doctor i will recommend a full check up with blood test analyze, a electrocardioram, echo-cardiography, a pressure and rhythm  holter monitoring.After this we can better judge how should we treat hypertension and ektopic beats.Hope I was helpful. Wish you good health.Best regards.