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Hogh BLOOD PRESSURE on lying down on LISINOPRIL.

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My 80 year old mother has had severe blood pressure issues for the last month. Our primary care doctor put her on 20 mg of lisinopril twice daily with clonidine to be used when necessary. He sent her to a cardiologist whom she has seen just once. She is due to see him next week again at the request of our PCP for the following reasons: She cannot lie down without her blood pressure going way way up to a point that it wakes her up from a sound sleep. She cannot stay down for more than one hour. Needless to say she is sleep deprived and so am I because she has to call on me to check her pressure. It has been trial an error to find the right timing of the dosing so she sleeps through the night. I have been giving her 20mg of lisinopril at 2pm and 20mg more around 8 pm. I am trying to get the biggest push at night with this. But, this is not enough and this is where I need to use the clonidine. In the past, I have only used it when her blood pressure went over 180 systolic...it was given to me by an ER doctor a few weeks ago. It was just Three days ago, her PCP prescribed clonidine. Her doc said when her pressure gets over 140 to give her half of the 0.1 mg and a whole one when it gets over 150. I have observed that if she does not go to sleep with her BP in the systolic range of 110-117 approximately, she will not get through the night. However, that is after she has been in bed for an hour, that her BP must be in that range. Last night her BP was 114/56 at 6:30. She had 1/2 if a clonidine at 5:00 when her pressure went to 141/79 and she was dosed 20 mg of lisinopril at 2:15 just so you know. By 8:30 her pressure was 146/74 and I gave her 20mg of lisinopril and just 1/4 of a .01 clonidine because I did not know if she should have a larger dose safely. I have seen 1/2 bring her BP down 40 mm/hg. But that is not with her lying down. Needless to say, by midnight she was woke up with a pressure headache and did not call me because I have not gotten a nights sleep in a month. Instead she suffered until 3:40 when she got up and took her BP and it was 167/93 pulse of 95. She called me at that point, I had her stay in her chair and by 4:00 just 20 minutes later her BP was 116/67 with a pulse of 67. I guess I am looking for advice on how to safely give her the clonidine so she can stay in bed all night. I do elevate her head 35-40 degrees with a low pillow under her knees. Her doc is on vacation and I am at my wits end. I have had to call the on call physician for a couple of other issues and did not want to call again. Can you help? SHe recently had a CT scan of abdomen and there was no aortic issues. She does have RA and takes five 2.5 mg methotrexate weekly and is well controlled.


Category: Cardiologist

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Category: Internal Medicine Specialist
Dr. E. Satish Kumar is online now

Expert:  Dr. E. Satish Kumar replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I have gone through your moms case file, i would like to know whether she has done EKG, ECHO-CARDIOGRAM , because the symptoms you have described suggest me of decreased cardiac function and at the age of 80 ,i would be comfortable to maintain with systolic blood pressure of 140 to 150 mm of Hg.
Unless the blood pressure suddenly shoots up , i wouldn't prefer tab clonidine .In your discussion you have mentioned that you giving tab lisinopril 20 mg at 2 pm and again at 8 pm, as a result you causing the blood pressure to fall more at night and increase at morning.Instead i would suggest to give 20 mg of lisinopril at 7 am and 7 pm respectively.
I would like to review her with EKG, ECHO-CARDIOGRAM and renal function tests which consists of B.Urea ,S.Creatinine and S.Electrolytes.
Regards
Dr Satish


Dr. E. Satish Kumar
Category: Internal Medicine Specialist
Experience: 
Fellowship, Cardiology - Tamil Nadu Doctor M.G.R. Medical University - DNB, Cardiology, 2002 – 2005Training in Germany in Complicated AngioplastiesMedical School - Maharaja Krushna Chandra Gajapati Medical college, MBBBS MD, Int Medicine, 1989 – 1999.
Trained in Rota Abalation for treating Calcific coronary artery disease in Japan
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