Quick question for the group
I'm a 34 general surgery resident with recently dx'd essential
hypertension. I started Prinivil and worked up to a dose of 40 mg qd
without marginal results in lowering BP (150/90). I went a saw a GP
that I thought was fairly knowledgable with current BP treatments (j7,
etc.) and started taking HCTZ 25mg daily. I lasted 5 days and had 2
syncopal episodes one morning about 3 hours after taking the
medication. Had orthostatic BP's taken about 1 hour after episode and
ssupine was 134/74 and standing 115/53.
I don't want to sound uninformed by BP regulation in a thirty yo white
male is definetly not my specality but I have a few questions.
I underwent a basic workup after the syncope (EEG,CT, Cartoids, Trop I
, CPK's, EKG) and all normal. Labs were normal as well. I orginally
thought I was dehydrated but Bun was only 17 and creat normal. Lytes
were WNL as well. So I assume this was hypotensive in nature but a few
things perplex me.
IN the mean time I've stopped the HCTZ and continue the Prinivl at 40
mg but still too high again. (138/85 thur 160/95).
To say the least I'm a little gun shy at starting the HCTZ again.
Syncope in a resident, definetly not a good thing.
I've reviewed the J7 document( which I beleive is the most current)
regarding anithypertensive regs.
Is Prinivil 40 and HCTZ 25 too much?? Is syncope common with this
dosage?
Should I try Prinivil 10 and maybe HCTZ 6.25. Just wondering, do you
guys ever see syncope with a low dose such as this?
Appreciate any input from the collective. Thanks in advance. Bill