Update on My Neighbor Jean
A Perfect Example of Persistent Chest Pain and Resistant Hypertension
Nine months ago my neighbor Jean was having repeated chest pain. She had been followed by a cardiologist who told her she did not have a heart problem. Her stress test and heart artery catheterization were normal. She is a perfect example of how heart artery disease is different in women.
In just nine months, her health is dramatically different. She could only walk two minutes on a treadmill before. Now she can walk three or four miles with ease and she does so regularly. She has lost twenty-three pounds. She is using intermittent fasting and carb restriction. She is really doing great, but Jean is teaching us another lesson. Despite her wonderful success with lifestyle, weight loss, and faithfully taking her medication, she still had high blood pressure. Here is the problem in her own words.
“My b/p had gotten higher as well. 140’s/80’s. As a result my primary added Carvedilol 3.125 BID (twice a day) in addition to Benazepril HCTZ 20/12.5, BID (twice a day). I am also taking, Amlodopine 5 mg qd (daily), Potassium Chloride 10mEq, TID (three times a day”.
She is on adequate doses of three medications for her blood pressure, one of which is a diuretic and her blood pressure is still not well controlled, at over 140 for the top number. It should be 130 or less. That is the definition of resistant hypertension. While adding carvedilol has controlled her blood pressure, it is not the best choice. Despite taking 40 mg. of benazepril a day, she has enough trouble with low potassium that she must take a supplement three times a day.
Carvedilol is not the best fourth drug for her high blood pressure. It is a non-selective beta blocker that can aggravate asthma and Jean has that condition. Beta blockers slow the heart, decrease energy, cause fatigue, and may be associated with weight gain and metabolic abnormalities. Moreover, she has a low potassium which almost certainly points to increased aldosterone activity. The best fourth medication is spironolactone, eplerenone, or finerenone. They block the mineralocorticoid receptor (MR) and benefit all of Jean’s problems including her low potassium. The block the biology that is causing the high blood pressure in the first place. Taking spironolactone solves the potassium problem and she would not need to take a potassium supplement three times a day. She should taper off the carvedilol and start low dose spironolactone while monitoring her potassium carefully. Jean is a perfect example of a person with resistant hypertension who would benefit from blocking the effects of aldosterone. She is a perfect example of the benefit of a protocol to support optimal medical therapy.
Let's get her the followup MCG Test session asap to measure her physiological recovery. This is an exciting milestone!
My friend has resistant high blood pressure. Going to show her this.
Thank you.