How can I reduce diastolic hypertension while taking Cilacar (Telmisartan) 10?

Managing Diastolic Hypertension with Cilacar (Cilnidipine)

To reduce your diastolic blood pressure from 92 mmHg to normal levels, you need to combine medication adjustments with specific lifestyle modifications, particularly focusing on dietary salt restriction and weight management.

Medication Adjustments

Your current blood pressure readings (131/92 mmHg) indicate Stage 2 hypertension that is not adequately controlled on Cilacar 10 mg alone. Here's what should be considered:

1. Add a thiazide diuretic:

   • Adding a low-dose thiazide diuretic like hydrochlorothiazide 12.5 mg daily would be particularly effective for reducing diastolic hypertension 1, 2
   • Thiazide diuretics can reduce diastolic BP by 2-8 mmHg and work synergistically with calcium channel blockers

2. Medication optimization:

   • Consider increasing Cilacar dose if no side effects are present
   • If side effects occur, consider switching to a combination pill containing telmisartan (an ARB) and amlodipine (CCB) which has shown superior diastolic BP reduction compared to monotherapy 3

Lifestyle Modifications (Critical for Diastolic BP Control)

Most Effective Interventions:

1. Dietary salt restriction 1:

   • Limit sodium intake to less than 2.4g (6g sodium chloride) daily
   • This can reduce diastolic BP by 2-8 mmHg generally, and up to 8 mmHg in resistant hypertension
   • Avoid processed foods, canned soups, and adding salt to meals

2. Weight reduction 1:

   • Even modest weight loss can significantly impact diastolic BP
   • A 10 kg weight loss is associated with a 4.6 mmHg reduction in diastolic BP
   • Target a BMI of 18.5-24.9 kg/m²

3. DASH diet 1:

   • Consume a diet rich in fruits, vegetables, and low-fat dairy products
   • Reduce saturated and total fat content
   • This approach can reduce diastolic BP by 5.5-14 mmHg

4. Regular physical activity 1:

   • Engage in aerobic exercise for at least 30 minutes most days of the week
   • This can reduce diastolic BP by 3-9 mmHg
   • Walking, cycling, or swimming are excellent options

5. Alcohol moderation 1:

   • Limit consumption to no more than 2 drinks per day for men and 1 drink for women
   • This can reduce diastolic BP by 2-4 mmHg

Monitoring Recommendations

1. Measure your BP at home regularly, ideally at the same time each day
2. Keep a log of readings to share with your doctor
3. Schedule a follow-up appointment within 2-4 weeks to assess response to these changes
4. Target BP should be <130/80 mmHg 1, 4

Important Considerations

• Diastolic hypertension (92 mmHg) significantly increases cardiovascular risk and requires prompt attention
• Most patients with hypertension require two or more medications for adequate control 1
• The combination of medication adjustment and lifestyle changes is more effective than either approach alone
• If BP remains uncontrolled after these interventions, further evaluation for secondary causes of hypertension may be warranted 1

Remember that consistency with both medication and lifestyle changes is essential for successful blood pressure control.