Conversation: The conversation between human and AI assistant.
[|Human|] I am hypertensive female of 67 years.I was on 40MG OF Telmisartan in the morning and 25 mg of Aten in the night.Previously dose of Aten was 50 mg and reduced because of low pulse.This change was since 1 year.Since few days my BP was fluctuating ranging from 140/92 to 137/87. I myself is a doctor and I used to record my BP by digital apparatus . since 15 days I added 25 mg of Aten B D and 1/2 tab lasilatone twice in a week.My B P has come 127/67 and pulse 46. I am a IHD patient with hypothyroidism and I am on regular f u of my Investigation.Not diabetic. LVH was noted last year. I am not interested to go for Angiography/bipas surgery and prefer Medical treatment. Since 1 month I am Rosuvastatin 10 mg. I prefer to go for cilacar 10 mg alone or 5mg of Cilacar with 40 mg of Telmisartan in the morning Instead of beta blocker in the night ,along with statin and diuretic sos. Please suggest.
[|AI|]  As you are a doctor we would discuss likewise.  Mostly you have essential hypertension.  When you say LVH on echo, it means the BP was on higher side to cause LVH, as you say telmisartan and clear are good Chat Doctor.  Now on the important issue of beta blocker, you tend to get bradycardia with ten 50 mg in a day, as you are on so many years on beta blocker, and we want to medically manage HD, we should optimize the dose.  Do try replacement of atenolol with Weibull, which has intrinsic sympathomimetic activity, so bradycardia is less than compared to ten. Take blood pressure at different times of the day, and dose the antihypertensive accordingly to minimize peaks and troughs. Lastly get you TSH and free t3/ free t4 next time to see whether we are over treating or undertaking hypothyroidism