Should my GP have asked for an appointment to be arranged?

[Robbie1964]

Current situation: two stents in RCA in February following unstable angina / 95% blockage in right coronary artery. two previous heart attacks / a stent each time in 2010 and 2021.

I'm currently on two blood pressure tablets (plus Bisoprolol 2.5mg): Lisinopril 20mg and Lercanidipine 10mg. I take the Lisinopril on a morning and the Lercanidipine on an evening. My blood pressure is controlled (though not always brilliantly) but I have a problem with the lercandipine as it can cause me to feel hot, have a flushed face and for a couple of hours, have a fast heart rate (in the high 70s and low 80s instead of the 60s). It basically was stopping me from going for a walk on an evening as my heart rate would be too fast and would take over an hour to come back down to anywhere near normal. I can't increase the lisinopril as I have had bad side effects on 30mg - I basically was barely urinating and was sweating profusely. When I went back down to 20mg everything went back to normal.

I had an appointment three weeks ago with the consultant cardiologist at the hospital. We discussed the above and he suggested that I replace the lisinopril with Candesartan and then when my blood pressure is well controlled, to come off the lercanidipine. He sent a leter to my GP suggesting I start on 4mg of Candesartan (the lowest dose). and to uptitrate the dosage as necessary depending on my blood pressure response and then to consider stopping the lercandipine. The consultant explained to me that what should happen is that I will start on 4mg of Candesartan. After two weeks my GP should then check my blood pressure, do any necessary blood tests and increase the dosage to 8mg and repeat this as necessary.

However, today I got a text from my pharmacist to inform me that my tablets were ready. As I wasn't expecting any _ phoned up to discover that there is a box of 4mg Candesartan for me to pick up. I then checked my online Patient Access account. My GP has stopped my Lisinopril and has instead prescibed 56 Candesartan 4mg tablets for me. I've had no advance warning, no phone call from the surgery to ask me to speak to the GP, no blood tests, nothing. Not even any instructions on what I should do next. Am I right in thinking my GP should have arranged to see me (via his receptionist phoning me?). It has taken me ages to get my blood pressure right and to be expected to go 56 days on the lowest dose of Candesartan could sent my blod pressure back up again. The equivalent dosage to 20mg of Lisinopril is 16g of Candesartan so taking 4mg of Candesartan would be the equivalent of taking 5mg of Lisinopril, a quarter of what i currently take. I worry I could end up having months of trying to get my blood pressure down again or worse (another heart related hospital admission) and it still doesn't address the problem of the Lercanidipne giving me a fast heart rate and flushing.

I feel like I should just contact the surgery and ask if i can just stick to what I'm currently taking. It's not great but it does keep my blood pressure OK. Plus some nights the Lercanidipine doesn't always cause problems and my heart is always as fast. the fast heart rate comes on about two hours after I take the lercanidipine and it does go away about two hours or so after that.

Apologies for the lengthy post. I'm very disappointed that my GP has just prescribed the replacement medication without making any arrangements to see me or to give me pointers on follow up treatment.

Has anyone else had a similar problem?

[Robbie1964]

I've got a copy of the letter. While it doesn't go into as great a detail as what the cardiologist told me it says:

He feels that his tablet Lercanidipine might be giving him some palpitations and fast heart rate and he wishes to come off it.

I understand you earlier tried to increase the dose of Lisinopril from current 20mg daily but he could not tolerate the higher dose. Under the circumstances you may consider changing his Lisinopril to Candesartan 4mg daily and up titrate the dose as necessary depending upon his blood pressure response. Lercanidipine may be stopped later once his BP is stabilised on Candesartan.

Perhaps I'm making assumptions on what GPs do when swapping over one BP medication for another but I wouldn't have thought swapping one medication to another which is a quarter of the strength and then seemingly leaving it at that would be the way to do things. It doesn't even address how I would be able to come off the Lercanidipne, which is the reason why I raised it with the cardiologist .

I'll have to go and see my GP but as of last week it's no longer possible to book an appointment beyond that day with any of the GPs in my practice and we've just become another practice where you have to phone up at 8.30am to try and get an appointment on the day itself.

[Hidden]

As Hidden has said you should check what your consultant has advised in his letter and take it from there. If you haven't got a copy ask for one. Nowadays I always get a copy of any correspondence written by hospital specialists, with the original sent to the GP.

[Robbie1964 in reply to Hidden]

I got a copy sent to me. Like yourself I always get any hospital specialist I see to send me a copy of any correspondence sent to the GP. I've included part of what the cardiologist wrote in the letter in my reply to Heartifact.

[Captain_Birdseye]

Best thing to do would be to call your GP and discuss it to be honest... it's the only way you'll get a resolution

[Sljp0000]

I would take the new med as prescribed and get your blood pressure checked in 2 weeks as the consultant suggested. Can you male an appointment with the nurse if you can't get a GP appointment? (Do you have your own BP monitor? I send my GP my readings and he texts me back) The dosage can then be altered accordingly. You may have to go through a few weeks of higher blood pressure to get where you what to be. It may be a drug they want to ease you onto gently. Different drugs have different effects on different people. Go with it and try to relax. I would also try your walks again. Exercise reduces blood pressure and heart health over a period of time. I wouldn't have though a heart rate of 70s/80s was too high to prevent you from walking?If you want to get away from all the horrible side effects of your present drugs I would certainly heed the consultants advice and move forward.

All the best

Susie

[Robbie1964 in reply to Sljp0000]

Thanks for the reply. My worry about going for a walk on an evening after taking the lercanidipine is that with my heart rate being elevated due to the tablet as it is reaching its maximum effect is that after walking my heart rate is above 100 but unlike when I walk during the day, it takes a considerable length of time to return to its base rate. During the day when I go for a walk my heart rate will be around 90bpm after I've walked but will very quickly (within 10 minutes maximum) be back into the 60s. On an evening it rises from high 70s / low 80s to 100+ but is then often still in the 80s an hour later.

[Cee-Cee1]

Hi Robbie, I'm so sorry you've been having this confusion with your medication. It's just a suggestion, but does the new surgery have a pharmicist at all? My surgery didn't have one before but I'd rang on Friday about 10am for some advice and found that one has just recently been employed there, and she called me back at 2:15pm. I had a really helpful conversation with her re my own medication (I was due to stop clopidogrel & lansoprazole as it's a year since my bypass and wasn't quite sure whether it was 'okay' just to stop or if I'd need to see the GP first and I didn't want to waste anyone's time!). I do hope you get this sorted out soon. Carol

[Robbie1964 in reply to Cee-Cee1]

Thanks for the reply. That's a good idea, to ask if the practice has a pharmacist I can speak to.

[Robbie1964]

Thanks for the replies. I'll start to take the 4mg and will monitor my blood pressure. I think the consultant cardiologist has perhaps not provided enough guidance to my GP so will make an appointment with my GP if it becomes necessary.

[Hidden]

With my recent poor experiences of GP follow up I'd go ahead now and make your GP appointment to review new medication for the 2 week time period as explained by your cardiologist. I'm finding that consultants are writing letters in the same terms as they always did back when GP's actively followed up with timely reviews but if my GP experiences are anything to go by some will only do the minimum of what is written ie in your case change the medication.

[Robbie1964 in reply to Hidden]

That's what I'm thinking, the GP has changed the medication without putting a review in place. I can't book an appointment in advance now as my GP practice has recently changed to only allowing patients to book an appointment for that day so I'll just have to phone up one day at 8.30am to try and get an appointment once I've been taking the Candesartan for 2 weeks. It's not an ideal way to do things.

[Hidden]

Patch or e-consult is definitely a bridge to far for my GP practice (in England). No web based facilities other than repeat prescription which take four days to become available. They do have Patient Access but that only duplicates the NHS app. Definitely no online bookings or emails. And in the last two or three years since a take over and the pandemic the service has deteriorated significantly. It is now almost impossible to get a routine appointment with a GP whether face to face or by phone, and if you are not on the phone at 0830 sharp and prepared to wait 30 minutes will not get an 'urgent' appointment for a triage on the day, ring later and they have gone. And if you do get an appointment it may not be at the surgery you are registered with it could be at another surgery miles away!