###Human: Can long term usage of Ismo trigger low blood pressure and vertigo? ###Assistant: Hello. Firstly, Ismo (Isosorbide Mononitrate) is given for angina or chest pain. If one is not having it without Ismo then it may be stopped. So it is not an absolutely necessary medicine in absence of angina. Next thing, it can cause low BP, and low bp can cause dizziness. But, you mentioned, the lowest BP recorded was 110 systolic, and it is not too low to cause dizziness usually. Have you checked your BP while you being dizzy? So this BP can cause dizziness but not usually. Next thing, you said the response to Vertin (Betahistine), which is not likely in Ismo or hypotension induced dizziness. Vertin is for vertigo induced from the internal ear which is a very common problem. Also, importantly. dizziness induced by hypotension or Ismo will occur on standing or walking, but not while lying down or resting. So if it occurs on lying down as well or on neck movements then it is likely from the internal ear. Next, you should get one echo done to rule out the decrease in heart function as BP is remaining on the lower side. So overall, just go through the above description, and try to decide whether it is Ismo induced or from the internal ear, and you may stop Ismo as advised by the local cardiologist. Also, echo is necessary.