Meds for High Blood Pressure



Take Your Meds!

 

I attended my mother-in-law’s funeral just a few days ago. A great gal, she had a stroke in 1996 and succumbed to a second stroke that occurred about a month ago. It was a great joy to know her and steal her daughter away many years ago. She was a model farm wife, and I will always miss her pies.

But as folks often talk at funerals, two important points came out about high blood pressure.

  • First, it is important to take your medicines before you have a serious problem.
  • Second, it’s worth it to work with your prescriber and pharmacist to get the right medicine for you.

It was upsetting to learn from one of the family members that prior to her first stroke Norma really did not treat her high blood pressure. As the story was told, she had high blood pressure for many years, and prior to her first stroke would take her medications only when she thought she needed them. If someone measured her blood pressure as high, as was frequent, she would take her blood pressure meds, but only for a while.

High Blood Pressure Needs to Be Taken Seriously!

High Blood Pressure Needs to Be Taken Seriously!


Another woman told her personal story about high blood pressure.

She also has high blood pressure and has worked through several different medications. Lisinopril was an excellent first choice for this and many patients. The ACE inhibitors decrease the body’s production of angiotensin, a substance that contracts blood vessels. ACE inhibitors protect the heart and kidneys in patients with heart failure or diabetes. But, they also produce a nagging dry cough in about 15% of patients taking them. She had the cough, so moved on to another medication.

Calcium channel blockers slow down the entry of calcium into the muscle cells surrounding blood vessels.

  • With less calcium, the blood vessels relax to lower blood pressure.
  • Amlodipine is an excellent choice for many patients, as patients taking amlodipine have good long-term survival.
  • Calcium also regulates contraction in many smooth muscle tissues throughout the body, so sometimes there are side effects; one of the most common side effects is edema, fluid remaining in the body.
  • This patient did not enjoy feeling like the Michelin tire man, so she moved on to another medication.

Angiotensin receptor blockers are often called ARBs; that’s right – it makes you sound like a pirate. ARBs have the same beneficial effects as the ACE inhibitors, without the cough. But they cost more, so the ACE inhibitors like Lisinopril are a better first choice. This patient was happier with the generic ARB olmesartan. On the third try, she finally found a good drug for her that controlled her high blood pressure without intolerable side effects.

Human nature being what it is, we have a strong tendency to be influenced by short-term pleasures more than by long-term consequences. I enjoy eating today; the consequences of weight gain don’t occur until tomorrow morning if I even get on the scale. The diabetes, heart attack and their potential consequences are even further away.  But sometimes they catch up with us. I’ll certainly watch my diet more after something happens.

It’s easy to neglect high blood pressure medicines when the medicines don’t necessarily make you feel any better and you can’t even see that they are protecting you against a heart attack or stroke. After something goes awry, most patients take their meds.

Think about this:

High Blood pressure medications protect best before you have a heart attack or stroke.

It’s worth working with your prescriber and pharmacist to find the right blood pressure medicine for you: medicine that will control your high blood pressure without making you feel bad; medicine that will prevent or delay that heart attack or stroke; medicine that will keep you around to bring joy into the lives of others, perhaps even by making pies.

Take care of yourself! Your prescriber and pharmacist are happy to keep you around.

Talk to them about your medications.  Make them work for you. And October is American Pharmacists Month, so give a shout-out to your pharmacist and pharmacy technician when you see them.

References:

  1. http://www.mayoclinic.org/drugs-supplements/lisinopril-oral-route/description/drg-20069129
  2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200815/
  3. http://www.cdc.gov/bloodpressure/
Dr. Peter J. Rice

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.
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