VIDEO
High Blood Pressure: Doctor’s Remedies
Taking your tablets
I have been on tablets for my high BP for over 2 years providing you are properly assessed initially and have sustained high BP, probably not.
A few people rightly treated with definitely raised BP in their 30s seem to be able to stop taking medication after many years of good control, without returning to their original high pressure, but this seems to be rare. Even these people need careful supervision, with annual BP checks needed or the rest of their lives. Most people who stop medication have a gradual rise in BP, which often starts several months after stopping medication.
I am being changed onto slow-release tablets. What advantage will this have?
Slow-release (SR) tablets or capsules are designed to delay absorption in your stomach. SR preparations are much more expensive, more profitable, and are rarely available as ‘generic’ preparations, so manufacturers tend to promote them more energetically than is justified by their occasional real advantage.
Manufacturers claim that SR preparations help to supply drugs more evenly through the day, with consequent better control of BP. This is rarely important, because most of the drugs have a long half-life (which is the time taken for the blood level of a drug to fall to half its highest value), and so do their active metabolites (simpler but still usefully active chemicals resulting from chemical breakdown of the original drug). Manufacturers also claim that SR drugs give better control at night. As BP falls by as much as 10 to 50 mmHg during sleep, even in people with untreated severe high BP, this argument is rather unconvincing. The real justification for SR preparations is in terms of avoiding unpleasant side effects at peak blood levels, or avoiding rebound high BP when blood levels fall. For these reasons, many calcium-channel blockers are best taken only as SR preparations.
My eating habits are a bit erratic. Should I take my SR tablets before, during, or after meals?
All slow-release drugs are designed to be taken either with a meal, or soon after. Otherwise, timing in relation to meals is unimportant, except that a fixed routine is easier to remember.
I take another two types of tablets every day. Can I swallow my BP drugs at the same times as these other tablets for other problems?
Yes.
Because I take various other tablets, I am worried that my BP tablets might interact with these. Will it be safe to do this?
Diuretics are used to treat heart failure and swelling (‘oedema’) from kidney and heart problems, as well as for BP lowering. You have to watch out for this if you start taking ACE inhibitors because, if these are started simultaneously with diuretics, you may have a sudden very severe fall in BP, which can give you kidney failure. ACE inhibitors should be started on their own, although, once you have been taking them for some time; the doctor may add diuretics cautiously to increase their effect. People already on diuretics, who seem to need treatment with ACE inhibitors, may be referred to a hospital-based specialist, who may arrange for treatment to begin under close supervision in hospital. To make it more complicated, ACE inhibitors are also very effective for treating heart failure. Otherwise the main potential interactions are with non-steroidal anti-inflammatory drugs (NSAIDs) used for treating arthritis and other bone, joint and muscular pains; with steroid drugs used to treat severe rheumatoid arthritis and asthma, and with some antidepressant drugs.
I rather like a drink in the evenings with my meal. Can I drink alcohol while on BP-lowering drugs?
Yes, within reason. No BP-lowering drugs have any specific harmful effects in combination with alcohol, but you must bear two things in mind.
• First, alcohol in excess of the recommended amounts (more than 2 pints of beer, or 4 glasses of wine or single measures of spirits for a man of average size, a bit less for women – much less than social custom!) is itself an important cause of high BP. People who cannot get good control of their high BP despite normally adequate BP lowering medication often find that, if they cut alcohol intake by half or more, they obtain good control with smaller doses of their drugs.
• Secondly, BP-lowering drugs that cause drowsiness (such as methyldopa,) will do so much more if combined with even small doses of alcohol. All other BP-lowering drugs cause some drowsiness in some people.
My memory isn’t what it used to be! How can I remember to take my tablets?
The commonest problems are either forgetting completely, or wondering whether you actually took a tablet, a few minutes after taking it. Devise your own method, stick to it, and make sure that your partner knows it too, so that he or she can help you remember. Not taking your BP-lowering tablets is one of the main reasons why people fail to reach BP treatment goals. It is important to be honest with your doctor as it is important to distinguish between people who are not responding to BP medication and require additional drugs and those who are not taking their tablets properly and have uncontrolled high BP for this reason.
Obviously, you should try to take your tablets always at the same times. Make sure that your doctor prescribes them to be taken once or twice a day, not three times. Shift workers can usually stick to the same times, if they are taking tablets only once or twice a day. Some branded tablets come in foil packs marked with the days of the week, like the contraceptive pill, and these are a great help. Your chemist will also be able to offer you a range of special containers designed to help you remember your medication – these are usually divided up into daily ‘boxes’ where you can place all your pills for the day.
If I do forget to take one of my tablets, what should I do?
Take your usual dose as soon as you remember it. Don’t take a double dose, and don’t worry about a couple of hours either way on dosage times.
So is taking a double dose dangerous?
This usually happens when people have just swallowed their tablets, but forget they have done so. That’s why using a failsafe system is a good idea. None of the drugs used to lower BP is harmful in any important way if a single normal dose is doubled, although some of them could make you a bit drowsy.
What should I do if I can’t swallow tablets because of a sore throat, or can’t keep them down because of vomiting?
If you are ill enough not to be able to swallow or keep down tablets, you need to see your doctor, both for treatment and to have your BP checked. Neither aspirin, paracetamol (called acetominophen in the United States, antibiotics, nor any other medication likely to be bought or prescribed for sore throat, has any harmful interaction with BP lowering drugs.
Some drugs used to treat nausea and vomiting (phenothiazines such as prochlorperazine – – Stemetil) can interact with methyldopa (Aldomet) to cause involuntary writhing movements of the face and limbs. This effect is reversible, won’t last, and is not serious, but it can be very frightening. Metoclopramide (Maxolon) is an effective prescribed alternative. It also may cause involuntary movements of the same kind, particularly in children and young women, but does so more rarely. Otherwise you can buy hyoscine (Joyrides, Kwells, Scopoderm). These are less effective but do not have this side effect. Your illness is not likely to continue long enough for your BP to rise out of control.
When my BP has been controlled, can I stop taking the tablets altogether?
No. Your BP will probably rise to its pretreatment level, usually within a day or two, but occasionally up to 3 months after stopping. BP-lowering drugs, mainly beta-blockers and calcium-channel blockers, also control angina. This also may transiently get much worse if you stop taking your drugs suddenly.
It seems sensible always to both start and stop BP-lowering drugs slowly, one step at a time, with BP checks between. You should be able to arrange these with your practice nurse or doctor.
I sometimes feel very ill and I think it is because of my BP tablets. Can I vary the dose of my BP-lowering drugs according to how I feel from day to day?
Your symptoms are probably not related to BP except at very high and dangerous levels, which are rare. The only way to know about your BP reading is to measure it properly with a sphygmomanometer. The main value of home readings of BP using your own or a borrowed machine is that you will learn this from experience. If you feel ill, you should consult your doctor or practice nurse. If you are convinced your medication is making you ill, stop taking it, and see your doctor as soon as possible.
I am about to go into hospital for an operation. What should I do about taking my BP drugs when I’m there?
The most sensible policy is usually to take with you just enough of your tablets to last a day or two, putting them in envelopes with their names and strength written on the outside. Most admissions are for planned surgery, when the only doctor likely to show much interest in high BP is the anaesthetist. Most hospitals allow people to continue their medication, but may still insist on supplying their own drugs during your stay in hospital.
I know I leave my tablets lying around sometimes. Are BP-lowering drugs dangerous if taken accidentally or misused?
None of the drugs commonly used for high BP is much good for killing either yourself or others! All are widely tolerated between the lowest and highest effective doses, and there is a large margin between the highest effective dose and a lethal dose. Some are dangerous to children and, for this reason; all drugs should be locked out of harm’s way.
I ran short of my BP drugs the other week before I could get my repeat prescription. If this happens again, can I borrow some from my friend, who is also being treated for high BP?
No – this is not to be recommended and should only be done in an emergency; even then, you should do this only if you are completely certain that your friend’s tablets are identical to your own. Check both the name and the strength on the chemist’s label, and look carefully at the tablets themselves.
If there is the slightest doubt about this, do not take chances. Although there is little difference in effectiveness or tolerability between the large numbers of different tablets available, they work in different ways, and it is very unwise to start mixing up treatments yourself.
Keep an eye on how many tablets you have left, and make sure that you get a repeat prescription well before they run out. Trying to get prescriptions at weekends can be difficult, so plan ahead
