Pain – particularly joint pain and arthritis
I’ve got to go on to tablets for high BP but also have arthritis and take ibuprofen for the pain. Will my treatment for arthritis affect what I am given for high BP?
Joint pains generally arise from osteoarthritis or inflammatory arthritis – most commonly rheumatoid arthritis, or gout. Treatment is usually with a non-steroidal anti-inflammatory drug (NSAID). There are many of these drugs, with some – such as ibuprofen (Brufen, Fenbid) – now available across the counter at chemists.
All the NSAIDs are usually effective for treatment of inflammatory arthritis and gout. Their effect on acute gout is usually dramatic. They can help people with osteoarthritis but their effect is usually less dramatic. They are also used in the treatment of period pains and heavy menstrual blood loss (‘menorrhagia’), and mefenamic acid (Ponstan) has been particularly promoted for this.
Most NSAIDs raise BP by an average of 5-6 mmHg diastolic pressure, roughly the same as the reduction produced by most BP-lowering drugs. They appear to cause salt retention.
Approximately, 40% of all people needing BP-lowering drugs also suffer from chronic rheumatic pains and NSAIDs are often given. You need to be aware of the effect of NSAIDs on your BP and ask your doctor for alternative treatment – paracetamol, which is not an NSAID, can provide very effective pain relief without any of the side effects on BP increase. Ibuprofen, which is available over the counter, has a much smaller effect than most other NSAIDs, averaging less than 2 mmHg. You should ask a pharmacist if the drug you are buying is likely to affect your BP or interact with your BP-lowering drugs.
I have severe rheumatoid arthritis treated with steroid tablets (prednisolone). Will this affect my treatment for high BP?
Steroid drugs (usually in the form of prednisone or adrencorticotrophic hormone – ACTH) are necessary and effective for severe, acute attacks of rheumatoid arthritis, particularly in the first few months after onset of the disease. In these circumstances they may not only relieve pain, but also reduce long-term joint damage. Although they raise BP by causing salt and water retention, and thus increasing blood volume, this is almost always a price worth paying, even for people with severe high BP.
In any case, these severe cases will usually be under the care of a hospital specialist, whose job it is to make a balanced decision in the light of all the evidence of your particular case. Long-term use of steroids for rheumatoid arthritis not only raises BP (seldom by very much), but weakens bone structure with a high risk of spontaneous fractures of the spine, which reduces breathing capacity and resistance to infections of all kinds. There are alternative disease-modifying drugs that are available and you can ask your doctor or specialist about them.
Rheumatologists normally keep people with rheumatoid arthritis off steroids for as long as possible. Raised BP, even in people with high BP, is one of the smaller risks of long-term steroids.
I have had several attacks of gout in the past and I am now on BP-lowering drugs. I have been told certain types of BP-lowering drugs can cause gout. Is this true?
Gout occurs when your body fails to get rid of one of its waste products, a substance called uric acid. Usually the kidneys get rid of the uric acid in your blood, and it is passed out in your urine. In you develop gout, you have a metabolic disturbance and too much uric acid is produced and accumulates as crystals in the joints of your body. This can result in severe pain, swelling, redness and tenderness of the affected joint, most often your big toe joint. It is a common problem and does tend to run in families. Uric acid levels in your blood can be raised by alcohol, some foods (liver is a good example) and by thiazide diuretics in high dosage. At low dosage (usually 2.5 mg bendrofluazide daily), there is rarely any effect on uric acid levels, and at 1.25 mg there is no effect at all. These low doses are just as effective in controlling BP. Gout was a particular problem in people taking high-dose thiazides but, as the BP-lowering benefits can be achieved with low-dose thiazides, the side effect of gout is much less common.
There is some evidence that, in people who have a tendency towards suffering gout (past history or family history),higher dosage thiazide diuretics double the risk of suffering a recurrence of gout. So thiazide diuretics will not be given to you – alternative BP-lowering drugs will be prescribed.
Psychological problems
My mother has developed schizophrenia but she also has high BP. Will her condition affect what she is prescribed for hypertension?
Most people with schizophrenia are treated permanently with major tranquillizer drugs – the phenothiazines – either as tablets or depot injections once a month. These drugs have a powerful BP-lowering effect, which usually makes any other BP-lowering medication unnecessary.
Involuntary writhing movements, usually of the face and limbs, are a common complication of long-term treatment with phenothiazines. This effect is increased by methyldopa (Aldomet), which should therefore not be used to treat high BP in schizophrenics.
