High blood pressure - Discussion about drug options

Jenny15 · Jun 2, 2018

This issue came up in a thread and I want to start a new thread about it. I'm happy with my ACE inhibitor med for high BP but I'd like to learn about the experiences others have had with various treatments for this problem.

I realise some have been able to normalise their BP without ongoing meds, which I think is awesome.

In particular I'd like to know what side effects people have had from this group of drugs that made you stop taking one or more of them.

Jenny15 · Jun 2, 2018

Contralto said:
Everyone is individual. I cannot have ACE inhibitors, nor ARBs, nor a number of other heart drugs, nor thiazides. Spent half of today at my cardiologist.

There are a lot of variables to normalizing heart issue including your heart and lungs and what you have done to them over time, how old you are, your resilience, also an area where age factors in with outcomes, the amount of physical and emotional and disease stress you are under and a lot of factors that you might or might not be able to actually in real life control

Thanks, that's useful info. When I was diagnosed with primary hypertension I had no other cardiovascular conditions and that's still true. I'm considered low risk for them, unless I stop managing my diabetes, BP & lipids, I guess.

When I think about it, if I replaced "heart issues" in your post with blood glucose issues, it would describe my battle with blood glucose well.

I hope you made progress with your cardiologist today. Thinking of you.

Rachox · Jun 2, 2018

I had been treated for hypertension for several years before my diabetes diagnosis. I was initially started on Ramipril and had the dose gradually increased to try to achieve control but reached a certain level and I got bad headaches from it, so dropped the dose down a little and started on Amlodipine too. This combination brought my BP down to the top end of normal, so still not brilliant. Fast forward to Feb ‘18, 9 months after my diabetes diagnosis having lost 5 stone I was beginning to get dizzy when I stood up quickly, so did a week or so recording my BP at home and it was actually dropping too low on occasions! I had a review with the GP and have stopped the Amlodipine. My BP is now consistently normal, I’m so pleased to have cut my tablet count down. Having said that I’m happy to stay on the Ramipril as it has kidney protecting qualities for a diabetic I believe.

Jenny15 · Jun 2, 2018

Rachox said:
I had been treated for hypertension for several years before my diabetes diagnosis. I was initially started on Ramipril and had the dose gradually increased to try to achieve control but reached a certain level and I got bad headaches from it, so dropped the dose down a little and started on Amlodipine too. This combination brought my BP down to the top end of normal, so still not brilliant. Fast forward to Feb ‘18, 9 months after my diabetes diagnosis having lost 5 stone I was beginning to get dizzy when I stood up quickly, so did a week or so recording my BP at home and it was actually dropping too low on occasions! I had a review with the GP and have stopped the Amlodipine. My BP is now consistently normal, I’m so pleased to have cut my tablet count down. Having said that I’m happy to stay on the Ramipril as it has kidney protecting qualities for a diabetic I believe.

I agree, BP medication does protect the kidneys. In consultation with my GP I once trialled stopping my Quinapril because my BP was a bit too low. At my next 3 monthly blood test, I showed early kidney problems so went straight back on it.

Jenny15 · Jun 2, 2018

I found this website which has lots of useful info about meds and BP in general.

http://www.bloodpressureuk.org/BloodPressureandyou

Lamont D · Jun 2, 2018

Because of my family's history with coronary disease and a fussy doctor, I was started on Irbesartan about twenty years ago.
At different stages of my battle with my health issues, I have started statins twice and both times had side effects, so stopped them.
There was always a concern with my heart health due to high cholesterol levels, but they were concerned about my organs, period, as my general health and obesity took hold.
But the lot of them didn't have a clue except a misdiagnosis of T2.

It wasn't until I controlled my blood glucose levels that my health changed.
I do not have any heart health problems!
I'm still taking Irbesartan for hypertension, just in case!!

Jenny15 · Jun 2, 2018

Lamont D said:
Because of my family's history with coronary disease and a fussy doctor, I was started on Irbesartan about twenty years ago.
At different stages of my battle with my health issues, I have started statins twice and both times had side effects, so stopped them.
There was always a concern with my heart health due to high cholesterol levels, but they were concerned about my organs, period, as my general health and obesity took hold.
But the lot of them didn't have a clue except a misdiagnosis of T2.

It wasn't until I controlled my blood glucose levels that my health changed.
I do not have any heart health problems!
I'm still taking Irbesartan for hypertension, just in case!!

Good to hear. A couple of things for others to note about Irbesartan:

It's an angiotensin II receptor antagonist, so it's not considered a first line treatment for most people. The first line treatment is an ACE inhibitor.

It carries the risk of birth defects, so comes with a warning for women who may become pregnant while taking it.

I can see why it would have been prescribed for you, given the cardiac risk factors.

Jenny15 · Jun 2, 2018

Contralto said:
I did a short trial of Amlodipine, had the side effect for which it is notorious, an unexplained cough.

Cardiologists often will not tell you about expected side effects, and a lot of people don't use a magnifying glass to read the accompanying literature which often only discusses a couple but not all the side effects. The cardiologists are waiting for you to tell htem the bad aspects of something you have tried.

Amlodipine also interacts badly with a lot of very commonly taken medications

https://www.healthline.com/health/amlodipine/oral-tablet#dosage

You're absolutely right, and that's one reason why I started this thread.

I once asked a locum doctor what side effects a new drug he was prescribing me had, and he said "all drugs have side effects."

I was asking so that I would know what to look out for, not so I could refuse the drug. I hope he learned from the chat.

I take the ACE inhibitor Quinapril, which does cause a dry cough in some people. I've never had any negative side effects from it, and it is fine with all the other drugs I take and have taken in the last decade or more. I'm lucky.

Rachox · Jun 2, 2018

Contralto said:
I did a short trial of Amlodipine, had the side effect for which it is notorious, an unexplained cough.

Cardiologists often will not tell you about expected side effects, and a lot of people don't use a magnifying glass to read the accompanying literature which often only discusses a couple but not all the side effects. The cardiologists are waiting for you to tell htem the bad aspects of something you have tried.

Amlodipine also interacts badly with a lot of very commonly taken medications

https://www.healthline.com/health/amlodipine/oral-tablet#dosage

I luckily didn’t get badly affected by Amlodipine in any way but I did notice a very slight drop in my blood sugars when I stopped it. Every cloud! You’re not supposed to drink large quantities of grapefruit juice with it either, not that that bothered me as I never liked grapefruit!

Deleted member 308541 · Jun 2, 2018

Just taken my after breakfast medication which included one Olmesarten 40 mg. tablet.

Rachox · Jun 2, 2018

Contralto said:
Well, through the wonders of fifteen minutes consultations, no one told me that one, but by the time I took it, I was already diabetic and grapefruit was a no no, although initially, while still visiting my father in Florida, I couldn't help bringing blood oranges and red grapefruit from the trees near his place.

I do like to back up statements l make with info from trusted websites so here we go:
https://www.nhs.uk/chq/Pages/2474.aspx?CategoryID=73&SubCategoryID=103

Jenny15 · Jun 3, 2018

Contralto said:
Well, through the wonders of fifteen minutes consultations, no one told me that one, but by the time I took it, I was already diabetic and grapefruit was a no no, although initially, while still visiting my father in Florida, I couldn't help bringing blood oranges and red grapefruit from the trees near his place.

I agree with you about 15 minute consultations. I've even had to accept 10 minute consultations sometimes, which is ridiculous.

My pharmacy seems to be obsessive about putting stickers on my medication packs/bottles that warn about grapefruit, sunlight, driving, using machinery etc. They also ask or tell me stuff I already know about each drug, but I'm glad they do. Sometimes they might be the only way we find out.

Jenny15 · Jun 4, 2018

Contralto said:
Sometimes, the vial isn't large enough diameter for all the stickers, so they put stickers back to back and hang them off the vial. Never had one for grapefruit, even though, as I said earlier, it is a very common American breakfast item. And way lower on the glycemic index than oranges, especially the red ones.

The American breakfast differs from the English one. A lot of Americans are used to a bowl of sugared cereal with a banana sliced into it, a half grapefruit, a glass of orange juice and toast with jam. But actually, there have been quite a few articles warning people about grapefruit drug combination and whether that or the citrus blights that have hit Florida, consumption is way down.

https://www.washingtonpost.com/news...ricas-favorite-fruits/?utm_term=.d6fb77d71de6

IMO there's nothing like a good old English or Irish cooked breakfast. Food of the gods.

ann34+ · Jun 10, 2018

Jenny15 said:
I agree with you about 15 minute consultations. I've even had to accept 10 minute consultations sometimes, which is ridiculous.

My pharmacy seems to be obsessive about putting stickers on my medication packs/bottles that warn about grapefruit, sunlight, driving, using machinery etc. They also ask or tell me stuff I already know about each drug, but I'm glad they do. Sometimes they might be the only way we find out.

That is interesting about sunlight, it is good that your pharmacy is as it is. Maybe you are in the USA? here in uk 10 mins consultations are the usual, and no one mentioned sunlight, and was not on any sticker on the packet or bottle, and , in fact, GPs do not commonly know. I am still suffering, after stopping, it seems that Losartan causing sun sensitivity is on the patient leaflet that you need a magnifying glass to read, the local pharmacist drew my attention to it - waiting to see dermatologist.

Jenny15 · Jun 10, 2018

ann34+ said:
That is interesting about sunlight, it is good that your pharmacy is as it is. Maybe you are in the USA? here in uk 10 mins consultations are the usual, and no one mentioned sunlight, and was not on any sticker on the packet or bottle, and , in fact, GPs do not commonly know. I am still suffering, after stopping, it seems that Losartan causing sun sensitivity is on the patient leaflet that you need a magnifying glass to read, the local pharmacist drew my attention to it - waiting to see dermatologist.

I'm in NZ, but I would have thought in the UK it was a legal requirement for pharmacies to tell customers about the sunlight risk with certain meds?

I always look online for drug info if I am taking something new. I've had issues so many times that it pays to do this. Another good way is to ask the pharmacist at the time - and don't let them fob you off with a less qualified person. Often pharmacists are more up to date on these things than GPs, understandably.

Struma · Jun 10, 2018

Contralto said:
I did a short trial of Amlodipine, had the side effect for which it is notorious, an unexplained cough.

Cardiologists often will not tell you about expected side effects, and a lot of people don't use a magnifying glass to read the accompanying literature which often only discusses a couple but not all the side effects. The cardiologists are waiting for you to tell htem the bad aspects of something you have tried.

Amlodipine also interacts badly with a lot of very commonly taken medications

https://www.healthline.com/health/amlodipine/oral-tablet#dosage

@Contralto I don’t think that amlodipine is notorious for an unexplained cough, and it isn’t mentioned in your link. It is common to have swelling of the ankles with it however.
But, ACE inhibitors are - it is explained as being due to bradykinin breakdown prevention.

Struma · Jun 10, 2018

Jenny15 said:
I found this website which has lots of useful info about meds and BP in general.

http://www.bloodpressureuk.org/BloodPressureandyou

@Jenny15 The website that is used by Healthcare staff here, is the BIHSoc.org - British and Irish Hypertension Society. You might like a perusal to compare. NICE and SIGN also has hypertension guidelines.

ann34+ · Jun 10, 2018

Jenny15 said:
I'm in NZ, but I would have thought in the UK it was a legal requirement for pharmacies to tell customers about the sunlight risk with certain meds?

I always look online for drug info if I am taking something new. I've had issues so many times that it pays to do this. Another good way is to ask the pharmacist at the time - and don't let them fob you off with a less qualified person. Often pharmacists are more up to date on these things than GPs, understandably.

The sunlight aspect was not mentioned, and i was not aware of this aspect either, though i did a fair amount of research first. i did have a lot of side effects to start and was referred to https://beta.nhs.uk/medicines/losartan/ by a pharmacist, and saw nothing about the sun, i have checked again and still can see nothing - maybe i missed it.......it was not until i spoke to my local pharmacist with a query months later, that she looked into it and phoned me back with the information, my GP did not know, and the skin specialist GP did not even ask about medications, just said i had allergic dermatitis.
If anyone else has problems, and has not linked them, i would caution that this sensitivity to sun (photosensitivity), even daylight in summer, seems to build up, and, as i found, when i started on ACE after 2 months medication free, both ACE and BBs can make it a lot worse again. Looking into ACE i see that these also can initiate the same problems, and that beta blockers can enhance any existing allergy.

Jenny15 · Jun 11, 2018

ann34+ said:
The sunlight aspect was not mentioned, and i was not aware of this aspect either, though i did a fair amount of research first. i did have a lot of side effects to start and was referred to https://beta.nhs.uk/medicines/losartan/ by a pharmacist, and saw nothing about the sun, i have checked again and still can see nothing - maybe i missed it.......it was not until i spoke to my local pharmacist with a query months later, that she looked into it and phoned me back with the information, my GP did not know, and the skin specialist GP did not even ask about medications, just said i had allergic dermatitis.
If anyone else has problems, and has not linked them, i would caution that this sensitivity to sun (photosensitivity), even daylight in summer, seems to build up, and, as i found, when i started on ACE after 2 months medication free, both ACE and BBs can make it a lot worse again. Looking into ACE i see that these also can initiate the same problems, and that beta blockers can enhance any existing allergy.

Good to know. I don't know what system the UK has but in NZ, a GP can report an adverse reaction to a drug the CARM - Centre for Adverse Reactions Monitoring, which I think is under the auspices of the MOH. I have asked my GP to do this on two occasions, because I wanted my experience to be of benefit to other patients.

In these cases and in general I have found that GPs and specialists usually mention the biggest risks but aren't particularly bothered by the risk or the reaction when it happens, but I as a patient am very bothered by it. They do get bothered by certain types of risk though - eg fetal effects, anti-coagulants, tardive dyskinesia risk from drugs to augment anti-depressants. So that's something.

There's a really good dermatologist-run website that happens to be run out of NZ, if you're interested in deeper knowledge about the field: dermnetnz.org

Jenny15 · Jun 11, 2018

Contralto said:
You are right, had problems switched, looked up in my notes. Not only was there swelling on the amlodipine, there were these really fast heartbeats that were irregular. Sort of irregular palpitations.

The faster than normal heartbeats I currently have on clonidine are not irregular. In fact, on the Clonidine, if you don't take your blood pressure often enough, you get BP spikes and they are more likely to be irregular. One of reasons I have a meter than indicates IHBs. Basically, the stuff works pretty well and steadily, but tanks you 40-60 points so you risk low BPs and makes you slightly thirsty which is a minor diuretic effect.

Just out of interest, I take Clonidine but not for BP or my heart, it's to treat restless leg syndrome that is a side effect of other drugs I take. It has an astonishingly long and diverse list of off-label uses like this that make it a really valuable little drug.

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