Dear Dr. Eva,
Doctors and nurses have told me over the years that my blood pressure is high. Because I felt fine, I didn’t want to take medicine for it, but eventually family members convinced me to get treated to prevent strokes (my father had one.) I am now taking three different blood pressure pills. When I looked up the medicines, it looks like I am not on the top dose of any of them. Why not increase a medicine to the top dose before adding another one? Even better, why not just use one medicine that really works in the first place?
I understand your frustration. It does seem as if it should be possible to control blood pressure with just one medicine. (The medical term for high blood pressure is hypertension.) Many people with high blood pressure can be treated with a single medicine at first. Like other chronic conditions, high blood pressure gets worse over time. Unless a person can make major changes in factors that contribute to high blood pressure, more medicines must be added to keep blood pressure at a safe level, below 140/90. Some lifestyle and habit changes that help lower blood pressure are: stopping smoking, decreasing or stopping alcohol, losing weight (as little as ten pounds), decreasing salt and salty foods, and moderate exercise (30 minutes of brisk walking, swimming or biking at least three days a week.) Decreasing emotional stress and getting enough sleep can help as well.
As far as why you are not on the top doses of your blood pressure medications, often the highest approved dose of a medicine often doesn’t lower blood pressure any better than a lower dose does. Higher doses also cause more side effects than lower doses. Most people with high blood pressure need two or more medicines to control their blood pressure.
Using blood pressure medicines that work in different ways is more effective than using a single type of medicine. Blood pressure is the amount of pressure that flowing blood produces as it presses against the walls of arteries. To lower the pressure, you can:
1) Decrease the amount of fluid in the blood with “fluid pills,” diuretics such as hydrochlorothiazide, HCTZ.
2) Slow down the heart rate or decrease the force of the heart pump (heartbeat) so that less blood is pumped each minute. Beta blockers and some calcium channel blockers have that effect.
3) Relax the muscles in artery walls so the arteries open wider, lowering the pressure. Medicines called calcium channel blockers (CCBs), angiotensin converting enzyme inhibitors (ACEs), and angiotensin receptor blockers (ARBs) all work by relaxing the blood vessels, but each type of medicine has a different way of doing it.
People are most likely to be able to keep taking medicine if it is taken just once a day and doesn’t cause side effects. Taking three medicines together once a day is easier to manage than taking one kind of medicine three times a day.
Dear Dr. Eva,
I am taking a medicine called carvedilol to treat my blood pressure. I recently found out that a friend is taking the same medicine, but he thinks it’s for congestive heart failure. I haven’t been told that I have congestive heart failure. Is my friend correct?
You are both right. Some medicines, including the beta blocker carvedilol, can be used for more than one condition. Carvedilol can be used to lower blood pressure and also to treat heart failure. The dose for congestive heart failure is usually lower than the dose needed to lower blood pressure.
Some other examples of medicines used for more than one condition:
- Viagra is used both for erectile dysfunction and for an unusual condition called pulmonary hypertension
- Spironolactone is a diuretic (water pill) used for heart failure which is also used for hair loss in women with male-pattern hair loss
- Some antidepressants are helpful for chronic pain
- The beta blocker propranolol, originally used for high blood pressure, also controls some kinds of tremors and relieves certain types of anxiety, such as performance anxiety (“stage fright.”)
• Several different types of seizure medicines are also effective as mood stabilizers, especially in bipolar disorder.
- Eva Hersh is a family physician. Send your comments and questions to her by email at firstname.lastname@example.org