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Question: How should you treat high blood pressure if a medication doesn't work?
My husband, age 45, has been treated for high blood pressure over two years. At first, he was treated with hydrochlorothiazide, which was not effective. Next, he was put on an enzyme-inhibitor, which lowered his blood pressure to a low 120/80, but resulted in frequent and severe heart and chest pain. He is now on Norvasc, which is only mildly effective -- his blood pressure is now about 140/90 instead of 150/95-100. With Norvasc, he is very fatigued and has gained 30 pounds since starting the meds. He's no longer gaining weight, but is unable to lose the extra 30. Should he try a different medication? Since he's always been healthy until now, he has a low tolerance for clinic visits, is too busy at work for frequent appointments, and is considering just stopping the meds. Any advice or suggestions would be appreciated. Also, where can we order a blood pressure monitor with a large cuff for taking a reading at home? Dr. Gordon Fung responds:
Thank you for your excellent question. I'm glad to see that you and your husband are working together to get this problem taken care of. To begin, please continue to encourage your husband to stick with the clinic to get his blood pressure under control. The medical literature is quite clear that uncontrolled high blood pressure is a silent killer resulting in strokes, heart attacks, kidney failure and congestive heart failure. Although he sounds like a patient with essential high blood pressure –- no other obvious cause for high blood pressure –- if simple treatments are not effective, then it may be time to investigate other causes for his high blood pressure. There are some tumors that can produce hormones that raise the blood pressure. There can be arterial problems to the kidney that can raise the blood pressure. These should be excluded and treated before combining drugs. Your question regarding a home blood pressure monitor is a good one. If your husband is a large person and requires a large cuff, then he may benefit from having your physician ordering a home unit from the pharmacy or medical supply house and having a medical supply store modify it with a large cuff. The manufacturer may be helpful in doing this as well. With regard to blood pressure treatments, it is important that your husband also exercise regularly and modify his diet to minimize his salt intake. Being at optimal weight and regular exercise is an excellent way to maintain goal blood pressure of 120/80. Using drug treatment, there are still a few classes of medications that can lower blood pressure that usually do well when taken at night before bed so the morning high blood pressure is blunted and any potential side effects of low pressure would occur during the evening while in bed and thus less likely to cause symptoms. There are also some fixed combinations of drugs at low doses that can lower blood pressure with much less side effects of the single agent at higher doses. Unfortunately, it does take time and persistence to find the appropriate agent for each individual. But the work is well worth it in preventing future cardiovascular problems. Good luck. And tell us how it goes. Thank you, Dr. Fung -- Dr. Gordon Fung, MD, MPH, is a cardiologist and associate clinical professor of medicine at the University of California at San Francisco Medical Center at Mt. Zion.
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First published December 31, 2003
Last updated May 6, 2008
Copyright © 2003 Consumer Health Interactive
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