Multiple Drugs for Blood Pressure

Oct 26, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

I was doing my Thursday shift at the Winnipegosis Clinic Pharmacy. It was a beautiful, warm, sunny October day. The girls working with me were discussing politics. Winnipegosis seemed to have a near record number of people running for council. I was very impressed there were so many civically minded people in town. It was great that they all wanted to spend their time working together to make the village better. A customer came to the counter with a question. She wanted to know why the doctor had given her another blood pressure pill. She was already on one blood pressure pill. She wanted to know if it was normal to be on two blood pressure pills.

Should a patient be on two or more blood pressure pills? The answer is. Ill get to that in a minute. Lets talk about high blood pressure in general first. Your heart is a pump. It moves blood through pipes we call blood vessels. These pipes take blood out to the top of your head and the tips of your toes. The blood does lots of important things, but some of its most important jobs are to get food and oxygen out to all the cells and bring back all the waste and carbon dioxide for disposal. To get the blood moving through the blood vessels, the heart has to apply pressure. But you will notice the doctors always talk about two blood pressure numbers. They will say things like your blood pressure is 125 over 85. The top number is the amount of pressure the heart has to exert to get the blood through the pipes when it squeezes. This top number is called the systolic blood pressure. The amount of pressure left over in the pipes as the heart muscle relaxes is called the diastolic blood pressure. Unlike the pipes in your house, blood vessels are flexible. They are designed to expand and contract as pulses of blood go through them. But, blood vessels can harden and get plugged. When this happens, the amount of force the heart must exert to get the blood to flow goes up. This is called high blood pressure or hypertension.

Yeah, but what about the original question? What does that diatribe have to do with multiple blood pressure pills? Nothing yet, but. It is important to treat high blood pressure. A patient doesnt feel bad when they have high blood pressure, but it increases their chance of having a heart attack or stroke. About 1 in 4 people who are put on a blood pressure pill stop taking it within six months. About 1 in 2 people stop their blood pressure pills within a year of it being prescribed. It is unfortunate, but understandable why so many people quit their blood pressure pills. They went to the doctor feeling good. Their doctor checked their blood pressure, found it was high, and wrote them a prescription for a pill. In the best case scenario, that pill costs them money every month and they feel no different. In a worst case scenario, the pill costs them money, and gives them some annoying side effects. So within six months the patient goes from feeling well to spending money every month on something that makes them feel worse. Again, no wonder they quit. But, if you are given a blood pressure pill, you shouldnt quit. The reason you shouldnt quit is you know that blood pressure pill is reducing your chance of having a heart attack or stroke.

But, I am off topic again. Lets answer the question. Is it normal to be on more than one blood pressure pill? Well, yes it is getting more common for doctors to put people on more than one blood pressure pill at once. It seems that even when people take their blood pressure pills properly, at least 75% of patients will need more than one different type of blood pressure pill to get their blood pressure down to normal.

Why not just jack up the dose of one blood pressure pill instead of adding a second one? Well, chances are if we just go to an extremely high dose of one type of blood pressure pill, we wont get the blood pressure down to normal and we will increase the chance of side effects. If your doctor chooses medications from different drug families, they can work together to reduce blood pressure better. Lets look at some examples.

Medications called angiotension converting enzyme or ACE inhibitors and angiotension receptor blockers or ARBs are very good blood pressure pills. They are good at reducing the blood pressure and they can add some heart protection and some kidney protection. But when you add the relatively weak water pill hydrochlorothiazide (HCTZ) to them, they work even better. The blood pressure goes down even further. The combination of HCTZ to an ACE or ARB reduces the chance of a patients potassium going too low. There have been lots of good studies showing an ACE and HCTZ reduces the chance of a stroke, heart failure, and diabetes complications. As an added bonus many drug companies have recognized the value of an ACE or ARB added to HCTZ. Many ACE inhibitors and ARBs actually come with hydrochlorothiazide available in a single pill. That can simply how many pills you have to take, while still getting the benefit of two different medications for your blood pressure.

So just like a municipal council is more productive if different people work together, if you have more than one blood pressure pill working together they can be more productive working towards your better health.

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As always if you have any questions or concerns about these products, ask your pharmacist.


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