Today I read on Facebook that a Facebook friend was considering stopping her blood pressure medication on her own. She is reaching out to her Facebook friends to find out if anybody has stopped their medications on their own.
She wants to find out if others considered stopping their medications. She also wants to know what happened to them when they stopped their medications.
She said that she was having side effects from her medication and she was fed up. Apparently, she thinks that her medication is causing her to shake and startle and it’s disturbing her sleep.
The Facebook friend is also having panic attacks and she has needed anxiety medication to get her through the night and prevent her from going to the emergency room.
She said her blood pressure is extremely high (180/110 mm Hg) after taking her medication. Because she is experiencing high blood pressure despite taking her medication, she wants to stop.
In addition, she is having anxiety and other problems she believes are coming from the medication. So she is saying, in other words, why take blood pressure medications that don’t work?
Reasons For Uncontrolled Blood Pressure Despite Taking Medication
1) Inappropriate treatment regimen
2) Lack of responsiveness to hypertension medication
3) Resisitant hypertension
Question posted in the Facebook Group:
“Had anyone stopped taking their meds on their own and succeeded in lowering your BP afterward? I’m tired of the shaking and startling awake every night. Panic attacks and needing anxiety meds just to get through a night without running to the hospital. My BP was 180/110 all night with my medication. What’s the point?!?
Answers from Facebook Friends
Facebook Friend #1 said:
“Just be careful stopping by yourself. I came off my bp meds (stopped by gp) as I had kidney trauma. My body filled with fluid and caused heart failure. You can’t take any chances.”
Facebook Friend #2 said:
What meds are you taking
Facebook Friend #1 said:
I take 5 mg Amlodipine, I’ve been cutting that in half the last three days though, and I take 40mg fuerosimide, 100mg Losartan, then two blood thinners, clopodigrel, and aspirin 81mg.
Facebook Friend #1 said:
then Ativan (lorazepam) for anxiety as needed, the doctor keeps trying to push antidepressants but I’m refusing.
Facebook Friend #2 said:
Vicki Cornell for my anxiety I have tried lots and they all made me sick. But I am now on the generic of Wellbutrin. 75 mg twice a day which I tiered up to. And it seems to be doing the trick.
Here is a person who might be considering discontinuing her medications because despite taking her medication as prescribed, her blood pressure is still uncontrolled.
My reply: Dr. Tonya Breaux-Shropshire
So sorry that you are not feeling well. You are not alone. Many people are experiencing frustration with the care they receive when the medications don’t work. Know that there are effective medications available and a way to get your blood pressure controlled. I know that it can happen for you too. Not trying to scare you but it’s important to call your doctor with these severe blood pressures to get medical advice to lower your blood pressure to prevent stroke, heart attack, etc. I will address this on my podcast today at 3 pm central time. Listen in. Hope you feel better soon.🦋
Explanation
Here, I would like to expand on my reply to help people address this problem. Now, we in the health care field might call this medication non-adherence if the patient stops her medication on her own. This patient is labeled non-adherent but we are not addressing the reason for her nonadherent.
Rightfully so, she wants to stop the medication that does not seem to be working and seems to be causing her uncomfortable side effect.
We know that there are effective medications that are tolerated by many patients. However, we also know that all medications have potential side effects. Yet, many of those side effects never happen at low to moderate doses. We know that medications at high dosage are more likely to cause side effects than medication prescribed at low to moderate dosages.
We also know that there are certain medications that are recommended to treat patients for the best blood pressure reduction. In other words, there are many blood pressure medications but they should be prescribed in a systematic way.
For example, for mild pain, you might use Tylenol but you will not likely use a narcotic. A narcotic for mild pain would be inappropriate as certain classes of medication that treat blood pressure are used for mild hypertension.
Levels of Blood Pressure
In order to know what type of medication to prescribe, your doctor has to know your blood pressure level. Your blood pressure is either normal, elevated, high (stage one, stage two), or a hypertensive crisis.
Certain medications or combinations of medication are needed based on your blood pressure level. It is helpful to monitor your blood pressure at home for the most accurate measurement. Then, log your measurements and share the numbers with your health care provider for the most appropriate treatment.
This Facebook friend might not be on an appropriate treatment for her blood pressure.
1) Stopping medication on own
2) Medication is too expensive and no money for f/u visits
3) Unclear of how to take the medication (given in written)
4) Failure of a physician to increase or change therapy to achieve blood pressure goals
5) Inadequate or no patient education
6) Lack of involvement of the patient in the treatment plan
7) Side effects of medication
8) Organic brain syndrome (e.g., memory deficit)
9) Inconvenient dosing schedule
10) White coat hypertension
11) seudohypertension
12) Drug-related causes
13) Doses too low
14) Inappropriate combinations (e.g., two centrally acting adrenergic inhibitors)
15) Rapid inactivation (e.g., hydralazine, oral clonidine [Catapres], captopril [Capoten], short-acting calcium channel blockers)
16) Drug interactions
17) Glucocorticoids
18) Mineralocorticoids
19) NSAIDs
20) Tyramine and MAO inhibitors
21) Appetite suppressants
22) Phenothiazines
23) Oral contraceptives
24) Sympathomimetics
25) Antidepressants
26) Adrenal steroids
27) Nasal decongestants
28) Cocaine
29) Cyclosporine (Sandimmune, Neoral)
30) Erythropoietin
31) Associated condition (Increasing obesity, Alcohol intake greater than 1 oz of ethanol per day, sedentary lifestyle, sleep apnea, volume overload, inadequate diuretic therapy, excess sodium intake, fluid retention from the reduction of blood pressure, progressive renal damage
32) Secondary hypertension
33) Renal, renal parenchymal disease, chronic nephritis
34) Polycystic kidney disease
35) Collagen vascular disease
36) Diabetic nephropathy
37) Hydronephrosis
38) Acute glomerulonephritis
39) Renal vascular disease, renal transplantation, renin-secreting tumors
40) Endocrine
41) Adrenal
42) Primary aldosteronism
43) Overproduction of 11-deoxycorticosterone (DOC), 18-OH-DOC, and other mineralocorticoids
44) Congenital adrenal hyperplasia
45) Cushing’s syndrome
46) Pheochromocytoma
47) Extra-adrenal chromaffin tumors
48) Hyperparathyroidism
49) Acromegaly
50) Pregnancy-induced hypertension
51) Sleep apnea
42) Coarctation of the aorta
53) Neurologic disorders
54) Dysautonomia
55) Increased intracranial pressure
56) Quadriplegia
57) Lead poisoning
58) Guillain-Barré syndrome
58) Postoperative hypertension
59) Isolated systolic hypertension
60) Aging, with associated aortic rigidity
61) Increased cardiac outpuThyrotoxicosis
62) Anemia
63) Aortic valvular insufficiency
64) Decreased peripheral vascular resistance
65) Arteriovenous shunts
66) Paget’s disease of bone
67) Beriberi
However, after a month of treatment, the reason for uncontrolled blood pressure is complex. Resistant hypertension is not the cause of the majority of uncontrolled blood pressure. Matter of fact, less than 10% of patients with hypertension have resistant hypertension.
Resistant hypertension is currently diagnosed if you require three or more medications to control your blood pressure. The three medications should include a water pill.
High blood pressure due to a secondary cause is seen even less. According to research, inadequate medication, poor adherence to medication, and inappropriate medication regimen are the main reason people have uncontrolled blood pressure. Based on my observational studies, I have learned that inadequate medication and inappropriate medication regimens might be due to the limitations of office blood pressure measurement. Thus, much of the medication non-adherence might be due to side effects, inadequate medication, and inappropriate medication.
In this Facebook friend’s case, her high blood pressure despite taking the medication and presence of side effects are the reason why she is considering non-adherence. The questions are: is she on the appropriate medication regime which includes the right class, number, and dosage of medication?
Sources
Oparil et al., 1998
American Heart Association
The Fifth Report of the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med. 1993;153:154–83.
