Managing Medications

I hold out hope that some day, I'll be able to send my patient to the lab for a "hypertensive DNA genotype array" which will check a person's genetic makeup and tell me why an individual has high blood pressure and which medicine will work the best for that particular patient.  We have learned much in the last 50 years in regards to why people have high blood pressure but we do not have a simple way as of yet to apply that on an individual basis.  As of right now when a patient needs medications to control their blood pressure, we as physicians use our knowledge, experience and our best guess as to what will work for a given person.  Trial and error is inevitable.  Some patients may require three, four or even five separate medications to control their pressure.  Others may be able to do it with life style changes alone.  Each medicine may have side effects that might limit its usefulness.  One may need to be stopped and another started.  As discussed previously, though, it is essential to get the blood pressure down and to keep it down.

I want to reemphasize that it is always better to be on less medication if possible.  I talk to all my patients with high blood pressure about their salt intake but very few of them really take me seriously.  I believe that it has a much greater influence than most people realize.  I came across a study some years back where researches studied a primitive island population in the Pacific.  They grew and or gathered almost all of their food.  Their diet was high in potassium given the high fruit content and it was extremely low in sodium in comparison to ours.  The astounding aspect to me was there was not a single person on the island that had high blood pressure.  Not even one.  Surely, I would suspect that someone would have a genetic defect giving them hypertension but it was overcome by a much healthier diet.  As stated in last week's post, it is essential to keep the sodium level under 2000 mg a day.

Some medications can be taken as needed.  Allergy medications, pain relievers or acid reducers can all be taken sporadically.  High blood pressure medications may not be used now and then.  They must be taken every single day.  The medicine will only work when it is taken and will have no lasting effects if doses are missed.  In fact, beta blockers if used inconsistently will trigger the blood pressure to spike to potentially dangerous levels.  I encourage all of my patients who are on daily medications to use a weekly pill box.  Many don't want to do so, saying they are not "old and senile."  We all will make mistakes if we are taking medicine from a bottle.  We can easily become distracted and then not remember if it was taken.  If we are using the pill box we will know for sure if it was taken or not.

Make sure you set up a routine.  Many patients will say that they remember their morning medications but often forget in the evening.  Put the medicine next to your tooth brush (which you should be using every night !), set an alarm if you need to.  Leave a note next to your bed stand to remind you.  Make sure you are consistent.

I want to finish with a word about side effects.  The printout given by the pharmacy is rather daunting.  It lists so many possible problems that most feel rather timid about taking any medication.  In general, medicines have 2-3 potential side effects that are more common.  If you think you are having a side effect to a medication, ask your physician.  Don't just stop the medicine and tell him three months later.  It is not always easy to tell if a symptom is related to a medication or not.  Remember that uncontrolled high blood pressure has side effects also.  The risks of both need to be weighed prior to making changes.  Your doctor is your health partner.  Don't leave him or her out of your important medical decisions.