Issues with Switching Antihypertensive Medications
Hello Doctor: My father is 56 years old and has high blood pressure.
Previously, he measured his blood pressure about once a week, and it was around 145/85.
Recently, he had a follow-up appointment and changed his medication.
Today is the first day he took the new medication, and after taking it, his blood pressure was 122/66.
Although he hasn't reported feeling unwell, is it concerning that his blood pressure dropped so significantly? Thank you.
Li, 20~29 year old female. Ask Date: 2021/07/26
Dr. Xiao Yongxun reply Family Medicine
Dear Ms.
Lee:
1.
Regarding your concerns, it is advisable to consult your father's attending physician for more appropriate guidance.
2.
Hypertension is classified into primary hypertension and secondary hypertension.
The former accounts for approximately 90-95% of hypertension cases, with unknown causes; it may be related to genetic factors, diet (salt, fat, smoking), personality, external stress, and endocrine factors, with genetics being the most significant.
The latter accounts for about 5-10% of hypertension cases, where the causes are known, mostly related to kidney diseases.
3.
The more common primary hypertension or essential hypertension is generally classified as benign hypertension, with the majority having a mild course and remaining stable over several years to decades.
It predominantly occurs in older adults.
4.
Hypertension can lead to arterial wall hardening, thickening, degeneration, and necrosis, as well as narrowing and obstruction of the lumen.
Its effects can cause hypertensive heart disease, left ventricular hypertrophy, heart failure, glomerulosclerosis, renal sclerosis, kidney shrinkage, renal failure, cerebral hemorrhage, stroke, and retinal hemorrhage, among others.
5.
It is also important to be aware of white coat hypertension, where blood pressure is normal outside of a clinical setting but rises in a medical office.
Conversely, masked hypertension refers to individuals who have high blood pressure outside of a clinical setting but present with normal readings in a medical office.
Therefore, it is currently recommended that patients measure their blood pressure at home at least once in the morning and once in the evening, and keep a record for their healthcare provider's reference.
6.
There is no definitive standard for how low blood pressure should be; it must be considered individually by the clinician based on the patient's condition, especially when the hypertensive patient has other comorbidities or complications.
7.
Blood pressure management is not solely reliant on medication; dietary habits, lifestyle, exercise routines, smoking or alcohol consumption, and weight are all significantly related.
In simple terms, it is advised to avoid excessive salt intake, overeating, prolonged sitting, smoking, and drinking alcohol, control weight, avoid heavy dinners, limit intake of trans fats or high fructose corn syrup, maintain a regular sleep schedule, and manage stress levels.
This approach will help effectively control blood pressure and prevent complications of hypertension, such as stroke, myocardial infarction, kidney disease, and peripheral artery obstruction.
Otherwise, if blood pressure remains poorly controlled, clinicians may need to continuously increase medication to prevent immediate dangers such as stroke or myocardial infarction.
Reply Date: 2021/07/26
More Info
A sudden drop in blood pressure after a medication change can raise concerns, especially if the decrease is significant. In your father's case, transitioning from a blood pressure reading of approximately 145/85 mmHg to 122/66 mmHg represents a notable reduction. While it is not uncommon for blood pressure to fluctuate with medication adjustments, it is essential to monitor the situation closely.
Firstly, it is important to understand the mechanisms behind blood pressure medications. Different classes of antihypertensive drugs work through various pathways to lower blood pressure. For instance, beta-blockers, ACE inhibitors, calcium channel blockers, and diuretics all have unique effects on the cardiovascular system. When switching medications, the new drug may have a more potent effect or a different mechanism of action, leading to a more significant drop in blood pressure than anticipated.
In general, a drop in blood pressure can be safe if it remains within a tolerable range and does not lead to symptoms such as dizziness, fainting, or fatigue. Your father’s current reading of 122/66 mmHg, while lower than his previous measurements, is still within the normal range for many individuals, especially if he is asymptomatic. However, it is crucial to consider individual factors such as age, overall health, and any other underlying conditions that may influence how his body responds to the medication.
Monitoring is key. If your father experiences any symptoms like lightheadedness, confusion, or weakness, it would be advisable to contact his healthcare provider immediately. Additionally, regular monitoring of blood pressure at home can provide valuable information. If his blood pressure consistently remains low or if he develops symptoms, his doctor may need to adjust the dosage or consider alternative medications.
Furthermore, it is worth noting that some individuals may experience a phenomenon known as "white coat syndrome," where their blood pressure readings are higher in a clinical setting due to anxiety. This could explain why his readings at home were higher than those taken after the medication change.
In conclusion, while a sudden drop in blood pressure after a medication change can be concerning, it is not inherently unsafe if the patient remains asymptomatic and the blood pressure is within an acceptable range. Continuous monitoring and open communication with healthcare providers are essential to ensure that any potential issues are addressed promptly. If you have further concerns or if your father's condition changes, do not hesitate to reach out to his healthcare provider for personalized advice and management.
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