Managing Hypertension: Do I Need to Continue Multiple Medications?

Issues with Hypertension Medications

Hello, Director Wu! I started taking blood pressure medication six years ago when my blood pressure was 145/85, and my cholesterol was high at 230, while my triglycerides were normal at 100.
The doctor prescribed Amlodipine 160 mg.
After that, my blood tests returned to normal, and the doctor advised me to continue taking Amlodipine and switched my blood pressure medication to Lisinopril 2 mg.
However, I felt that since my tests were normal, I didn't need to take medication every day, so I didn't measure my blood pressure regularly or take my medication on time.
During my follow-up visit, my blood pressure was 160/90, and the doctor added Nebivolol 5 mg and changed my Lisinopril to Telmisartan 20 mg because my cholesterol was 235.
The truth is, I wasn't adhering to my medication regimen, and I was afraid to tell the doctor.
This year, during my health check-up, my coronary artery calcium score was very high at 1569.
The doctor arranged for me to undergo a nuclear medicine test, but since the scheduling takes over a month, the doctor advised me to start taking Beraprost.
The nuclear medicine report showed that my blood vessels were not blocked and my heart was not ischemic, but the doctor said I needed to take one tablet each of Amlodipine and Nebivolol, and I should continue taking Lisinopril.

May I ask, Director, do I need to take two types of blood pressure medications? I often feel dizzy, and my hands and feet are cold.
Now that I have to take an additional Beraprost, I mentioned my dizziness to the doctor, who prescribed me another medication for it.
I am currently measuring my blood pressure every morning and evening, and it ranges around 130/75/65.
Because my calcium score is very high, I am afraid to stop my medications abruptly.
Do I need to continue taking all these medications indefinitely? Thank you for your help, Director!

Ping An, 60~69 year old female. Ask Date: 2022/05/27

Dr. Wu Xueming reply Cardiology

Due to the presence of calcification in the coronary arteries, it is essential to properly control blood pressure and lipid levels.
If there are any side effects from the current medication, it is advisable to discuss with the prescribing physician whether a change in medication is necessary.

Reply Date: 2022/05/27

More Info

Managing hypertension effectively often requires a careful balance of medication, lifestyle changes, and regular monitoring. Your situation, which involves multiple medications and fluctuating blood pressure readings, is not uncommon among individuals with a history of hypertension. Here’s a comprehensive overview of your concerns regarding the necessity of continuing multiple medications for hypertension, along with some additional insights into managing your condition.

Understanding Your Medications
1. Current Medications: You mentioned taking several medications, including Diovan (Valsartan), Amlodipine, and Lisinopril. Each of these medications serves a specific purpose in managing blood pressure:
- Diovan is an angiotensin receptor blocker (ARB) that helps relax blood vessels.

- Amlodipine is a calcium channel blocker that also aids in relaxing blood vessels and reducing heart workload.

- Lisinopril is an ACE inhibitor that lowers blood pressure by preventing the formation of a hormone that narrows blood vessels.

2. Combination Therapy: It’s common for patients with hypertension to be prescribed a combination of medications. This approach can be more effective than a single medication, especially if blood pressure is not adequately controlled with one drug alone. Each medication works through different mechanisms, which can lead to better overall control of blood pressure.

The Importance of Adherence
You noted that you have not been consistent with your medication regimen. Adherence to prescribed medications is crucial in managing hypertension effectively. Inconsistent use can lead to fluctuations in blood pressure, which can increase the risk of cardiovascular events such as heart attacks or strokes. It’s essential to take your medications as directed by your healthcare provider and to communicate any side effects or concerns you may have.

Monitoring Blood Pressure
Regular monitoring of your blood pressure is vital. You mentioned that you have started measuring your blood pressure daily, which is an excellent practice. Keeping a log of your readings can help your healthcare provider make informed decisions about your treatment plan. Aim for a target blood pressure of less than 130/80 mmHg, as recommended by the American College of Cardiology and the American Heart Association.

Side Effects and Concerns
You expressed concerns about experiencing dizziness and cold extremities. These symptoms can sometimes be side effects of blood pressure medications. It’s important to discuss these symptoms with your healthcare provider, as they may need to adjust your medication regimen or explore alternative treatments. Do not stop or adjust your medications without consulting your doctor, as this could lead to adverse effects on your blood pressure control.

Lifestyle Modifications
In addition to medication, lifestyle changes can significantly impact hypertension management. Consider the following:
- Diet: Adopt a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy while reducing saturated fat and cholesterol.

- Exercise: Regular physical activity can help lower blood pressure. Aim for at least 150 minutes of moderate aerobic exercise each week.

- Weight Management: Maintaining a healthy weight can also help control blood pressure.

- Stress Management: Techniques such as mindfulness, meditation, or yoga can help manage stress, which can contribute to elevated blood pressure.

Conclusion
In summary, it is likely that you will need to continue taking multiple medications to manage your hypertension effectively, especially given your history and current blood pressure readings. Regular communication with your healthcare provider is essential to ensure that your treatment plan is tailored to your needs and that any side effects are addressed promptly. Additionally, incorporating lifestyle changes can enhance the effectiveness of your medications and improve your overall health. Always consult your healthcare provider before making any changes to your medication regimen or lifestyle.

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