Blood Pressure Medications: Concerns and Adjustments

Regarding blood pressure?

Hello Doctor, three years ago, due to being overweight (165 cm, 90 kg) and experiencing significant academic stress, I developed symptoms of retinal hemorrhage and was diagnosed with hypertension.
As a result, I started taking antihypertensive medication (only one pill: a beta-blocker).
The outcome has been very positive; my vision has recovered, and my blood pressure is normal.
However, this year I read in a book that beta-blockers can lead to sexual dysfunction.
Although I am not sexually active yet, I expressed my concerns to my attending physician.
After understanding my worries, he switched my medication to a calcium channel blocker in April of this year.

However, I have some questions: 1.
Why does it seem that my blood pressure has not stabilized after switching to the new medication? (When switching medications, the doctor adjusted the calcium channel blocker dosage to be equivalent to the original beta-blocker dosage.) 2.
Since I am so young and have started taking antihypertensive medication, am I doomed to be on it for life? I am worried that continuing this way might overload my kidneys (especially since losing weight hasn’t improved my condition).
I tend to be a bit anxious and have concerns, so I kindly ask for your guidance!

SR, 10~19 year old female. Ask Date: 2013/06/27

Dr. He Dongjin reply Cardiology

Hello, your blood pressure issues may be related to genetics, but a significant part is likely due to stress and an overactive autonomic nervous system, which is why beta-blockers are more effective.
First, it's important to clarify that taking antihypertensive medication is meant to control blood pressure to prevent it from becoming too high and damaging the kidneys, rather than the common misconception that taking too much Western medicine harms the kidneys.
In your case, I believe beta-blockers should still be the first choice, followed by ARBs.
If you have concerns about sexual function, you might consider switching medications.
Generally, this consideration applies to older adults, while younger individuals typically do not need to worry.
If possible, increasing your exercise to more than three times a week would be beneficial.
Changhua Hospital cares about you.

Reply Date: 2013/06/27

More Info

Understanding blood pressure medications and their implications is crucial for managing hypertension effectively, especially when transitioning between different classes of antihypertensive drugs. In your case, you have transitioned from a beta-blocker to a calcium channel blocker, and you are experiencing some concerns regarding your blood pressure readings and overall health.

1. Why did my blood pressure readings change after switching medications?
When you switched from a beta-blocker to a calcium channel blocker, it is not uncommon to see variations in blood pressure readings. Beta-blockers, such as propranolol, work by reducing heart rate and the force of heart contractions, which can lead to lower blood pressure. They also have a calming effect on the cardiovascular system, which can be beneficial for individuals with anxiety or stress-related hypertension. On the other hand, calcium channel blockers, like amlodipine, primarily work by relaxing the blood vessels, which can lower blood pressure but may not have the same heart rate-lowering effect as beta-blockers.

The increase in your diastolic blood pressure (the lower number in your readings) could be attributed to several factors, including the pharmacodynamics of the new medication, your body’s response to the change, or even lifestyle factors such as stress or dietary changes. It is essential to monitor your blood pressure regularly and discuss these changes with your healthcare provider. They may need to adjust the dosage or consider adding another medication to help manage your blood pressure more effectively.

2. Will I need to take blood pressure medication for life?
Starting blood pressure medication at a young age can be concerning, but it does not necessarily mean you will be on medication for life. Lifestyle changes, such as maintaining a healthy weight, regular exercise, a balanced diet low in sodium, and stress management, can significantly impact blood pressure control. Since you have already lost weight and are engaging in regular physical activity, you are on the right track.
It’s also important to consider genetic factors, as you mentioned a family history of hypertension. This can influence your risk and may require ongoing management. Regular follow-ups with your healthcare provider can help assess your blood pressure and determine if adjustments to your treatment plan are necessary. In some cases, individuals can reduce or even discontinue medication if they can maintain healthy blood pressure levels through lifestyle changes alone.

3. Concerns about kidney health and medication burden:
Your concern about kidney health is valid, especially when taking medications long-term. However, both beta-blockers and calcium channel blockers are generally well-tolerated and do not typically cause kidney damage when used appropriately. Regular monitoring of kidney function through blood tests (such as serum creatinine and electrolytes) is essential, especially if you have risk factors for kidney disease.

It’s crucial to maintain open communication with your healthcare provider about any side effects or concerns you may have regarding your medications. If you are experiencing anxiety about your health or the medications, discussing these feelings with your doctor can help alleviate some of your concerns and lead to a more tailored treatment approach.

In conclusion, while switching medications can lead to fluctuations in blood pressure, it is essential to work closely with your healthcare provider to monitor these changes and adjust your treatment plan as necessary. Lifestyle modifications play a significant role in managing hypertension, and with the right approach, it is possible to maintain healthy blood pressure levels without lifelong medication. Regular check-ups and open communication with your healthcare team will be key to your long-term health and well-being.

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