Diastolic Hypertension: Questions on Medication and Health

(Follow-up question) Regarding elevated diastolic blood pressure?

Doctor, I apologize for bothering you again! After your response in the article "Regarding High Diastolic Blood Pressure," I still have some questions:
1.
When you mentioned "maintaining the medication dosage," does that mean I can continue taking my current medication at the same dosage? (Initially, I was on a beta-blocker at 10 mg for three and a half years, but due to concerns about side effects affecting fertility, my doctor switched me to a calcium channel blocker at 5 mg.
Since I have lost 20 kg compared to my starting weight, my doctor reduced the dosage.)
2.
Why is my diastolic blood pressure still not coming down after changing medications? Although my systolic blood pressure remains somewhat high, it is still within the controlled range.
However, why does my diastolic blood pressure fluctuate, sometimes around 95 and other times spiking to about 105? (My systolic pressure is consistently around 140.)
3.
Since I started taking blood pressure medication at a young age, will long-term use of these medications affect the health of any future children? Could it have any impact on their health? (Excluding any potential hereditary hypertension issues.)
4.
Once I return to a standard weight, is there a significant chance I can become independent of medication? My current BMI is around 25.5, which is a considerable reduction from 31 when I was on medication, yet I still don’t understand why I need to continue taking medication while my diastolic pressure remains variable.
Could it truly be due to hereditary hypertension? I sincerely request your guidance! Thank you very much! I am still quite young, and I do not want to become overly dependent on medication at this stage.
I consistently jog for 35 minutes on weekends and walk for errands or dining instead of relying on a scooter!

EE, 20~29 year old female. Ask Date: 2013/08/27

Dr. He Dongjin reply Cardiology

Hello, elevated diastolic pressure has a relatively minor impact on the body, so there is no need for concern.
Most fluctuations in diastolic pressure are related to metabolism.
I suggest that if you can increase your weekly exercise and reduce your weight further, there is a significant chance that you may not need to take medication.
Additionally, fluctuations in blood pressure are normal; they can vary with changes in your internal and external environment, as well as autonomic nervous system activity.
Currently, the side effects of blood pressure medications are minimal and will not affect your child, so there is no need to worry.
The current instability in your blood pressure is likely related to adjustments in dosage.
If you prefer not to take too much medication, then increasing your physical activity is a good alternative.
Changhua Hospital cares about you.

Reply Date: 2013/08/27

More Info

Understanding diastolic hypertension and its management can be quite complex, especially when considering medication, lifestyle changes, and potential long-term effects on health. Let's address your questions one by one.

1. Medication Maintenance: When your doctor mentioned that you can "maintain the medication dose," it typically means that you can continue taking your current medication at the prescribed dosage. Since you have transitioned from a beta-blocker to a calcium channel blocker due to concerns about side effects and fertility, it’s essential to follow your doctor's guidance. If your blood pressure remains elevated, it may be necessary to reassess your treatment plan, but maintaining your current dosage is often a good strategy unless otherwise advised.

2. Fluctuating Diastolic Pressure: The variability in your diastolic blood pressure, where it can range from 95 to 105 mmHg, despite having a controlled systolic pressure around 140 mmHg, can be attributed to several factors. Diastolic hypertension can be influenced by lifestyle factors, stress levels, and even the time of day when measurements are taken. Additionally, the effectiveness of your current medication may vary based on your body’s response, which can change over time due to weight loss, dietary changes, or other health conditions. It’s crucial to monitor these fluctuations and discuss them with your healthcare provider, as they may suggest adjustments to your treatment plan.

3. Impact on Future Children: Concerns about the long-term use of antihypertensive medications and their effects on future pregnancies are valid. Most studies suggest that many blood pressure medications are safe during pregnancy, but some may carry risks. It’s essential to have an open dialogue with your healthcare provider about your plans for pregnancy and any medications you are taking. They can help you weigh the risks and benefits and may suggest alternative treatments that are safer during pregnancy if needed.

4. Weight Loss and Medication Dependency: Achieving a healthy weight can significantly impact blood pressure management. Many individuals find that losing weight can help lower their blood pressure and, in some cases, may allow them to reduce or eliminate their need for medication. However, this is not guaranteed, especially if there is a genetic predisposition to hypertension. Your current BMI of 25.5 is a positive change from 31, and continuing your exercise routine, such as jogging and walking, can further improve your cardiovascular health. It’s essential to maintain regular check-ups with your healthcare provider to monitor your blood pressure and discuss any potential for reducing medication.

In conclusion, managing diastolic hypertension involves a multifaceted approach that includes medication, lifestyle modifications, and regular monitoring. It’s commendable that you are taking proactive steps to improve your health through exercise and weight management. Always consult with your healthcare provider before making any changes to your medication or treatment plan, especially considering your concerns about future pregnancies and the long-term effects of medication. Your health is a priority, and with the right support and strategies, you can effectively manage your blood pressure while minimizing reliance on medication.

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