I taking the range of A B C D drugs for high BP and want to cut down. any suggestions anyone?

Heart health and blood vessels
1

I am 65 years and on so many drugs which I know is making me feel quite unwell most of the time.

 My GP first started me on a Ace inhibitor  Perindopril 8mg then the rest followed... Bisoprolol 2.5mg, Calcium channel blocker Amlodipine 10mg and Directic Indapamide 2.50mg also on Levothyroxin 125mcg for underactive thyroid.

I stick to a Gluten, wheat and dairy inolerant "healthy diet" without doubt and I walk everyday. I also add supplements to my diet.

I want to cut down on these awful drugs before they kill me!!!!

 

2

Don't rely on your GP just to tell you. Two years after my hospital spell, I am still taking all 8 medications daily. When I visited the gastro in May, I asked about this, and nothing really came of it. One of the medications (on prescription) is just folic acid, something I needed at the time, I got a full set of blood tests through recently and when I say full, I mean just about everything.

It actually shows my floate as outside and ABOVE the normal range, which isn't surprising since I've been taking it for two years. I was meant to have a review after 12 months (June last year) of medication and agian June this year, nothing.

So my plan is to visit my GP, tell him I'm going to unilaterally cut it from 8 to 4, which 4 would he like me to keep taking. What I'm try to say (rather badly), push your GP to cut it down, if you don't, they will just leave you on them for the rest of your life.

Amlodipine is a particularly nasty drug that causes a great many issues for people. I was on that up until a couple of months ago until I swapped it for felodipine. There is actually a forum here just for that drug alone.

https://patient.info/forums/discuss/browse/amlodipine-2497

BTW, what is your BP?

 

3

RHGB, I'm sure you're aware that excessive blood folate levels can mask vitamin B12 deficiency which, in patients already vulnerable to this deficiency, could lead to a degree of irreversible brain damage before the low B12 levels were noticed.

4

No I wasn't. I kind of have a double list of medications, from when I went into hospital a couple of years ago. One for suspected liver failure (ALD) and at the very same time an acute cerebral haemorrhage with 6mm midline shift.

No one has ever told me what the medicatiosn are for, I have had to try and work out what each one does in my particular circumstances. But I continue to take,

Amoldipine/felodipine

Carvedilol

Spironolactone

Omeprazole

Lactulose

Vitamin B compound strong

Thiamine

Folic acid

And like the OP, I'm fed up of taking this cocktail of drugs every day. You can probably guess from my first paragraph why I was give folic acid initially.

5

My husband has heart failure and he was on Perindopril, has been taken off that medication, because his blood pressure is and has been normal for a long time, so he doens't need it dropping.

But before he was taken off BP medication he was changed over from oil based BP and Colesterol medication to water based, and did alot better on the water based, not as many side effects.

Dr's do know what you are talking about if you ask, but it seems they are too lazy, husband should have been changed over long before he was, only my investigation, and asking questions resolved them to change him to water based medicine.

Bisoporol, from my understanding, my husband is also taking this, but at a higher dose, it keeps the muscles in your heart straight, as described to me, if you hurt yourself you develop scar tissue, and scar tissue becomes tight and doesn't move the same as normal tissue, and this scar tissue is the last thing we need to happen to your heart muscle.

Thank goodnes he does not need a directic, but he is on only 1 and half litre's of fluid a day, we have to watch and give him more if he has been sweating because of a very hot day, sometimes a real balancing act, trying to work out how much more fluid I should allow him.

At least once have had to take him to the hospital and have him on a drip in the ER, closely supervised so he doesn't develop congestive heart failure, even then they were only giving him 250ml an hour, his blood pressure was horrendously low, should not have even been concious I was told, although he was very confused.

6

Hi Pat,

Whatever you do, don't stop taking the levothyroxine. That's not for high BP and it's not strictly a drug anyway. It's synthetic thyroid hormone. If you're on that, it must presumably be because your thyroid isn't making enough of the stuff itself. I take it too, though only at 75mcg. This one really isn't optional. The dose will have been determined by your doctor on the basis of blood tests. Unfortunately, an underactive thyroid rarely rights itself. It tends to go rather in the other direction, gradually producing less and less hormone once its function is replaced by synthetic hormones. But that's nothing serious. L-thyroxine has no side-effects, apart from during the first few weeks of starting it, and can safely be continued for life. Whatever side-effects you might be suffering, you can rule out L-thyroxine as being the cause. A seriously underactive thyroid that's untreated will lead to all kinds of health problems over time.

I'm guessing the other meds are for high BP. Do you know what your BP was before you were put on them, and what it is now? If your BP was very high, that might well kill you too!

As Lyn says, it might be worth discussing this with your doctor and asking him/her to explain what each of the three BP meds are supposed to be doing and whether you still need them.

7

The first thing I wondered about was how long it has been since you have had your levothyroxine reviewed, people often need less as they get older and this does increase the BP. You dont say what your BP is but again as we get older we can be a little more flexible in whats acceptable. It doesn't sound as if there is much you can do in terms of lifestyle changes, I presume your weight is Ok.

If your feeling this bad you should discuss that with your GP, its a bit pointless reducing the risk of illness if the treatment makes you feel ill. I suspect that one of these drugs may be responsible for the worst side effects so it might be a case of trying to identify which one. Bisoprolol is fairly infamous for adverse effects, so that would be my first suspect and as RHGB suggests some people react badly to calcium channel blockers like amlopidine. Your GP can also try alternative drugs in the same class as they can have different side effect profiles. You might need to be quite assertive, your GP is principally interested in your BP control, make the point that your not prepared to tollerate feeling like this, I'm sure he/she will try to help.

8

Going through that list of meds - and at the risk of repeating stuff you already know, but others might not - they are in order:

- Amlodipine/felodipine - calcium channel blockers (CCBs) for high BP

- Carvedilol - Beta-blocker, to steady heartbeat and/or as an adjunct to CCBs for BP

- Spironolactone - Diuretic, for congestive heart failure or more likely in your case as another adjunct to CCBs

- Omeprazole - Proton pump inhibitor (PPI) to treat GERD - or GORD as you insist we have to call it. Some liver problems can cause oesophageal varices, which could be worsened by GERD, putting you at risk of haemorrhage

- Lactulose - mostly used as a laxative but in view of your liver problems it could be to prevent hepatic encephalopathy caused by build-up of ammonia in your blood. You'd need to ask your doctor exactly why you're taking this one, as stopping it could have far worse consequences than constipation if it's for the latter reason

- The last three are all variants of the B group of vitamins, all essential in your condition but which, as you rightly state, should be prescribed strictly in function of your blood levels.

You and I have met on other boards and I know from some of your other posts that you're no shrinking violet when dealing with the medical profession! (I don't see that as a bad thing, btw.) In fact, I often misread your username as GBH. I'd therefore suggest you take your usual firm but polite line with your doctor and get him/her to give you a full explanation and justification for each of your meds, as well as their dosage. Clearly, with your history of such a serious stroke, it's going to be essential to keep your BP in check for the rest of your life, and your liver will probably require support too.

9

The Mediterranean diet is considered the healthy diet for high blood pressure

10

RHGB and to all who kindly replied to my letter.

 Thank you for your replies. I was thinking I will probably be taking these drugs for the rest of my life as my GP says he cannot take me off them?

Before taking the Amlodipine my BP was around150/85 which he says was too high. I do not understand why it goes up like it does, it tends to peak around 4am whilst I sleep My GP has not got a clue either. He just said he hoped the Amlodipine works!!!

Perindopril makes me cough a lot!

One of the main worries is my ankles have swelled quite considerably, they have always been very slim. I am of slim build (11st 8lbs) anyway. I seem to have lost my get up and go, basically I appeared to have slowed right down. I have to push myself to do what i used to do one year ago, fast walking for 1/1/2 hrs every morningI always manage to reduce my BP to around120/75 by using the breathing tecnique and walking, but the stress of it all makes things far worse.

I think you are right, I shall try and see him soon. Felodipine seems to be better. I shall stop the directic as it strong and dries me out (eyes Mouth etc).

Funny thing is I drink loads of water 2litres plus, morning and night daily.

MY B12 levels are more than 2000 which i think is good.

I have a healthy heart (after tests) yet why am I on bisoprolol I felt like I was falling through the floor when put on this one. I am going to reduce it by half, slowly of course.

I shall continue to take levothyroxin after recent blood test they said my TSH levels were to high so I was upped 25mcg now it is too low!!.

Thank you all very much for giving me a push into helping myself.

Patx

Ps My BP is now 135/80 whilst typing this

 

11

Hi g..

Thank you for your advice, yes, I agree with you.

As I am Gluten wheat and dairy intolerant I tend to eat as much fruit and veg that I can. I juice dark green cale and any veg every morning Organic when possible.

I eat only chicken/turkey, stay off sugar and drink homemade kefir (see online) 

I just don't understand what is going on with my BP.

Best wishes Patx

12

4am is the time circadian motion kicks in.

13

 Hi G.

Hmm, just looked it up, very interesting.

Thank you for that,

 

14

you are being wrongly prescribed the vasodilator (at uk licenced dose of 2.5mg) Indapamide as a diuretic. See my post

https://patient.info/forums/discuss/diuretics-in-hypertension-and-indapamide-error-nice-pathway-523586

I suggest you try Valsartan 80mg with 25mg (half a tablet use a pill cutter) Chlortalidone (take 50 mg for the first two days only due to the long half life) (+ the Levothyroxin) and drop the rest. If that does not reduce your BP enough add in Indapamide 1.5mg slow release (also called MR for modified release) not the 2.5mg.

Check your electrolytes and kidney function and uric acid ideally do both blood tests and a 24 hour urine creatinine clearance test so you have your base values before and after taking diuretics watch your sodium and potassium levels carefully by regular blood tests before the change ideally do a voiding dairy for 48 hours before starting and record your blood pressure and pulse.

Consider the other options as to the possible cause for example renal artery stenosis, blocked arteries, adrenalin etc

15

Always nice to see a famailiar face. The carvedilol and spironolactone, I was told by a gastro when I came out of hospital, to never stop takng them. I think he meant, if I got lazy and couldn't be bothered tot ake the medications some days, whatever I did, at least take those two. When I saw a different gastro in May, in the letter to my GP, he again mentioned just those two medications.

From what I can gather, looking on the internet, the carvedilol is for (in my case) portal hypertension and obviously the oeosphageal varicies that go with it. Fortunately, because I have been good and sensible, my abdomen ultrasound and gastroscopy in June shwoed that I no longer have either of.

The spiro I think is for peripheral oedema, partly to do with the liver and partly because amlodipine etc cause it as well. The omep you are quite right, was to do with the varices, and it is GORD because it is an acronym and the second word is Oesophagus, it begins with an 'O' not an 'E'. Again the lactulose was for HE.

The last three, you are correct, I think my health and diet means that they are surplus to requirements.

Mr.GHB, I'll go with that one, but let me just type a few lines from the psychiatrist's report on me last December.

"Mr.Smith has a gentle natured approach and a good sense of humour. He has high standards and adopts a professional attitude to how he approaches things and applies the same expectation to others."

That about sums me up, always ask nicely first, only then if I feel that I am getting fobbed off/ignored, do I resort to a more direct approach. I walked out on a neuro surgeon once, my only regret is that I didn't turn around to see the look on his face, can't imagine that happens to him much.

 

16

Hi 7878.

Wow a lot to take in. Thank you so much for your help.

I am seeing my surgeon today for another problem concerning  increased, continuous pain after right sided bowel surgery eight years ago.  Then I shall see my GP so will definatly have a chat with him.

Though 69 years old I don't like this getting old lark.

Thanks

Pat

 

17

Oh you pussy-cat, you, RHGB! But why: "Mr.GHB, I'll go with that one..."? Last time I looked, GHB was a date-rape drug.

18

It's called a typo.

However, GHB does have medical uses, one of which is the treatment of alcohol issues, including relapse prevention and also withdrawal and in certain situations may be a better solution than benzos, where unexpected hospitalisation occurs with trauma for withdrawal.

19

OK, Mr. GBH, and yes, I had heard about medical uses of GHB. I was just winding you up, as I'm sure you knew!

I'm with you all the way on anything that reduces benzo use. I volunteer in a mental health centre and we deal on a regular basis with a few individuals who were casually put on diazepam or similar 40-50 years ago, when they were still being handed out like sweets. These are people now in their 60s, taking enough of their medications to kill a horse, but who can't be taken off them because of the withdrawal effects. Well, not strictly true that they can't come off, but none of them has been able to go through with it, and their doctors have decided it's safer at their age to leave them on benzos. Which doesn't stop them going to multiple doctors, of course, and getting even more, or buying them from dealers.

One woman told me the other day that getting off alcohol was a walk in the park compared with her unsuccessful attempts at getting off benzos.

20

I do understand your point, and in general I do agree with you, but doctors follow rules and not common sense.

I needed diazepam last year, because of a bout of stupidity regarding alcohol. I had to use psychology on the GP, who didn't want to prescribe it. In a far more subtle way, I had to say, drink myself to death or help me stop, the choice is yours, but the NHS has already spent a shed load of money on me, and it would seem a waste.

I got two packets, I only needed one, and still have the other packet in my draw to this day. However, when I went in hospital, although every time they wrote on my notes, alert and orientated, with slightly humourous once. They never asked if I was alcohol dependent at the time, which I wasn't, but they still pumped me full of Librium all the same.

Funny, when I didn't ask for it, they gave it to me without asking. When I knew I needed it, I had to shock them into prescribing it. And that is where rule book thinking comes in and common sense goes out of the window.