Isolated systolic hypertension: Should I take Amlodipine?

Heart health and blood vessels
1

Hi all I am a male in my seventies and for the last 8 years I have had isolated systolic hypertension (ISH). During this time, I haven't been on any medication for the problem and the BP readings have been fairly similar for most of this time, averaging 170 / 70. However, at a recent visit to my doctor, he took several BP readings which fluctuated quite widely, between 148 and 220 systolic and a low diastolic between 60 and 70. I have seen in some articles that, with ISH, older adults do worse when the diastolic reading falls below 70mm because 70mm is already low enough.

So the question is, should I take medication for my ISH or not as the latest reading using my own BP machine was 180/66 with a pulse of 58? In other words, because I already have a low diastolic reading, would it be dangerous to go on to medication to reduce my high systolic reading? And if you do recommend that I need to go on to medication, is Amlodipine a suitable choice? Overall, I am in very good health, and walk about 4 kilometres a day, and I don't feel any ill effects when walking up hills. Thanks very much for your help with this. Regards Martin

 

2

I think the smallest pill is 2.5mg. Maybe try half of that. Ask your doctor. Also these medicines stay in an elderly body longer and can be very powerful

3

Hi Martin,

I'm really glad to hear from you! I posted a question about ISH in a new thread on this forum several months ago but have not as yet had a single reply. Was beginning to think I'm the only person in the world who has it!

I'm of similar age (72), had a steady BP of around 110/70 until my mid-50s, when it went up to 150/90. My GP prescribed a CCB, but I didn't take it, put myself on Mg instead (google it - I don't think we're allowed to mention it on these boards any more!) which brought my BP down to 120/80. It stayed there for 15 years but as soon I hit 70, the systolic started creeping up and the diastolic down. My "record" so far - in my doctor's office a year or so ago - is 160/50. My average is less worrying than yours, at around 140/60, and my pulse similar or slightly lower. Like you, I walk around 5km four or five times a week and do a 30-min aerobics programme at home several times a week. I also eat a healthy diet - very little salt, practically no sugar, low-ish carbs, plenty of oily fish and green veg, no junk food or ready meals. My weight is OK - BMI around 24 - but I'm also working on that a little.

As a former nurse, I'm very reluctant to start on any conventional meds for this. Fortunately, my doctor agrees, especially as my diastolic is so low. (It occasionally falls as low as 40 after exercise.) He feels - and I agree - that any medication would lower both values and that's the last thing I need as I'm already subject to occasional dizzy spells.

Around a year ago I put myself on a daily dose of ubiquinol - more bioavailable version of co-enzyme Q10 - and this seemed to be showing results at both ends of the scale, as well as reducing the extrasystole problem I'd had all my adult life. However, four months in I was struck down by catastrophic diarrhoea. I didn't even connect it with the ubiquinol for a few weeks, due to the delayed effect. I stopped it once I made the connection, and started again at a minute dose - a 100mg capsule once a week - after everything had calmed down. So far I've got as far as three 100mg capsules once a week without ill-effect, but I'm going very slowly indeed, given the delayed side-effects - increasing by one capsule per week every two months. Seems to me there's a very slight improvement again (and no diarrhoea so far) but I think I may have muddied the waters by starting to eat a very small amount of 99% cocoa-solids chocolate every day for the last two months. This is reckoned to lower BP slightly as well. But have you ever tasted 99% cocoa chocolate? Yuk...! At least there's no temptation to exaggerate though!

To answer your question, I've no idea whether you should be taking meds or not. However, if you do decide to start, I'd echo g.90572's advice to keep the dose as low as you possibly can, regardless of what your doctor says. I'd be interested to hear updates on your progress, and will post my own updates as I (hopefully) increase the ubiquinol dose over the coming months.

4

CORRECTION (no edit on this site): line 8 of para 4 should read "So far I've got as far as three 100mg capsules PER WEEK", not "once per week". Given the history of diarrhoea, I dread to think what would happen if I took three 100mg capsules at the same time!eek

5

Thanks very much Lily for your reply, it's very helpful to know that you need to consider carefully what effect conventional medication may have on both systolic and diastolic readings when you have isolated systolic hypertension (ISH). It's interesting that you are taking ubiquinol to help with ISH and I hope this continues to work well for you. I am a little concerned that once I start taking amlodipine, even in small doses, it may be hard to come off it.

Best wishes

Martin

 

6

Thanks a lot for your reply, I agree that keeping the initial dose down as low as possible is the best approach. Even with a very low dose of amlodipine I am still concerned that my diastolic BP may fall too low. In the "old" days it seems that doctors weren't so worried about a high systolic reading and regarded the diastolic reading as the main consideration. Perhaps it's my low diastolic reading that has kept me going over the last 8 years even though my systolic has been way too high!

Regards

Martin

7

The difference between systolic and diastolic pressure is called pulse pressure. You might want to look that up. Normal is 40.

8

In looking up widened pulse pressure vitamin d and magnesium and healthy eating were suggested as helpful. Sometimes diuretics or blood pressure medicine are needed

9

Thanks very much for this advice, one article on internet says that "there is also an enhanced risk for cardiovascular events associated with increases in pulse pressure".

So perhaps this tends to reinforce the view that isolated systolic hypertension should be treated, even if there are some dangers in reducing diastolic pressure, such as dizziness etc. I need to reduce my systolic pressure from around 180 to 140, so I hope the medication can eventually do this without reducing the diastolic pressure too much! It's a weird situation really because my diastolic pressure (at around 60-70) is already low enough.

Regards

Martin 

10

What did your last blood work say about your sodium level?  Calcium and magnesium together are good for nerves and blood pressure.  I would speak to the doctor about this.

11

Thanks a lot Pam for mentioning this, I am due for an updated blood test and will arrange this shortly. I have been on a very low sodium regime for many years and I have a healthy diet with no alcohol or very fatty foods.

Regards

Martin

12

Thanks for that advice, I agree that healthy eating (and exercise) are also very important factors. I think that Vitamin D supplements are a very good idea, particularly in the Winter months and I will check my levels in the next blood test. Yes, magnesium is also important and I will keep that in mind. I am not looking forward to trying out Amlodipine as the list of possible side effects looks pretty formidable, even though I guess most people can tolerate this drug pretty well? Regards, Martin

13

Good luck with that one, Martin! Like you, I've only recently found out about the importance of pulse pressure. However, I've been doing a lot of reading on this, most of which indicates that all BP meds reduce both values equally, therefore leaving pulse pressure unchanged! I can find virtually nothing about medications or supplements which will actually reduce pulse pressure. The only reference I've found so far to anything that will bring down systolic without too badly affecting the diastolic was to ubiquinol - which had indeed started having a noticeable effect before the side-effects kicked in. I'm currently trying to build the dose up again slowly to see if I can establish a therapeutic level that doesn't cause diarrhoea.

However, on the side of taking medication, I found a couple of articles opining that a lower systolic, even with the same pulse pressure, favoured heart attack rather than stroke. I must confess that if I had to have one of the two I'd rather the latter!

You might want to try taking Mg alongside a low dose of medication. (I think I'm the only one who gets posts deleted if I say it on here, because I've mentioned it too often and am deemed to be "campaigning"!) This too causes diarrhoea in some people - albeit not the catastrophic kind - but if you can tolerate it, it can bring both values down. It certainly did that for me, and the effect lasted 15 years. Provided it's taken in the correct dose, diarrhoea is the only possible side-effect of Mg. It's perfectly safe to take alongside conventional medication, and over time may mean you can take a lower dose of meds. However, unlike medication, which normally acts immediately, Mg takes at least six weeks to kick in.

I hope you find something that "closes the gap" for you. If you do, don't forget to let me know!cheesygrin

14

Thanks very much Lily for your informative reply. I can see that your nursing background has been very helpful to you in analysing this difficult problem! You mention that "all BP meds reduce both values equally, therefore leaving pulse pressure unchanged". This is a very important observation because I have to reduce my systolic pressure from 180 to 140, so if I achieved this, I wonder what would happen to my diastolic pressure which averages in the 60 - 70 range? This has been my main concern and the reason why I haven't taken any medication for the problem so far. My pulse pressure at present is 110 (180-70) so if the systolic pressure was reduced to 140 and the pulse pressure remained at 110, then my diastolic pressure would be only 30..ouch!

I would prefer to take your "alternative" approach, but everything I have tried over the last 8 years hasn't made much difference, but at least my BP hasn't increased much over this time either!

Best wishes

Martin

15

Martin, no need to worry about coming off Amlodipine at the very low dose - I had to stop it after some months due to very swollen and inflamed ankles resulting in a diagnosis of varicose eczema.  No bad side effects from cessation at all.....just good ones!

16

Thanks very much Mrs O for this reassurance. I have read that swollen and inflamed ankles is a common side effect of Amlodipine and I don't look forward to this happening to me! But I guess you just have to accept some side effects if these cause you less problems than the primary condition of very high blood pressure.

Apart from this side effect, do you mind my asking whether the Amlodipine reduced your BP as desired and what alternative medication (if any) you are on now for the problem? Did your BP go up after you came off Amlodipine?

Thanks for your help..regards Martin

17

I have done a search on "widened pulse pressure" and this has been very worthwhile, thanks. If blood pressure medication, such as Amlodipine, can be successful in reducing pulse pressure, then I guess that it must be able to reduce systolic pressure by a greater amount than diastolic pressure? For example, if my BP is currently 180/70, then an acceptable result for me after taking Amlodipine would be 140/60, which would reduce pulse pressure from 110 to 80. Do you think that such an outcome may be possible? Regards, Martin

18

Oops - the gremlins got in again! I just cast an eye over this post and realised I said the opposite of what I meant. In the second para, I meant to say that if I had to choose between stroke and heart attack I'd rather have a heart attack - i.e. I'd go for lowering systolic if it's really high even if that means not not reducing pulse pressure.

I take my BP at odd times throughout the day - usually an average of three consecutive readings - and have found two things that consistently reduce pulse pressure, though not for long in either case. One is walking. Whenever I take my BP immediately after coming in after walking fairly briskly for at least an hour, I tend to get average readings of around 115/65 - i.e. a pulse pressure of around 50 which, though still too high, is low for me. This effect lasts about half an hour before my BP returns to its usual value of 140-145/60.

The other one, which I've only recently discovered, is chocolate! I've taken to eating a small quantity of 99% cocoa chocolate every day, and find to my amazement that this consistently reduces the systolic slightly without touching the diastolic. The effect is less marked than for exercise, but my BP usually goes down to around 130-135/60, which is still a small improvement. Unlike the exercise effect, the effect of chocolate lasts a couple of hours.

A short burst of aerobic exercise, on the other hand, raises PP considerably, producing readings in the region of 150/50, but I believe this is a normal phenomenon. It only lasts about half an hour in any case.

I suspect that anything that reduces pulse pressure, even for short periods at a time, is helpful in taking the strain off the arteries for a while.

19

Martin, it is by no means a given that you, too, will experience swollen ankles.  My hubby takes Amlodipine 5mg as does a friend and they don't experience the same problem.  In my hubby's case, the swollen ankle problem did occur when they increased the dose to 10mg so the dose was reduced back down to 5mg and another low dose drug added in.

I must be the doctor's worst nightmare as far as treating my blood pressure is concerned as not only am I highly sensitive to even the smallest dose of the drugs, but I also have chronic kidney disease (only have one kidney) so some of the BP drugs have proved a no-no from this angle as well.

My BP did reduce whilst on Amlodipine and when taken off it I was given a break from medication for about a month until the swelling resolved.  Since then I have been prescribed various drugs, and the only one to date not to cause side effects has been Losartan Potassium 50mg.  My pharmacist has said that this is the pill he hears the least complaints about by his patients.  However, on its own it doesn't reduce by BP so other pills are being tried.  One, Indapamide caused raised creatinine, reduced sodium and reduced eGFR and a feeling of weakness following just a short walk.  Doxazosin is the latest pill to be added to the Losartan but I fear that may fall by the wayside as well as my ankles and feet don't look as though they belong to me.  I am under a renal consultant who is prescribing all these different pills but as my next appointment isn't until September I am seeing a locum GP tomorrow - already feeling sorry for him!

So Martin, don't go by me and my experience - I am the doctor's worst nightmare!  I'm sure a tiny dose of medication will help you - perhaps ask about Losartan Potassium - the 50mg pill I take has a score line so you could try just 25mg initially and see if it has the desired affect of reducing your systolic pressure without affecting your diastolic too much.  Good luck. 

20

I'm not sure why there's so much procrastination regarding whether to take any meds for the high systolic BP.

We know that a high systolic BP increases the risk of heart attack and stroke. End of. The health risks associated with a diastolic BP that's too low (which yours isn't-it's normal) are far less than those associated with a systolic BP over 140, let alone over 150. A recent study of people over 60 found that (after adjusting for things like race and other risk factors)  people with a systolic of between 140 and 150 had up to a 60% increased risk of stroke compared to those with a Systolic of below 140.

A high systolic BP over time can damge or tear the intima (innermost lining) of arteries, which can activate the blood clotting cascade to attempt to repair the tears and can also lead to "turbulent" blood flow which increase the risk of blood clot formation. You have to remember that some strokes (and vascular dementia) which affect the deep brain tissue are caused by the blockage of very small branches of the main arteries in the brain.

Has your PCP calculated your 10 year risk of an event based on your systolic BP and any other risk factors for you, and then recalculated it with a systolic BP of below 140?

Why not try some meds and see what happens to your diastolic BP, and whether, if it falls,you experience any symptoms?

Risk is a hard thing for people to get their heads around, as it's non-tangible and it's about the possibility of something happpening in the future,