Two many blood pressure pills required to control it.

[kate38]

I was diagnosed with essential hypertension in May 2003. During the time between then and now the doctors have been adding different types of medicine to control the pressure. I am on seven different medicines to control my blood pressure. They are: calcium channel blocker, an ARB, vaso dilater, beta blocker, two different diuretics, and an alph blocker.

I have had an abnormal finding on a stress test. I also have asthma which caused great difficulty with the beta blocker. It resulted in severe problems with my breathing. I have to take Prednisone to help with the inflammation of the lungs. The doctors have been unable to arrive at a combination that works to control the blood pressure but does not affect my breathing. I also have a high  cholesterol. My LDL 197, total cholesterol 308, Hdl 55, and  triglycerides 298.

They recently took me off the beta blocker but my blood pressure has elevated back to the 190/100 range again. This medication causes the asthma to be more severe when I have an attack.

What other medications are available that have a similar effect comparable to the beta blocker that will not have the problems with my asthma? Can taking me off the beta blockers abruptly cause my blood pressure to elevate? Can blood pressures in excess of 190/100 readings cause nosebleeds, headaches, chest pains and arm pains? My father had a blockage of a vein in his neck in his 30's or 40's. Should I be concerned?

The doctor says that I wuill be on all of these mdicines for the rest of my life. Is there any alternatives to taking this massive dose of pills?

[CCF-M.D.-RCJ]

Kate38,

Thanks for the post.

You need to have a workup for "secondary hypertension".  Your story of rather sudden onset of very difficult to control hypertension suggests that some other condition may be leading to the high blood pressure.  Examples of things that might do this include renal artery stenosis, hyperthyroidism, Cushing's disease, steroid use, weight gain, alcohol use, over-the-counter stimulant use, plus many others.

Hypertension specialists are available in every major center, and are usually internists, endocrinologists, or nephrologists.

High blood pressure can lead to the symptoms you've described ("nosebleeds, headaches, chest pains and arm pains"), but so can other conditions.  Make sure your doctor knows about these symptoms.

If your father had a blockage of an artery (not vein) in his thirties, then it might mean that you are predisposed to early vascular disease, and thus should be extra vigilant about looking for this in you.  As an example, renal artery stenosis is a manifestation of vascular disease.

Hope that helps.

[tessa0825]

From my persoanl experience over the last 31 yrs with High Blood Pressure I can answer one of your questions...Yes, HBP that is not controlled can cause nosebleeds, headaches, and chest pains.....Im on toprol, demedex, and hyzaar, and have been on BP meds of some sort for many many yrs...When they get the right combination then I stay under good control....In the past there have been several Drs. come along who would think since my readings were good on Meds that maybe they would also be good off of meds....They would try to discontinue my meds and the results were always the same...Weight gain from retaining to much fluids, SOB, headaches and nosebleeds that would send me to ER and require 36 hrs of packing to get under control...My BP would always, within several days off meds, be around 188/118.....After being evaluated at a top notch heart center I gained much more understanding of my medical conditions and would not allow any Dr to stop all my meds again....Sorry I couldnt be of more help.....Tessa

[kate38]

Tessa,

Thanks, that helped, My blood pressure was pretty resistant in the begining, however I thought I had the right combination. When I was put on labetalol and two other drugs, blood pressure readings were low, but had some severe asthma problems. Had to be taken off the labetalol, was switched to metoprolol. I then saw a cardiologist, started having problems with the metoprolol. It was decided that the dosage of metoprolol needed to be dropped, with the intent of going off from it. It did'nt happen, had a problem with going off and had to restart, By then two other medication had been added. I presumed he was waiting for the new ones to take effect before maybe pulling me off some of the others. I was hoping maybe the minoxidil would be one due to the bad side effects. That wasn't the case. I've been told I will have to take them all.
                                                
I fully understood what was going to happen when I was started on the medication, most of my family has high blood pressure,as well as history of diabtes. I guess I didn't realize I would be taking so many,  I feel like I should own part of our local pharmacy or maybe I should ask for a kickback from the drug manufacturer. lol

My blood pressure has actually been elevated since about 98
150's/90's, I thought I could bring it down on my own,as you can see that didn't work. I started having headaches, nosebleeds, chest pains, rapid heartbeat, sometimes waking me up in the middle of the night. I changed my mind.
I had one reading in 200's/130's had a severe headache, nosebleed, dizzeness, was then but on minoxidil, I should look like a gorrilla in a few months,but thats ok, my husband says he will love me no matter how hairy I get, as long as I don't shed in the house. Sorry, only way to stay sane.


The feeling all I'm getting now is, I've done all I can, your on practically every class of drug now, were done. I have tried to provide as much information as possible, in hopes of helping to make a descision on how to adjust the medication. I take in blood pressure readings, making sure he has an updated medication list, I've told him about the nosebleeds, the headaches, chest pains, pulse rate, I take all my medication in case there is a question about one of them. I'm taking all the medication but, concerned, not sure I really need to be taking them all. I've heard he is very good at what he does, his bedside manners leave a lot to be desired.
  
I know the case has been kind of complicated, but I can't be stuck on all these medication for life, I know I could just pick two and stop taking them but which two should I pick, would they be the right two, or would they be the ones actually keeping the blood pressure down.

I just want to work on getting the right combination of medication. I understand there may be some side effects I would just have to live with. I was hoping it could all be done with a little less medication. Yes, I would like some cheese with my wineeeee!!!!!

Any ideas on what I might be doing wrong or how to approach him with my concerns so that he will listen. Any help would be greatly appreciated.

Thank You !!!!
:) :)  

[kate38]

Have had a work up for secondary causes and none were found. Hypothyroid since 1992. I was given radioactive Iodine three times. I think my thyroid is pretty well toasted. I am on thyroid medication and thyroid levels are all fine. Don't drink, smoke, do any kind of illegal drugs, I'm taking enough drugs behind the counter (prescribed). So I don't take anything over the counter unless absolutely neccessary.
Only on steroids because of problems while on the beta blockers. Hypertension diagnosed before most of asthma medication started.

Any other Ideas would be greatly appreciated.


Thank You

[tessa0825]

I wish I had some really good advise for you but unfortunately I dont have....If I were in your condition I would ask to be referred to one of the top training hosp. like CCF, for an evaluation...That's where I had mine....Dr.Rimmerman was very through and explained things to me in great detail....I, of course, don't know where you are or how far you are from a good training hosp but I would ask my Dr. to send me to one of them that is easy, or reasonable, access for you to get to...Best of luck...Tessa

[kate38]

Tessa,

Actually, I wish i did live near CCF, I've heard a lot of great things about the facility. Unfortunately I live on the West Coast.  


Although, you're probably right about going to a training Hospital. I do recall having really good luck with the Enodcrinologist who treated me for Grave's disease, He was at a University Hospital.


You have been a great big help.

Thank you!!!
:):)