Blood Pressure Pills Worth The Effort

Published by Contra Costa Times

Posted on Tue, Jul. 04, 2006

By Stephen Daniels, MD

"WHY SO MANY pills, doc? Can I just stop all of them?" It's a common complaint from many patients with hypertension (high blood pressure), tired of taking many pills each day.

My reply: "Sure, but would you rather take your pills, or spend the rest of your life short of breath after a heart attack, or limping or unable to talk from a stroke? That is, if you don't die."

Given these risks, most people choose the pills.

High blood pressure usually causes no symptoms until it's too late. Despite what you may have heard, "hypertension" rarely causes tension, fatigue or headaches.

And unfortunately, the pills taken for treatment can cause you to feel worse than the disease. That is, until you have a heart attack or stroke.

Usually the first pill taken for blood pressure is a thiazide diuretic, also called a "water pill." It makes some people urinate (make water) more frequently than usual.

These include hydrochlorothiazide (HCTZ), Maxzide, chlorthalidone, Esidrix and others.

Diuretics cause the kidneys to excrete salt in the urine, which draws extra water with it, causing increased urination. So, people with high blood pressure can often obtain similar blood pressure lowering by eating less salt. This is difficult, though, because our processed and prepared foods already have lots of salt in them, and low-salt or unsalted food tastes bland.

A common side effect is low potassium, so some patients need potassium supplements. Many fruits contain potassium, but sometimes not enough to make up for the losses from diuretics.

Some diuretics, such as Maxzide, contain additional medicines to help preserve potassium in the body.

Thiazide diuretics are the only blood pressure medicines that have been shown to prevent the dangerous complications of hypertension. And they are generally inexpensive with few side effects. So, if you have high blood pressure and aren't on a diuretic, ask your doctor why.

A second class of pills often used for high blood pressure are the beta blockers, such as atenolol and metoprolol.

These lower blood pressure by lowering how fast and forcefully the heart beats. If too much, they may cause dizziness, decreased alertness, fatigue or fainting. In general, these are effective with few side effects.

A third class of blood pressure pills is called the ace inhibitors, such as Lotensin, lisinopril, Capoten, and enalapril. These may work by relaxing blood vessels, but it's not known for sure. These medicines have remarkably few side effects for most people.

A fourth common class of blood pressure pills is the calcium channel blockers, such as Adalat, nifedipine, Calan, Dilacor or diltiazem. These are a diverse class of medicines that dilate blood vessels. Side effects include headache; fast or slow heart rate; constipation; and ankle swelling, depending on which one you are taking. Cost and side effects can limit the use of these medicines.

These are the most common, but not the only medicines for blood pressure. In general, blood pressure treatment starts with a diuretic, then an ace inhibitor and/or beta blocker, then a calcium channel blocker. Controlling blood pressure may require many pills a day.

Remember, these medicines do not cure high blood pressure, they only control it. And you may have to take them for the rest of your life.

Daniels practices family medicine at the Pittsburg Health Center.