Stroke risks linked to blood pressure drugs (beta blockers)

The Scotsman ^ | Oct. 18, 2005 | JOHN VON RADOWITZ

[FairOpinion]

There days there are much better blood pressure medications available, without such negative impacts.

Some are called ACE inhibitors, and even newer than those, ARB-s.

Read up on them and talk to your doctor.

Here is just one link that discusses the different classes of anti--hypertension drugs.

Blood Pressure Medications/Treatment Options

[FairOpinion]

health & science ping

[Gamecock]

All meds will have a "negative impact."

The fact is that Beta Blockers do have a role to play in the management of hypertensions.

As an example, hypertensive blacks have a 28% decrease in mortality following an acute MI if placed on Beta Blockers.

Blacks and Asians also have a greater amount of angioedema and cough when placed on ACE inhibitors. ALL medications should be prescribed in a thoughtful manner and in full consideration of the big picture.

BTW, many of my patients who have chronic migraines do very well with low dose beta blockers. A nice side effect that occurs with beta blockers is that patients tend to be a bit less crabby, a side effect that is noticed by many spouses. ;-)

[FairOpinion]

Thanks for the info. I am sure there are situations, when some drugs are more appropriate than others, but as I understand doctors tend to typically prescribe beta blockers as a first drug, willy nilly.

I knew several friends who have had terrible side affects, such as not being able to go up a flight of stairs without almost passing out, though they were in excellent physical shape, used to run several miles a day. Needless to say, when the doctor changed their meds, they were fine again.

I think the point is that beta blockers shouldn't be the first blood pressure medication prescribed for everyone.

[neverdem]

I believe this is the referenced article's abstract. Atenolol in hypertension: is it a wise choice? It's too bad they didn't do a subgroup analysis of hemorrhagic versus ischemic stroke. The former is usually more severe. The latter is about 4 - 5 times as common.

[Gracey]

ping

[Gamecock]

You point out some very real concerns. But any drug can have undesirable side effects. That is why any patient should be followed closely whenever starting on long term medications.

Beta Blockers generally are not the first like of drugs for high blood pressure. The gold standard reccomendation is that the majority of patients should start out with thiazide diueretics. BTW, there is a rule of thumb that 1/3 of all patients will only require 1 drug, 1/3 will require 2 drugs, and 1/3 will require 3 drugs.

[Conservativegreatgrandma]

Why is it that drugs are always prescribed by doctors? Isn't it ever possible that there are natural choices that could be tried first?

[syriacus]

Doggone!! I've just started taking Quinapril again this week... taking HCTZ again, too. I had let my prescriptions lag for months.

My mothers's kidneys were damaged, supposedly by high blood pressure, even though she took some other HBP medications for 40 years.

Quinapril supposedly "protects" kidneys (if they are not already damaged) and does not cause the excretion of potassium that, say, the water pills do.

Doctors are very aggressively attempting, nowdays, to lower blood pressure to close to 120. The acceptable limit had been 140.

Can this new goal, of BP of 120, be causing the problem with increased strokes?

Also, I am a little curious about the way in which beta blockers might upset the sodium-potassium balance. I thought that keeping the two minerals in balance was a good idea.

When I first heard I had hypertension (4 years ago), I told my doctor I bought the book on the DASH eating plan* and was going to try to follow it, as well as take my meds. He didn't seem to know what the DASH eating plan was and told me that I didn't need to lose weight. (I think my blood pressure would be helped if I lost about 15 pounds.)

*"The plan that is clinically proven to significantly reduce blood pressure"

[Gamecock]

Such as?

IOW, are you referring to lifestyle modification or herbal products?

[Conservativegreatgrandma]

Such as anything else other than drugs? Diet, exercise, supplements, etc.

[Gamecock]

That depends.

I spend a lot of my time discussing options with patients. I ask them two questions:

Do you know that once you start BP meds, you will be on them the rest of your life?

Can you seriously commit to changing your diet and lifestyle? (I give them two things to change every 2-3 weeks and then follow-up in three weeks with other changes. At some point I transition to a cheerleader.)

I've had some patients become normotensive after 3-4 months using that approach.


That being said, if my patients are honest and tell me that they enjoy eating super sized burger meals and won't change I will start them on meds.

As far as supplements go, I will try them on some conditions, but remember that supplements have side-effects as well. I try to keep up with the latest studies, but the fact remains that most supplements do not stand up to serious clinical studies. The overwhelming majority of results you see touted at your local GNC or health food store are based more on anecdotal evidence than clinical trials.

[Ditter]

I have been on Diovan for my blood pressure for about 6 weeks. I noticed that I was feeling very tired in the middle of the day for no apparent reason. I had been taking Diovan first thing in the morning. Two days ago I started taking it at night and I feel better already. My doc never told me when to take it, should I call and discuss this with him or is taking it at night OK?

(I know you must just love getting medical questions from your freeper friends, forgive me)

[Gamecock]

I don't see any problem taking it at night. Two common side effects are dizziness and fatigue. I would mention it at your next visit.

(I know you must just love getting medical questions from your freeper friends, forgive me)

Next time you see a kid with a roadside lemonade stand, stop and buy some. Consider that my bill. ;-)

[Gamecock]

Soooo, when you're not sure, "don't ask a doctor," listen to your body.

Bad idea. People with high blood pressure may show no symptoms for years. Your first clue that you are sick might be that you are dead.

If you have a trust issue with a doctor, find another doctor.

[norraad]

...find another Dr.

I would like to find one who is not "practicing" &/or a whore for B I G D R U G !

[Ditter]

OK I love lemonade! %;9) Thanks!

[Gamecock]

I would like to find one who is not "practicing" &/or a whore for B I G D R U G !

Fine. When you come down with a life threatening disease, stay home.

You'll have your principles. That will look good on your headstone.