High Blood Pressure

Video transcripts reprinted with permission from Dr. Allison Jorgensen, RP

"Hi, welcome to Health Wise. I'm Ally Jorgensen.

Today we are going to be talking about treating high blood pressure; specifically treating blood pressure with prescription drugs and a few other mechanisms to keep your blood pressure lower and safer.

When we talk about treating high blood pressure, there are a couple of words we just have to know so that we are sure we are all communicating. The first one, hypertension, is another name for high blood pressure. Sometime, when pharmacists write notes or doctors write prescriptions, we use the letters HTN to mean hypertension. We are not really talking in code, it is just shorthand that makes it faster for us to write things.

The other two words that you need to know about your blood pressure are systolic and diastolic. Systolic is the pressure in your blood vessels when your heart is pumping. So, it is always the bigger number. Diastolic is the pressure in your blood vessels when your heart is not pumping, or that is the blood is running into your heart. It is always the smaller number. If, for instance, your blood pressure is 120 over 80; the 120 number is systolic, the 80 number is diastolic. And we treat both to keep them low. High blood pressure can cause problems if we do not. High blood pressure can damage your eyes, high blood pressure can damage your heart, and it can damage your kidneys. Our job is to keep your blood pressure to save your eyes and your heart and your kidneys. And, lower blood pressure helps prevent stroke and other diseases that we would rather you not get.

When we treat blood pressure, very often we end up using prescription drugs. And there are a number of classes of drugs that each work a little bit differently to treat your blood pressure. So, sometimes, treating your blood pressure means we use more than one drug.

The first class of drugs that we use to treat high blood pressure are called diuretics. And they do sort of what they sound like they do. They get rid of extra body water. Sometimes that water is in your blood stream and your heart has to work too hard; so that increases your blood pressure. Sometimes that water is not in your blood stream and that is what makes your fingers swell up and your ankles swell up; we call that edema.

The diuretics come in lots of different forms. The most powerful ones we call loop diuretics and we will talk about those in a minute. The most commonly used diuretics, at least in Nebraska and the United States right now, are called thiacids. The generic names are very hard to pronounce, and I understand if you cannot do it. But you need to know the name of the drug you are taking. The thiacid diuretics help you get rid of a little extra body water, and generally we ask that you take those in the morning simply so that the result of the drug does not make you get out of bed in the middle of the night.

The loop diuretics are the most powerful. Because of that, we do not start with them very often unless you have very high blood pressure or lots of edema, especially with swollen ankles. The loop diuretics get rid of more water. When they do that, sometimes they cause us problems. Those problems are as they are getting rid of extra body water, they also get rid of a very important chemical in your blood called potassium. Potassium is important because it helps your muscles contract and it helps your heart beat. Often, if you are taking one of the loop diuretics, especially the drug Lasix, we are going to ask you to either eat a banana a day to get potassium, eat a tomato a day to get potassium, or we may even give you another prescription so that we can put back the potassium that the first drug took away. Those are all very important to keep your heart beating normally. And, sometimes, because the thiacids do not hurt your potassium much, we combine the drugs, so we give you a drug that takes away a lot of potassium, but we give it in a smaller dose, because we have given you a drug that saves potassium.

Those combination products also should be taken in the morning like all of the diuretics, so they do not interrupt your sleep patterns. It is important that you remember when you take diuretics in the beginning, the first two or three weeks when you take them, you are going to know they are there. You will go to the bathroom much more often that you ever did before. After we have gotten rid of a lot of the extra body water, that will stop. That does not mean the drug stopped working, it just means that all of the extra water you needed to get rid of is gone.

Then, the diuretics do something very special in the lining of your blood vessels. We are not sure how yet, and I am sure science will figure it out someday, but just having that diuretic touching the lining of your blood vessels also keeps your blood pressure down. So, it is important, even when you stop going to the bathroom so much, you keep taking these drugs because they are still working. If you stop taking them, all of that extra body water will come back. Your ankles will swell up again, your fingers will swell up again, and your blood pressure will go up again. So, we do not want you to stop taking them even though you do not sense that they are working like you used to.

Another group of drugs that we use to treat high blood pressure are called beta blockers. I know that sounds like a silly name, but there are beta receptors on your blood vessels and in your heart and when you push on a beta receptor, just like a light switch and you turn it on, your blood pressure goes up and your heart beats faster. So, if I block that, I won't let your finger touch that light switch, then your blood pressure goes down and your heart rate goes down.

In fact, it is the heart rate going down that is one of our big problems with the beta blockers. Sometimes, your heart beats too slowly. When you start taking a beta blocker, your doctor or your nurse or your pharmacist will tell you, 'you should take your pulse every morning. And if it ever gets below 60 beats per minute, one beat per second, you should give us a call so that we can be sure that the drug isn't working too well.'

Beta blockers do not do many other things that you can feel. You won't feel your blood pressure going down. You may not even feel your heart rate slowing down. So, it is important to remember when you are taking beta blockers, you have to go get your blood pressure checked. When they put the cuff around your arm and listen to the beats with a stethoscope, that is the only way we will know what your blood pressure is. You cannot feel it any other way.

And sometimes, very rarely, beta blockers make you feel sad. They make you feel so sad, sometimes that we call that depression. If you have a problem with your mood while you are taking a beta blocker, please be sure to talk to your doctor or pharmacist. It is important that we catch that early, so that we can make you feel better and take care of your blood pressure.

The next group of drugs gets broken in half. They are called ASIN inhibitors when we are using shorthand. When we are using longhand, we call them angiotensin inconverting inhibitors. What they simply do is that they stop a process in your body that actually raises your blood pressure. Just like you need to sleep and you need to be awake, sometimes you need high blood pressure if you are running very hard or you are very scared, and sometimes you need your blood pressure to go down.

Unfortunately in some of us, the system that makes it go up makes it go up even when we are not running away and even when we are not scared. So, we use the ASIN (angiotensin inconverting) inhibitors to shut that off so that your blood pressure doesn't stay too high. The chemical that actually raises your blood pressure (pumps/put) through your blood, but it only gets turned on in your lungs. So, one of the problems we have with the ASIN (angiotensin inconverting) inhibitors are that they can make you cough.

Somehow, when we block that chemical in your lungs, your lungs do not like that and you end up with a cough. It is not a productive cough and it does not sound like you have a cold, it is a dry hacky, icky sounding cough. If that happens to you while you are taking any of these drugs, and it is easy to remember these drugs, they all end in OPRYL....if you are taking any of these and you get a dry, hacky cough, it is important that you talk to your pharmacist or your doctor and do not go out and buy an over-the-counter cough medicine, because it is not going to help, it is not that kind of cough. Some of those over-the-counter cough medicines actually make your blood pressure go up. So, we have done a little bit of harm.

The second group of ACIN (angiotensin inconverting) inhibitors end in the word SARTAN. They are not supposed to cause a cough as often, but sometimes they do. So, it is important when you are taking the ACIN (angiotensin inconverting) inhibitors to watch for a cough and to pay attention and get your blood pressure checked. Because, just like with the beta blockers, you cannot feel your blood pressure going down, you just know that it is.

The last group of drugs that we use to treat high blood pressure are called calcium channel blockers. It seems like every time we treat blood pressure, we block something. Actually that is true. We block the systems that make your blood pressure go up so that it has to stay down. Calcium channels exist pretty much in your heart and in any other muscle that gets tight. When I block those calcium channels, your blood pressure stays down because your blood vessels cannot get too tight and your heart rate changes because calcium channels also help decide how your heart beats.

The calcium channel blockers are used for lots of diseases. We use them for hearts that just do not beat right. We occasionally use them for congestive heart failure and we use them for high blood pressure. The ACIN (angiotensin inconverting) inhibitors that we talked about earlier, we use both for blood pressure and congestive heart failure and sometimes, we use them to protect your kidneys if you have diabetes. The beta blockers, the ones that slow down your heart rate, get used for so many things, it is hard to list them. We have actresses who take them for stage fright. We have people who take them because they get migraine headaches. And we use them for blood pressure and unusual heart beats and congestive heart failure. And so many things that just because you are taking one of the drugs we have talked about today, does not mean your blood pressure is too high.

If you are using it for high blood pressure, it is important to remember with all of these drugs, know when to take them. Most of them you take first thing in the morning and most of them you only take once a day. If you have to take the drug more often than once a day, you need to know what times of day to do that. The calcium channel blockers do not like grapefruit juice. And you have to be careful when taking those not to take them with grapefruit juice. You can drink almost anything else, and your doctor or pharmacist can help you with that, but it is important to ask lots of questions when we are treating your blood pressure: 'How often do they want to have it checked? Can you check your blood pressure at home?' or 'Should you go to the pharmacy or the doctor's office to have that done?'

What happens if you are taking a beta blocker and your heart beats too slowly? Or if you are taking a ACIN (angiotensin inconverting) inhibitor and you start to cough. What should you do? You need to know the answers to that. The answers to both are, do not stop taking the drug and do call the doctor and pharmacist as soon as you can. You need to know how to ask those questions.

You need to remember that systolic is the big number and diastolic is the little number and you need to know what your blood pressure is. It is also important that you know drugs alone are not the best way to treat hypertension. If you can walk or do other exercise, you should do that. One of the easiest ways to lower your blood pressure is to lower your body weight. When the doctor says to you 'if you lose ten pounds, you may be able to stop taking this drug,' she means it! It is actually possible to lower your blood pressure as you lower your body weight. Please do that safely. Do that with good diet choices. That is, eat the broccoli instead of the potato chips every once in a while. That is, go out and walk around the block or walk a couple extra stalls worth of space in the parking lot. Those are smart ways to lose weight.

Some of the drugs that people tell you will help you lose weight, raise your blood pressure so badly that you cannot use them if you already have high blood pressure. People with high blood pressure should not use any over-the-counter weight loss product without talking to their doctor or pharmacist first.

People with high blood pressure should not treat coughs and colds over the counter without talking to their doctor or pharmacist first. Both over-the-counter weight loss drugs and over-the- counter cough and cold drugs sometimes make your blood pressure dangerously high if you already have high blood pressure. It is important to know which class of drugs you are taking to treat your blood pressure. Some of you are taking more than one class of drugs because one drug alone would not control your blood pressure.

It is important that you remember what the side effects are. If you cannot remember, or you think you have a side effect you have not talked about, please call your pharmacist or your doctor for more information. You'll be glad you did.

For Health Wise, I am Dr. Ally Jorgensen. Thank you for listening."