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Dear Anonymous,

You have good reason to be frustrated but I commend you for being an active patient and asking very good questions. You are in good company. Up to 70% of patients with hypertension (high blood pressure) ARE NOT adequately controlled. The target blood pressures have been defined by the American Heart Association as a systolic (upper number) < 140, preferably <130 and a diastolic (lower number) < 90. On the other hand, given the number of anti-hypertensive drugs available, nearly all patients SHOULD be able to eventually achieve good control. That said, it often requires a lot of trial and error and up to 3-4 drugs. Obviously lifestyle changes are very important as well, including lowering your intake of salt (sodium), exercising and controlling your weight. As difficult as it might be in some patients, getting good control of one’s blood pressure is critical to protect you from the risk of stroke, heart disease and other serious conditions.

There are several categories of drugs to treat hypertension, each acts in a different way and may be more or less effective in a given person. Some drugs are more or less effective by race. Each drug has a range of dosages. The most common types of drugs are:

ACE Inhibitors (ACEI)
ARB’s (similar to ACEI)
Beta Blockers (BB)
Calcium Channel Blockers (CCB)
Diuretics (water pills)
Alpha Blockers

You are on a low dose of an ACEI (Mavik 1mg, typical range 1-4 mg), a low to medium dose of a CCB (Diltiazem 120, typical range 120-240 mg) and a low dose of a double diuretic (Spirozine 12.5/12.5, typical range 25/25 to 50/50). So, overall, you are on a low dose of three types of drugs. There is room to increase each, there are many alternatives within each category and there are other categories, (e.g. BB’s), that you are not on. I recommend that you continue to work with your doctors on increasing doses and trying different combinations of medications until your blood pressure is consistently under 140/90 and preferably under 130/85. It is absolutely critical to get things under control so don’t be satisfied until you are consistently in range.

Some people simply have different reactions to different drugs. You were initially without symptoms despite a blood pressure of 210 so it is reasonable for you to wonder if your not feeling well may partly be related to the specific drugs you are on. If your blood pressure is better but you still feel lousy don’t assume you have to live that way. Ask your doctor to consider further adjustments to your medication.

Finally, there is a condition known as REFRACTORY HYPERTENSION. It is defined as a blood pressure of >140/90 despite the maximum dose of at least 2-3 drugs. As frustrated as you are, you don’t qualify yet because you are still on relatively low doses of the medications. If after further work you find that your blood pressure is still high on high doses of at least 2-3 drugs then you need be evaluated further for a variety of unusual conditions that can cause refractory hypertension. These include renal artery stenosis, several hormonal conditions, sleep apnea, etc. Each has specific testing and treatment regimens.

Hope that helps.

August 3, 2010 - 8:47pm


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