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Medical Forum / General / Cardiology / November 2007Hydrocholothiazide, and other alternatives
I've been taking 12.5 mg of HCTZ for some time now for high blood pressure, and my doc suggested, as one option, increasing it to 25 mg. I've had no detectable side effects from the 12.5 mg. Is 25 mg the kind of dose you can usually get away with without problems? Even long term? I'm also on a CCB at pretty much full dose. I've tried ACE inhibitors and angiotensin blockers, but neither has much effect at all on my blood pressure. I'm not willing to take a beta blocker. So the only other alternative to the increased HCTZ is adding a centrally-acting med like Clonidine. Anybody have experience with that? My inclination is to try the increased HCTZ, not the Clonidine. Does that make sense? I'm asking primarily with respect to side effects, particularly sexual and exercise side effects even over the long term. If it matters, it's primarily a systolic problem - typical reading at the doctor's office of 150/80, but more like 135/74 at home. And I'm already quite fit, exercise a lot, am not overweight, and eat a good diet, albeit more than 2 lbs a day. I'm 5'10", 170, 33" waist. Would like to hear from men having experience with either 25 mg of HCTZ, or any amount of Clonidine. > I've been taking 12.5 mg of HCTZ for some time now for high blood > pressure, and my doc suggested, as one option, increasing it to 25 [quoted text clipped - 24 lines] > Would like to hear from men having experience with either 25 mg of > HCTZ, or any amount of Clonidine. Why are you treating white coat ht? And you might try taking some potassium chloride in the form of lite salt a few times per day, or getting some time released pill form of it, taken with magnesium. I had labile ht for decades, and on that combination, except in the doc's office, I'm almost always at about 111/66 or so. Susan > I've been taking 12.5 mg of HCTZ for some time now for high blood > pressure, and my doc suggested, as one option, increasing it to 25 [quoted text clipped - 3 lines] > kind of dose you can usually get away with without problems? Even > long term? Yes. > I'm also on a CCB at pretty much full dose. I've tried ACE > inhibitors and angiotensin blockers, but neither has much effect at > all on my blood pressure. I'm not willing to take a beta blocker. For some folks, ACE inhibitors and angiotensin receptor blockers (ARBs) do not have much of effect on lowering blood pressure until a diuretic like HCTZ is either present or increased. For this reason, would suggest you consider asking your doctor to try an ACE inhibitor again in the setting of HCTZ if not done previously or add if/when the increase HCTZ does not achieve the desired BP lowering goals. > So the only other alternative to the increased HCTZ is adding a > centrally-acting med like Clonidine. Anybody have experience with [quoted text clipped - 4 lines] > particularly sexual and exercise side effects even over the long > term. Clonidine is likely to affect you more adversely than increasing the HCTZ +/- adding an ACE inhibitor. > If it matters, it's primarily a systolic problem - typical reading > at the doctor's office of 150/80, but more like 135/74 at home. The systolic is a problem. > And > I'm already quite fit, exercise a lot, am not overweight, and eat a > good diet, albeit more than 2 lbs a day. I'm 5'10", 170, 33" waist. Lowering to 2 lbs per day would definitely help you control your blood pressure and as you lose your harmful VAT, help you come off your medications. > Would like to hear from men having experience with either 25 mg of > HCTZ, or any amount of Clonidine. You have my comments. Be hungry... be healthy... be hungrier... be blessed: http://TheWellnessFoundation.com/BeHealthy Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com Bondservant to the KING of kings and LORD of lords. Andrew B. Chung, MD/PhD says... > For some folks, ACE inhibitors and angiotensin receptor > blockers (ARBs) do not have much of effect on lowering > blood pressure until a diuretic like HCTZ is either > present or increased. Well, I've tried Lisinopril, Losartan and Valsartan with the base CCB and 12.5 mg of HCTZ, with no added benefit from the ACEI/ARB. I just finished a one-month trial of the CCB, HCTZ and the new Tekturna renin inhibitor - 150 mg, with the same result. We're going to try 300 mg of Tekturna for a month to see if that makes any difference, but I'm not optimistic. My doc wants to increase the HCTZ too, but I've been really skittish about thiazides, and only reluctantly agreed to the 12.5 mg. I'm very active physically, and, uh, erotically, and want to keep it that way. And I've heard and read some bad stuff about thiazides in that regard, particularly with long-term use. But, you know, none of this matters if you're dead. So I guess the next thing to try is increasing the HCTZ. I had pretty much concluded that my hypertension just doesn't involve my renin/angiotensin/aldosterone system at all, perhaps because they're low already, so medications that reduce them just have little effect. I still think that may be the case, but that would leave the question of what DOES cause it. The med that definitely does affect my BP in a big way is the Diltiazem CCB. > For this reason, would suggest you consider asking your > doctor to try an ACE inhibitor again in the setting of > HCTZ if not done previously or add if/when the increase > HCTZ does not achieve the desired BP lowering goals. While the ACEI had little effect on blood pressure, it did make me cough. So it would probably have to be an ARB. > Clonidine is likely to affect you more adversely than > increasing the HCTZ +/- adding an ACE inhibitor. Yeah, I kinda figured that. But it would be just my luck that it would be particularly effective on systolic pressure. :-) Thank you for your reply, Dr. Chung. > Andrew, in the Holy Spirit, boldly wrote: > [quoted text clipped - 44 lines] > that it would be particularly effective on systolic > pressure. :-) No such thing as luck because everything the world would credit to chance happens by LORD Almighty GOD (Proverbs 16:33). > Thank you for your reply, Dr. Chung. You are welcome :-) Redirecting all thanks and praises to GOD so that we will both be that much more blessed (hungrier): http://HeartMDPhD.com/HolySpirit/BeBlessed Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com Bondservant to the KING of kings and LORD of lords. > I've been taking 12.5 mg of HCTZ for some time now for high blood > pressure, and my doc suggested, as one option, increasing it to 25 [quoted text clipped - 24 lines] > Would like to hear from men having experience with either 25 mg of > HCTZ, or any amount of Clonidine. I've been on Avilide since about Jan 2005, when I ended up in the ER with a BP of 170/90, pulse 120. Avalide is an ACE/HCTZ combo. Right now I'm on the 300mg/12.5mg dose. That's 300mg Ibersartan and 12.5mg hydrocholothiazide. While I had some initial minor adjustment problems such as mild light headedness (which was probably due to suddenly putting controls on probably 20 years of untreated hypertension), it's been working wonderfully for me. While I was obese when I started taking it, due to hypertension being a universal ailment on both sides of my family, I expect it to still need controls even when I get to a perfect BMI. Although I'm figuring the 300mg dose of ACE will probably be cut down to 150mg. The only problem I ever expected with my HCTZ being upped to 25mg, was maybe having to pee a little more frequently. Just checked my BP: 115/66, pulse 68. WOOOHOO! Zed says... > I've been on Avilide since about Jan 2005, when I ended > up in the ER with a BP of 170/90, pulse 120. Avalide is [quoted text clipped - 12 lines] > HCTZ being upped to 25mg, was maybe having to pee a > little more frequently. > Just checked my BP: 115/66, pulse 68. WOOOHOO! Thanks for the info, Zed. > I've been taking 12.5 mg of HCTZ for some time now for high blood > pressure, and my doc suggested, as one option, increasing it to 25 [quoted text clipped - 24 lines] > Would like to hear from men having experience with either 25 mg of > HCTZ, or any amount of Clonidine. There was an interesting study done on blood pressure measurement ..... http://www.healthsystem.virginia.edu/internet/news/archives06/nursing_research_bp.cfm Wait a Few Minutes: Blood Pressure Readings Lower when Patients Slow Down CHARLOTTESVILLE, Va., April 20, 2006 - After rushing to make your appointment, your name is called to be seen by the doctor. You are escorted to a room, where you sit on a table wrapped in crinkly white paper to have your temperature and blood pressure measured. Although a familiar scene, nurses at the University of Virginia Health System have confirmed a major problem with this scenario. According to a new study from a team of nurses headed by Melly Turner, R.N., systolic blood pressure can be an average of 14 points higher when taken immediately after arriving in the exam room and sitting on an examination table rather than sitting in a chair with your back supported and feet flat on the floor. In fact, all study participants had lower systolic and diastolic blood pressure measurements when seated in a chair versus the exam table. With a desirable blood pressure reading around 120/80, and the American Heart Association's definition of hypertension as 140/90 or greater on two consecutive tests, a 14-point difference can mean the difference between a clean bill of health and an inaccurate diagnosis. "Currently, most patients get called back for their appointment, sit on the table, and immediately get their blood pressure measured," Turner said. "Our study reaffirmed the American Heart Association's technique that patients should sit in a calm environment with feet flat on the floor, resting their back against the chair for at least five minutes before taking a blood pressure measurement on a bare arm at heart level. All too often, this doesn't happen. " In the first study of its kind conducted by nurses, the group found that taking a blood pressure reading in a chair after at least five minutes of waiting provided more accurate results than the traditional approach. Turner's team even factored in anxiety when seeing a doctor, or the "white coat syndrome" into their research. White coats did not result in any statistically significant differences as compared with health care personnel wearing scrubs or street clothes. ..... Thanks Vince > There was an interesting study done on blood pressure > measurement ..... > "Currently, most patients get called back for their > appointment, sit on the table, and immediately get their [quoted text clipped - 5 lines] > measurement on a bare arm at heart level. All too > often, this doesn't happen. " Well, you know, it NEVER happens. I've never had my BP taken the "right" way in a doctor's office, and always take it the right way at home. The difference is indeed about 15 points. But all of the studies linking BP to CAD and other malaldies are based on doctor office measurements, not measurements taken at home when you've fully rested for 10 minutes, are comfortable and not anxious, with arm at heart level, etc. So it's not clear that home readings are really the most relevant. The problem is that there are no studies showing, for people who have a big difference, which reading actually predicts future problems - statistically, are these people more like people who always have normal readings, or more like people who always have high readings, or somewhere in the middle? In my case I think it's mostly an anxiety-driven difference. I've always thought the only people who don't have white coat hypertension are those who don't understand the consequences of the results of the BP reading. :-) My brother gets significantly lower readings at the doctor's office than he does at home. And his meter has been checked. So, it's a strange world. My family history and past sins give me a high enough risk without adding high BP, so I thought if I could at least get it down from 150 to the 130's at the doctor's, without ruining the quality of my life, that would be worth doing. But it may just not be possible to do that. It would just be nice if I knew I NEEDED to do that, but I've found no answer to that question. > My family history and past sins give me a high enough risk > without adding high BP, so I thought if I could at least get [quoted text clipped - 3 lines] > be nice if I knew I NEEDED to do that, but I've found no > answer to that question. My bp cuff accurately tracks my doc's readings when compared at the same time. My bp at home is always healthy normal or very low normal. Rarely is it lower than 165/95 in the doc's office. I scrupulously avoid medicating WCHT. Susan Susan says... > My bp cuff accurately tracks my doc's readings when > compared at the same time. > My bp at home is always healthy normal or very low > normal. > Rarely is it lower than 165/95 in the doc's office. > I scrupulously avoid medicating WCHT. I don't know what WCHT is. Well, I'm still not sure what the answer is. I would like to ignore the office readings, but it's just not clear to me that that's the right answer. x-no-archive; yes > I don't know what WCHT is. White coat hypertension. > Well, I'm still not sure what the answer is. I would like > to ignore the office readings, but it's just not clear to me > that that's the right answer. Well, I think if you have a reliable home cuff and take your bp often, after 15 minutes of quiet rest, you'll become more confident if it's consistently lower/normal and avoid a lot of potential adverse drug effects. Keep a log and show it to the doc. You could also try supplemental potassium and magnesium. Drops my bp like a rock to very low normal, but not in the doc's office. :-) Susan Susan says... >> Well, I'm still not sure what the answer is. I would >> like to ignore the office readings, but it's just not >> clear to me that that's the right answer. > Well, I think if you have a reliable home cuff and take > your bp often, after 15 minutes of quiet rest, you'll > become more confident if it's consistently lower/normal > and avoid a lot of potential adverse drug effects. Keep > a log and show it to the doc. Yes, I've done that for years. It's consistently and repeatedly much lower at home, with a calibrated automatic meter, taken correctly, than at the doctors' offices. And on that basis I've drawn the line at the meds with major side effects - beta blockers, clonidine, etc. I'm not willing to be medicated into a coma, or impotence, just so the readings look good at the doctor. And by the way, one set of doctors is at the VA, and of course "we have to go by what we get here". It is bureacratically impossible to get them to consider any alternative. The high readings there make them look bad in their performance reports. So I've taken is issue out of their hands, and turned to my former civilian doctor. to treat my HTN. The fact is that we have no data correlating home readings with adverse events. You may be correct that home readings are the valid ones, but we just don't know that. That's why I'm willing to do what I can to get the pressures lower, but not to the point of screwing up my life with side effects. And my original question was about increasing the HCTZ without violating that rule, and it looks like it might be reasonable to try that. > You could also try supplemental potassium and magnesium. > Drops my bp like a rock to very low normal, but not in > the doc's office. :-) It's always frustrating to me to hear about somebody getting tremendous effects from this drug or that supplement. I do both potassium (lite salt) and magnesium daily. It has no detectable effect. Just like ACEIs and ARBs. I'm a tough case, Susan. :-) > Yes, I've done that for years. It's consistently and > repeatedly much lower at home, with a calibrated automatic [quoted text clipped - 11 lines] > their hands, and turned to my former civilian doctor. to > treat my HTN. Good move; THEY may have to, but YOU don't! > The fact is that we have no data correlating home readings > with adverse events. You may be correct that home readings [quoted text clipped - 4 lines] > without violating that rule, and it looks like it might be > reasonable to try that. I don't follow your logic; home readings are where your bp is almost all the time; how many minutes or hours per year do you spend at the doc's office? Do they remeasure you after you've been sitting quietly for 15 minutes? When my docs did, it produced a MUCH lower reading for me, even after a 190/120 years ago. > > You could also try supplemental potassium and magnesium. > > Drops my bp like a rock to very low normal, but not in [quoted text clipped - 5 lines] > detectable effect. Just like ACEIs and ARBs. I'm a tough > case, Susan. :-) Sorry. :-( Have you had your aldosterone and other adrenal hormones tested? I read a study a few months back stating that it's a universally overlooked frequent cause of ht. And how much K and mag did you take? The time released stuff I'm taking amounts to 1500 mg twice per day. I didn't start there, and 750mg twice per day helped a lot, too. Sorry you're so frustrated. Susan Susan says... > I don't follow your logic; home readings are where your > bp is almost all the time; how many minutes or hours per > year do you spend at the doc's office? Well, I don't spend much time resting quietly on the couch at home. I would say that circumstances similar to the doctor's office are closer to my typical awake time, although without the anxiety. But again, all the data about hypertension is gathered from doctor's office measurements. In my case, and yours, we don't really know that the home readings are more predictive. > Do they remeasure you after you've been sitting quietly > for 15 minutes? When my docs did, it produced a MUCH > lower reading for me, even after a 190/120 years ago. That helps sometimes. Usually not. High BP there may have become a self-fulfilling learned response to that environment. I don't know. > Have you had your aldosterone and other adrenal hormones > tested? I read a study a few months back stating that > it's a universally overlooked frequent cause of ht. Yes, all of that is normal. I was tested for every conceivable secondary HTN cause. > And how much K and mag did you take? The time released > stuff I'm taking amounts to 1500 mg twice per day. I > didn't start there, and 750mg twice per day helped a > lot, too. I don't know. I salt everything with KCl, but don't supplement otherwise. Magnesium is 200mg. Above that gives me the runs. > Sorry you're so frustrated. Me too. > Well, I don't spend much time resting quietly on the couch > at home. I would say that circumstances similar to the [quoted text clipped - 3 lines] > In my case, and yours, we don't really know that the home > readings are more predictive. Well, activity induced increases are supposed to be healthy, for one thing, I suppose for overall benefits of activity and for maintaining some vessel flexibility. In addition, I often measure my bp after going up and down stairs, carrying things. My activity related highs at home are in the 130s over 80 at most, and not for long. > > Do they remeasure you after you've been sitting quietly > > for 15 minutes? When my docs did, it produced a MUCH [quoted text clipped - 3 lines] > become a self-fulfilling learned response to that > environment. I don't know. It has for me; too many dopey docs and band news over the years. :-/ > > Have you had your aldosterone and other adrenal hormones > > tested? I read a study a few months back stating that > > it's a universally overlooked frequent cause of ht. > > Yes, all of that is normal. I was tested for every > conceivable secondary HTN cause. Okay. > > And how much K and mag did you take? The time released > > stuff I'm taking amounts to 1500 mg twice per day. I [quoted text clipped - 4 lines] > supplement otherwise. Magnesium is 200mg. Above that gives > me the runs. It might be helpful to try K Dur, if the doc will agree, and do routine measurements. I can tell you that using it makes no diff in my WCHT, though. Lowest I go there is 140/80 and rarely that low. Susan > Susan says... > [quoted text clipped - 13 lines] > to ignore the office readings, but it's just not clear to me > that that's the right answer. You should ask your physician about ambulatory monitoring. Thanks Vince bigvince says... >> Well, I'm still not sure what the answer is. I would >> like to ignore the office readings, but it's just not >> clear to me that that's the right answer. > You should ask your physician about ambulatory > monitoring. That would be good only if there are studies which correlate ambulatory readings to coronary artery disease in some way, or to heart attacks or strokes. Otherwise you're just guessing. I'm not aware of any such studies. > There was an interesting study done on blood pressure > measurement ..... [quoted text clipped - 3 lines] > Wait a Few Minutes: Blood Pressure Readings Lower when Patients Slow > Down You know, while I've always agreed with all of that, I'm starting to come to the conclusion that if I have optimal blood pressure, it shouldn't read a high number period. People who have consistently optimal blood pressure don't have to come up with excuses like "white coat syndrome" or "didn't have enough time to relax". They have a good reading during each and every check up, regardless. When I go straight to taking my BP, it always reads higher than when I sit still for five minutes, close my eyes and breath deeply. But I figure if that's what I have to go through to get an acceptable reading, then I still have hypertension. IMHO my BP should not be above 120/80 just because I didn't meditate for five minutes. A five minute cool down should take it down to at least 115/65. Yesterday it was 115/66, today it was 134/75. I still have hypertension. It's getting better, but I don't want to fool myself. |
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