Can you stop medicines for high blood pressure?

A lady patient came for consultation. I saw her file and the list of medicines she is taking. There were in all 11 medicines. Two of them for high blood pressure.

She was taking these anti hypertensives for nearly 20 years,
and regularly visiting the doctor who prescribed them.
At every follow up visit that doctor said only one word "continue"

I took her blood pressure. It was 130/ 70.
I told her to stop these two medicines for some time. She refused. "How can I stop?  it may increase" 

I explained to her that blood pressure will not rise suddenly. It may take at least 3 weeks to rise. You can monitor it at home with the instrument once in a week. If there is a rise within 3 weeks we can restart the treatment.

The arm should be resting on the pillow and cuff should be at the level of the heart 

The lady agreed and discontinued her two medicines. She monitored her blood pressure every week for the next 4 weeks. The blood pressure did not rise.

She felt confident but still was in doubt " what if it increases after 3 moths or 6 months?"  

I said " Please continue to monitor once a week. No need to worry"
. 
Six months have passed and her pressure is still normal

P.S.:

Millions of patients are taking treatment for many years. Doctors are not interested in a review in their busy practice.

Patients are also not keen for a review because they have been told:

"Treatment of high blood pressure is life long"

Not necessarily. 

Diabetics should monitor their blood pressure

100 diabetics who had normal blood pressure were studied.
These patients had fluctuations in the blood pressure which are as follows

• Early morning rise
• Night time surge (Nocturnal hypertension)
• Fluctuations during the 24 hr period

Such variations were associated with

• Albumin in urine
• High HbA1C (Average blood sugar during the last 3 months

Do they need medicines to lower the blood pressure?
No. 
These patients are not hypertensives.


But they should monitor their blood pressure at home 


Ambulatory blood pressure monitoring:

Use the same arm. Place the cuff on bare skin, not over clothing. 

Rest your arm,on a table raised to the level of your heart. If needed, place a pillow under your arm to elevate it to the level of heart

P.S.

These variations in B.P. will stop when we control our diabetes.

• Reduce weight and abdominal circumference
• Reduce calories
• Stop eating out

• 
  

Home blood pressure monitoring

  

Hand should be resting at elbow and cuff should be at the level of heart

American Heart Association (AHA) recommend that high blood pressure should be monitored at home. 
It can help you keep tabs on your blood pressure in a familiar setting, and confirm that your medication is working, 

.It is an important part of managing high blood pressure. 

• It Helps with early diagnosis of high B.P.
• It can discover 'white coat hypertension' This is when the B.P. is high in the clinic and normal at home. It does not need drug treatment (only a change in lifestyle)

• Multiple readings over a period is a good feedback to your doctor

• You get involved in your treatment

The arm should be resting on the pillow 
and cuff should be at the level of the heart.  

Blood pressure at your wrist or finger is not recommended 
It should be taken around the arm. Cuff size should be properly fitting. A smaller size cuff will give a higher reading.  

 Use the same arm. Rest your arm,on a table raised to the level of your heart. If needed, place a pillow under your arm to elevate it to the level of heart

• Measure twice daily, in the morning before breakfast and in the evening.Take two readings each time. Readings are little higher in the morning 

   Place the cuff on bare skin, not over clothing. 

Reading at the wrist is not recommended

• 
  

Drawback: 

Home BP monitors are not held to the same standards of accuracy as those devices in doctors' clinic. 

• 
  Products and Services