Blood Pressure Meds Don’t Work - Unless You Take Them
High blood pressure is called the “silent killer” because it has no symptoms. I have patients who swear they know when their blood pressure is high, but I remain skeptical. More often than not when I take a BP that’s elevated, the person has no idea and “feels just fine”. I have seen patients in the emergency room with alarming, stroke-range BPs who hadn’t a clue their blood pressure was high.
This is how BP is staged:
- Normal: is below 120/80
- Prehypertension: 120/80 to 139/89
- Stage 1: 140/90 to 159/99
- Stage 2: above 160/100
Blood Pressure Treatment – Behaviors and Medication
High blood pressure is a risk factor a long list of problems including heart attack, heart failure, stroke, and kidney disease – to name just a few. Most of the damage high blood pressure causes can be prevented when BP is controlled to normal levels.
If lifestyle modifications (weight loss, exercise, and a low salt, DASH diet) aren’t able to control it to normal levels, the mainstay of therapy is medication. If medication for high blood pressure is required, it is usually required for life. If you stop taking your medication then your BP goes right back up again.
Revealing Research
In a recent report published in the British Medical Journal researchers reviewed 21 studies in which participants were given medication containers that electronically recorded the time and date each time they were opened. They reviewed the electronic records of a total of 4783 patients who had been prescribed a once a day blood pressure medication. This is what they found:
- On any given day 10% of the doses were missed.
- After one year 50% the patients had stopped taking medication altogether.
- 95% of patients missed at least one dose at least once a year
- Almost 50% took a drug holiday that lasted longer than three days at least once a year.
- More doses were skipped between April and September and on weekends.
- People who took their medication in the morning missed fewer doses than those who took them in the evening.
- People who missed the fewest doses were more likely to continue medication than those who missed more.
Take home message for health care professionals:
- If your patients’ BPs are not coming down with appropriate medications – perhaps it’s not that the drug isn’t working; perhaps the patient isn’t taking it!
- If a single med, dosed once a day has 50% of patients stopping therapy within one year, what is happening with our patients on multiple medications for multiple conditions that are dosed more than once a day? This is a very troubling thought.
Take home message for patients:
- If you are having side-effects, discuss them with your health professional. There are many options available. You and your provider should work together to find the right drug at the right dose at the right price that adequately controls your BP without side effects.
- Medications will not work unless they are taken – faithfully!
- It is your responsibility to come up with a system that doesn’t fail when it comes to taking your medications. There is a lot at stake if you do not.
I will be writing more on this blog about medications. There is no area of my practice where I find a greater difference in perspectives between patients and providers. And there is no area that requires more mutual understanding and cooperation than where medications are concerned. I do not believe medications are a cure for everything – but when prescribed appropriately they are absolutely life-saving and life-prolonging.
Question: If you take your medications faithfully, how do you remember? What is your system? If you don’t take your medications properly – why? What’s the problem?
This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.
Citation: BMJ 2008;336:1114-1117 (17 May), doi:10.1136/bmj.39553.670231.25 (published 14 May 2008)
5 comments so far. (Post your own)
#2 | On July 08, 2008, Pat Perry said:
Being educated is the first step towards treating and preventing life threatening or debillitating conditions and I wish more of the American population could learn these things more readily. 1 out of 3 adult Americans is alot. Your blog site is wonderful. You ought to send it to every high school’s health educator. Also, you might think about adding something in about “white coat syndrome”. It is alot of patients’ excuse for brushing off the reality of HTN. Good job of blog!
#3 | On July 12, 2008, Carla Mills said:
Great comments.
I think we all need to kind of “grow up” and be adults about how we take care of ourselves. That includes both choosing and following through with treatments that will control our health risks in the long term and relating to health professionals as partners and colleagues rather than parents who might scold us or teachers who will grade us.
Pat, great idea for a post on “white coat hypertension” I will do that. It’s a very common problem that can make blood pressure management difficult.
Thanks,
Carla
#4 | On May 27, 2011, Kase said:
I like the old standby of ‘blame the patient’ as much as anybody else, but I’ve been attempting to lower my blood pressure (routine 180/110) to normal human levels for seven months and every attempt has failed miserably. I’ve been through half a dozen meds, I’ve exercised, cut salt, cut caffeine, cut nicotine… done it all and religiously to boot. I’ve never missed a dosage of my medicine, either. And still, nothing works. Not in the least.
But you go on blaming the patient. We’re used to it by now.
#5 | On May 28, 2011, Carla said:
Kase,
I’m sorry you perceive this post as “blaming the patient”. I find it even more disturbing that you are “used to it”. I hate to think of what kind of care you have received to make you feel this way.
After 25+ years working with patients I have learned firsthand that there are things we can control and things we can’t. I do, without apology, hold my patients responsible for the things they CAN control but I would never, ever “blame” my patients for the things they CAN’T control - no matter what it is that out of their control.
There is one essential element in a therapeutic relationship and that is trust. I hope you will find a professional who is able to earn your trust and steer you to whatever and whoever you need to help you get your BP under control.
Best, Carla
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#1 | On July 05, 2008, Val Stec said:
I often experience the same issue with compliance to a diet regime. I think patients often feel ashamed or embarrassed by not following recommendations. I would encourage any patient to be forthright, we are not going to judge you, we will just figure out a different way to help. As I tell my patients, “I have a lot of tricks in my bag, if one thing doesn’t help, I will find something that will!“ Great site, Val