TREATMENT OF HYPERTENSION WITH MULTIPLE DRUGS

WHEN IS IT NECESSARY?      

One of my readers asked me this question and I thought that I should share my answer with my readers who might be facing the same dilemma.

We are all unique and different individuals. We are genetically, metabolically, physically and mentally created different. Therefore, we metabolize and react to medications differently.  In medicine, one size or manufacturer’s suggested standard dose of medication, doesn’t fit all people. The effective dose of medications must be assessed and determined according to the individual’s response.

In case of hypertension that is resistant to one drug treatment, before deciding to change the drug regimen, the other effective measures in the management of hypertension must be taken into consideration. This includes the daily routine of strenuous exercises, a low sodium and high potassium diet, taking medication just before bedtime, and fluctuations in BP measurements in different circumstances. One BP reading is not enough to diagnose hypertension because BP fluctuates during the day. Every hypertensive patient should have a good quality automatic BP measurement device at home, check their BP a couple of times a day and record it for few days, and then look at the average of readings so that stressful life events and “white coat” induced elevation of BP could be avoided as hypertension. Maybe just taking into consideration all these important measures that are needed to control BP. If not, then the following options should be considered:

1.      Maximize the dose of present medication 

or

2.     Add different class of medications to the present regimen

Both options could cause some difficulties for the patient, in the form of increased medication related side-effects, difficulty adhering to the multi drug therapeutic regiment, and increased cost of treatment. So, both aspects of these treatment options must be discussed and agreed upon with all pros and cons with the patient and doctor.

In a recent, retrospective and cohort study, researchers try to address this question by identifying 487,000 elder (> 65) hypertensive patients in the USA who were resistant to the recommended dose of one drug. 75% of these patients received maximized dose of medication they were on, while 25% received a new class of antihypertensive medications, without changing the dose of present medication, to control high blood pressure. Both options were successful. But adding new medication was associated with increased cost of treatment and caused significantly less adherence to multi drug regimen, while maximizing the dose of existing medication caused more drug related side-effects.

The aim of treatment of controlling hypertension is to prevent hypertension-related severe and dangerous future complications, to simplify medication regimen, and to try to minimize drug related side-effects.