High BP Meds.....

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 21 Jul 2020, 9:13pm

RH20 wrote:Hello, if you did take too much Ramipril it could have been the cause of your problem, however. There is possibly another explanation. You might have had a nasty hypo, low blood sugar. I have a problem with hypos, What you have described sounds very similar to my own experience. Only last week I was out riding and felt a hypo coming on, low energy, feeling sick, eyes going blurred. I had to stop and take in some fast acting glucose. I waited a couple of minutes for this to get into my system, then carried on home. I get this out of the blue, no warning. Luckily I was only about half a mile from home.
The down side of this was feeling exhausted for a few days after. It might be worth considering keeping some fast acting glucose on you just in case of any future episodes. Hopefully you are now alright and will not have any similar experience of this again. This is just a suggestion to ponder.

Have you had that documented and investigated? I'd strongly recommend that for suspected or unexplained hypoglycaemia.

Jonathan

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 23 Jul 2020, 9:50am

thirdcrank wrote:Normally, I don't bother with the news of dramatic medical breakthroughs in newspapers, but fairly recently I read something which suggested it may be better to take BP meds in the evening, rather than morning. IIRC and if I understood it correctly, it said that there had never been any research into the best time to take these meds but it had generally been assumed that morning was best as daytime activities were most likely to raise BP. The report suggested that the danger from BP remaining high overnight, ie not falling during sleep, was greater than the natural increase in BP from exercise. I switched to taking my BP meds in the evening but I don't know if that contributed to my being here today.

That's probably this study:
https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehz754/5602478 (may be paywalled)
and here's the BMJ's coverage:
https://www.bmj.com/content/bmj/367/bmj.l6173.full.pdf

It's a fascinating area, and we'll probably find timing affects many drug regimes. But it's obviously expensive to study.

Jonathan

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 23 Jul 2020, 9:52am

thirdcrank wrote:Over those years I've tried everything to prompt me to take medication. I'm sure that it's not a question of forgetfulness, it's just that when you've done things countless times, you don't know if you are remembering an earlier occasion when you did it. I've a couple of cheap dosset boxes from Wilko's which have been the best for me, but they are discontinued. They don't prompt you but are easy to check if you cannot remember if you have taken it. Various similar gadgets available.

You're not alone: adherence (or compliance as was) is generally very poor. It's an enormous problem. Everyone needs to act accordingly and patients need to find what works for them.

Jonathan

drossall
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Re: High BP Meds.....

Postby drossall » 23 Jul 2020, 8:32pm

Belt and braces can help. I mentioned the phone app, which avoids my forgetting because it goes off every ten minutes till I comply. As long as I operate a strict regime of not cancelling it until I have actually taken the tablets (and have my phone switched on, which I normally do), forgetting is difficult.

As far as taking tablets twice in a day is concerned, again the fact that the app notification is cancelled helps. But also, two of the (currently) five I take a day have days marked on them. So I've begun to take those by marked day, which also provides a very simple check.

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Navara
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Re: High BP Meds.....

Postby Navara » 24 Jul 2020, 1:06pm

I have now ridden twice since the incident and everything has been normal.
I now take my tablets one type at a time to doubly make sure I'm taking the correct amount of each!

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531colin
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Re: High BP Meds.....

Postby 531colin » 24 Jul 2020, 10:15pm

Anybody with high blood pressure should read the recommendations of the British Hypertension Society http://www.sld.cu/galerias/pdf/servicios/hta/bhs_guidelines_4ta.pdf
Specifically, go to page 158 and read the chart for their recommendations on which drugs to use.
ACE inhibitors (anything ending in -pril) are recommended first line treatment only for people under 55 and non-black (their terminology)
People over 55 or black are recommended a calcium channel blocker (eg amlodipine) as first line treatment.
These recommendations have been imported wholesale into the NICE guidelines. (National institute for clinical excellence, or something)
I have come across a few general practitioners who thought they knew better than the Brit. hyper. soc, but it transpired that none of them did.
I have been on all sorts of stuff for a lot of years, and Amlodipine is the best for me by a country mile. Also the half-life is staggeringly long, more than a day. This is the time it takes for the maximum blood level after a dose to halve; so if I miss a day it scarcely matters.

Which reminds me, our diurnal rhythm governs that our blood pressure is highest in the early morning, which explains why so many strokes occur in the early morning. So in theory BP medication should be taken at night, to lop the top off the early peak pressure. Long half-lives mean we don't have to concern ourselves with this.

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NATURAL ANKLING
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Re: High BP Meds.....

Postby NATURAL ANKLING » 25 Jul 2020, 10:22am

Hi,

https://www.heart.org/en/health-topics/ ... ations#ARB

I am on candesartan (Angiotensin II receptor blockers ) which by the looks of it has the least side-effects of a lot.
If I don't exercise for a week my blood pressure starts to climb.
I also believe that it is used in combination with other blood pressure medication (I have previously mentioned that that one time I was on three different types at the same time) Also recommended for older people.
I've been on most of the other types apart from some of the ones which appear to be aimed at Severe cases of hypertension, some should not be used with pregnant women et cetera.
It doesn't help if you also have to take Anti Cholesterol too.
Diuretics can have a "dramatic affect post exercise, low body salts, my GP at the time failed to notice this despite A blood salt test which appeared low, I see it is recommended that if you are on diuretics that salt supplements may be prescribed too.
I have not read your link yet 531 Colin, I'm off now to do that.
NA Thinks Just End 2 End Return + Bivvy
You'll Still Find Me At The Top Of A Hill
Please forgive the poor Grammar I blame it on my mobile and phat thinkers.

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 25 Jul 2020, 12:27pm

NATURAL ANKLING wrote:Diuretics can have a "dramatic affect post exercise, low body salts, my GP at the time failed to notice this despite A blood salt test which appeared low, I see it is recommended that if you are on diuretics that salt supplements may be prescribed too.

Diuretics are the most common cause of low plasma potassium concentration, and amongst the most common causes of low plasma sodium concentration. This often doesn't require any action. But it can sometimes be difficult to convince practitioners and patients that it doesn't.

Jonathan

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 25 Jul 2020, 12:28pm

531colin wrote:So in theory BP medication should be taken at night, to lop the top off the early peak pressure. Long half-lives mean we don't have to concern ourselves with this.

I linked to a recent study of this earlier in the thread.

Jonathan

thirdcrank
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Re: High BP Meds.....

Postby thirdcrank » 25 Jul 2020, 12:52pm

While this is current, has anybody any informed information about aspirin?

I've been taking this on prescription daily for some 16 years. Every so often I read the latest scare stories AKA superficial media reports of research studies and just follow doctor's orders. Perhaps six months ago, having just read such a piece, I had a phone call from the doc saying that he was changing one of my meds. I took the opportunity to ask about the aspirin, and he used some well-known phrase or saying along the lines of "If it ain't broken, don't fix it." I didn't bother to waste my time suggesting that that's exactly what he was doing with the other med; presumably, he was just following orders from higher up the hierarchy.

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 25 Jul 2020, 12:57pm

Aspirin:

Can't comment on your specific need... but what area of medicine are we in, and any particular questions?

Jonathan

PS: I don't understand the comment about following orders... is that about guidelines or incentives or something else?

thirdcrank
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Re: High BP Meds.....

Postby thirdcrank » 25 Jul 2020, 1:51pm

I follow the doctor's orders.

I presume that when those orders change, it's as the result of something coming down from above.

I've been on medication since I was diagnosed with angina in 2004. Originally, that was atenolol, aspirin, simvastatin and a diuretic. That was eventually supplemented with irbesartan. (All spellings approximate.) More recently I was diagnosed with type 2 diabetes and prescribed metformin. We had a change of GP at the practice and he stopped the diuretic. In spite of me accepting his advice without question, he insisted on explaining that the diuretic was not to be taken with atenolol. Short of putting my fingers in my ears and going "Nah, nah, ni nah, nah" I had to listen to something over which I'd had no control, but which would increase stress levels if I thought it through.

More recently the statin and atenolol have been replaced with other meds.

So my query is what's the informed view about aspirin (75 whatever the units are with the coating.)

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 25 Jul 2020, 3:36pm

On aspirin in secondary prevention I'd start with:

Cochrane

"Antiplatelet agents and anticoagulants for hypertension"
https://www.cochrane.org/CD003186/HTN_a ... pertension

"Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular events"
https://www.cochrane.org/CD005158/VASC_clopidogrel-plus-aspirin-versus-aspirin-alone-preventing-cardiovascular-events

NICE

"Antiplatelet treatment for secondary prevention of cardiovascular disease"
https://cks.nice.org.uk/antiplatelet-treatment#!scenario:1

Jonathan

thirdcrank
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Re: High BP Meds.....

Postby thirdcrank » 25 Jul 2020, 4:00pm

Thanks for that, although I find the best way to avoid internet-induced hypochondria is to minimise the reading of stuff on the internet.

At my layman's level I've picked up this from those links:

Angina
Consider prescribing aspirin 75 mg daily for people with stable angina, taking into account the risk of bleeding and comorbidities.


I'll presume account was taken of the risk of bleeding and comorbidities and avoid worrying.

Jdsk
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Re: High BP Meds.....

Postby Jdsk » 25 Jul 2020, 4:08pm

thirdcrank wrote:Thanks for that, although I find the best way to avoid internet-induced hypochondria is to minimise the reading of stuff on the internet.

I don't think that the channel matters in the least, except that we now have an amazing medium that can make the best current information available instantaneously and free. What matters is the quality of the information. Both Cochrane and NICE do very well on that, and have the enormous strength of showing their working.

thirdcrank wrote:I'll presume account was taken of the risk of bleeding and comorbidities and avoid worrying.

You can find quantitative assessments of the risks in the Cochrane Systematic Review. And if anyone else is reading this NB the difference in that balance of benefits and harms between primary and secondary prevention.

Jonathan