Seniors can have adverse reactions to BP medicine

DEAR DR. ROACH: I wonder if you could comment on the negative side effects of various blood pressure medications for those over 65 — particularly folks who are 80-plus.

Should a person be on more than two medications if one’s blood pressure is generally 150160/70-80?

Does the answer change if the person also has chronic atrial fibrillation?

I would appreciate your thoughts on blood pressure medications and their adverse reactions, especially in seniors. S.B.

ANSWER: In an ideal world, people with high blood pressure could control it with a single medication that would not have any side effects. Unfortunately, it doesn’t always work that way. Some people do need two, three or even four different medications to control their blood pressure.

The guiding principal often becomes not what is ideal, but what is best in a difficult situation. Sometimes that means using medications like clonidine and atenolol, neither of which is the first drug a clinician would use for an older person with high blood pressure.

It often takes extensive trials to find the right combination of medications to get the blood pressure in an acceptable range while still having an acceptable level of side effects. It’s not clear that you have achieved either of those goals: 160/80 is not adequate blood pressure control, and life-altering lightheadedness and “brain fog” are not acceptable.

It’s dangerous to stop taking beta blockers like atenolol suddenly, but clonidine is even worse: The blood pressure can rebound higher than it ever was, leading to stroke. I understand your frustration, but please wait on your doctor before discontinuing blood pressure medication.

A new regimen is called for, and maybe a complete re-evaluation of the possible causes of high blood pressure. For example, when I see clonidine used, I often consider whether the diagnosis of obstructive sleep apnea has been missed.