Many meds complicate BP treatment

Dear Dr. Roach: Iama healthy 77-year-old male. I’m 5 feet, 7 inches tall and weigh 145 pounds, with difficult-to-control high blood pressure. For many years I had a blood pressure reading around 140/80 with no medicines. Last year I had a very severe headache, and I thought it might be a stroke or TIA. I had a reading over 180/100 and was diagnosed with high blood pressure.

My family doctor started me on hydralazine at 50 mg twice a day, then 50 mg three times a day. My blood pressure still fluctuated, and I was prescribed 5 mg of clonidine to take as emergency medication for anything over 180/100. Later, metoprolol 50 mg daily was added, then 80 mg telmisartan, then a few months later 5 mg amlodipine. It was not until I started taking the amlodipine that my blood pressure was finally controlled.

What are your thoughts regarding the hydralazine? It is inconvenient to take three times a day, and I wonder about the roller coaster of the medicine’s effects given its short half-life. Its long-term side effects are concerning.

My nephrologist recommended I try stopping the hydralazine and instead add an additional 40 mg of telmisartan taken in the morning. My family doctor is of the opinion that I should change nothing. Can hydralazine be stopped suddenly?

E.F.

Answer: Your regimen is quite unusual. Hydralazine is very seldom given for high blood pressure anymore. It is the most frequent cause of drug-induced lupus and can also cause vasculitis (blood vessel inflammation).

I am also concerned about the use of as-needed drugs like clonidine for arbitrary high blood pressure numbers. It’s never been clear that it helps. I am not a fan of this regimen.

Hydralazine and the amlodipine you are already taking work using a similar mechanism, as does the telmisartan. Since you’re not at the highest doses of either, I would favor slowly tapering the hydralazine and increasing one of the other drugs. Both last much longer in the body than hydralazine, with less risk of side effects.