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Thursday, December 18, 2014
High Blood Pressure
Best Blood Pressure Medicine for Blacks?
I am a 55 year old African American female. My blood pressure was on the low side until I turned 50 when it suddenly went up. I was prescribed Benicar about five years ago for high blood pressure. It controlled my blood pressure effectively and I was not aware of any adverse effects. Recently, I experienced stroke-like symptoms. The doctor in the hospital said I was not having a stroke, but CT scan revealed that I have had a stroke in the past. I was tentatively diagnosed with complicated migraines and prescribed Inderal. I continued to take the Benicar. After a very scary experience where my throat swelled and I had difficuly swallowing I was taken off of the Benicar. I continued on the Inderal, generally felt very poorly and stroke-like symptoms contiuned and in fact become more frequent. My heart rate on the Inderal was 42. A few days ago I asked my doctor if I could come off of the Inderal and he said yes. I am still having problems with numbness in my left arm and hand, and sometimes my face droops. I feel better in between these attacks than I did when taking the Inderal. I do take a 81mg aspirin a day. I was also diagnosed with a hole in my heart. I have a prescription for Norvasc. I have not taken it yet. After such a bad reaction to the other blood pressure medications I am leary of starting a new one. So for the past three days I have not taken any blood pressure medicine. My question is, what type of blood pressure medicine is best for African Americans, and specifically for me with my history. I am not diabetic and my cholesterol is excellent.
It is always s difficult to give specific advice, but a few points can be made:
Patients who had a stroke or a TIA (transient ischemic attack, which is a small stroke that resolved within 24 hours), should be treated with antiplatelet therapy. Aspirin, at a dose of 81 mg to 325 mg per day has been shown to reduce the risk of recurrent stroke. Compared to aspirin, dual therapy with dipyridamole plus aspirin or with clopidopgrel plus aspirin is somewhat more effective in reducing recurrent stroke risk, but is more expensive.
Regarding your blood pressure, you are in a higher risk group because you are African American and you may have had a stroke. Your blood pressure should be 130/80 or lower. If you don't tolerate beta blockers nor Benicar, a diuretic (hydrochlorothiazide or chlorthalidone) is a good option. If a diuretic is not enough to control your blood pressure, a calcium channel blocker like amlodipine can be added.
Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati