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Super Advisor
TikTok2
Total Posts: 2,153
Registered on: ‎05-13-2013
Helpful Response

High Blood Pressure: Which Meds do you take, What else do you do?

[ Edited ]

Another question for the forum:

 

For those of you who also have high blood pressure:

 

What nonmedicine things that you do have made the biggest impact?

 

• I already eat a pretty low salt diet. Already eat a lot of vegetables and as much fruit as the diabetes will allow. 

 

   I don't eat a lot of processed foods. We rarely put extra salt on our foods. We don't put it in most of the foods we cook. 

 

   Though of course I can go from low salt to no salt. That is one change I can make.

 

•  I already exercise for the diabetes, but will just need to increase it.

 

•  I'm also losing weight...again.....went from 145 to 140 over the summer....gained it back in 2 months when I started metformin ER (probably due to the gastric upset.....went from 145 back to 140 november through mid february.....so now I can start going into the 130s. My ideal weight is ~105. I know that sounds low, but my doctor agrees with me....I'm thin boned, short, and that was my weight in my 20s when I was "healthy". 

 

Anything else besides exercise and diet and weight loss?

 

 

Now let's talk about medication.  There are so many different types. Which one do you use and why? Why that class? Why not some of the other classes? Pros and Cons of each class?

 

This is a conversation my GP and I will have to have, but he does tend to just prescribe without a comparison of drugs, which in the past was OK as I knew which diabetes drug I wanted to start with, which statin I wanted to try after the first "failure", but I never thought about blood pressure meds before as that was surely one thing I could do with my low salt diet and my daily walking; surely I wouldn't need blood pressure medication too! I am reading and there are so many classes of meds, its not obvious which is best to use. Or which is best considering all the other meds I take (prilosec, zyrtec, synthroid, low dose naltrexone, zanaflex mostly at bedtime, pravastatin, metformin ER, humira, occassional methylprednisone), considering the supplements my doctors especially rheumatologist has me on (D, K, C, Mg, Ca, CoQ, fish oil, probiotics), considering the diabetes, high cholesterol, spondyloarthropathy. 

 

I'll keep reading about the different meds, but its nice to hear others experiences.

 

Too, side effects you had to various meds, and why you stopped various meds if you did. What you went to next. What you are currently on.

 

I ask here because the trifecta of diabetes, high cholesterol, and high blood pressure seem to affect a lot of us, no? Metabolic syndrome.

 

I think I've spent so much time and energy all these years focussed on the diabetes (and NAFLD), figuring it was the cause of the other things that I did not focus as strongly on the cholesterol and blood pressure. And to be honest, doctors (at least mine) don't / didn't focus on the diabetes, cholesterol, or blood pressure while they were all pre- or early or borderline. Too, I've had to focus so much on the pain from the inflammatory arthritis, that took a lot of my time and energy. Lots of balls in the air. Now a new one to throw in the mix. 

 

Went to Urgent Care for a UTI, BP was 166/100, maybe because I had an infection? But before Christmas it was 170/100 at another doctors office; I chalked that up to high stress as I was going through something at work at the time. At home it used to always be normal or even below 120/80 and would fluctuate between that and borderline (130s/80s) at the doctors. Now, it is borderline to stage 1 at home (130-140/80-90), and fluctuates all over the place at the doctors (highest readings being the two I mentioned in that first line of this paragraph).  That's why I'm trying to prepare for the next GP visit, now...he said we'd address this "next time" if it continued to be a problem. When he sees that value when he gets the UC report....I know we're gonna have a talk about meds....I'd rather be knowledgeable about them before I go.

TikTok2

• Diabetes on both sides of my family.
• Assumed trouble metabolizing sugar as long as I can remember; migraines induced by hunger, very sleepy after meals high in carbohydrates from childhood. Learned how to avoid sugar and lots of complex carbs early on.
• Since early 2000s, "prediabetes" controlled through low carb diet and exercise, mostly walking. FBG 95-105, A1c below 6; glucose tolerance test was borderline.
• But weight drifted upwards but working on it.
• NAFLD brought under control with pravastatin.
• Metformin ER, 500 mg, started sept 2013 when A1c reached 6.5 despite diet and exercise regiment since early 2000s. A1c back down to ~6.0.
Advisor
1lainey
Total Posts: 323
Registered on: ‎01-01-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

[ Edited ]

You realize, only about 20% of people with high blood pressure are affected by salt.  Given your diet and exercise habits, how much you would get out of further restriction is debatable.

 

Typically, they start you on a diruetic, such as hydrochlorothyazide.  It is also typical to have patients that are on metformin taking lisonopril (an ACE inhibitor) to protect their kidneys--this is also a blood pressure medication.

 

Also, blood pressure guidelines have changed.  They are here: http://www.health.harvard.edu/blog/new-guidelines-published-for-managing-high-blood-pressure-2013121...

 

If your doctor is going to medicate you specifically for blood pressure, the medication should be titrated--typically, the patient starts at a low dose for a short time and then is checked and the dose changed until the thereaputic goal is reached.

 

I take metoprolol (beta blocker) but my high blood pressure is in the setting of an arhythmia.  The biggest issue with this is that it can cause fatigue, so I take it at night.  I have been on it for 7 years with no other issues from it.  As for non medicine things--I have never been overweight, my exercise habits have always been consistently good and I don't eat much in the way of processed, packaged foods so---not much to cut out there.

September 2014 A1C 5.9%
March 2014 A1C 6.0%
December 2013 A1C 6.2%
June 2013 A1C 6.0%
December 2012 FBG 142, A1C 5.3%
June 2012 FBG: 154, A1C 5.9%

No meds--normal weight, mod-carb diet, exercise
Super Advisor
TikTok2
Total Posts: 2,153
Registered on: ‎05-13-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

Thank you for that link. 

 

 

Thanks too for the medication comparisons. I am in the process of reading about each class.

 

 

The diabetes educator was reprimanding me about salt in my diet without even asking me what I ate; just assumed a high salt diet. 

 

But the GP is smarter than that; he told me that as we get older, high BP can be due to less flexible arteries...in other words its the nature of aging to some degree in some of us. 

 

I just so didn't want to add in yet another med: pravastatin added in a year ago (but it did help my NAFLD a lot so I'm happy with that), humira added this summer, metformin ER added this fall.....all good and necessary meds for me.....the thought of one more....Uggh! :smileytongue:

 

In a way its good to know its probably not my diet, exercise, or weight (so I don't have to beat myself up), but then of course its bad becasue there isn't much I can fix.....still I'm gonna try.....

 

Of course some of the meds I'm on have "good" side effects, like the low dose naltrexone. I take it for the autoimmune stuff and there is some clinical evidence that its good for things like cancer prevention, etc. 

 

I hope the BP meds have "good" side effects. I like the idea of the one that is supposed to help the kidneys.....

 

Well, I have A LOT of reading to do....

 

Thanks again :smileyhappy:

TikTok2

• Diabetes on both sides of my family.
• Assumed trouble metabolizing sugar as long as I can remember; migraines induced by hunger, very sleepy after meals high in carbohydrates from childhood. Learned how to avoid sugar and lots of complex carbs early on.
• Since early 2000s, "prediabetes" controlled through low carb diet and exercise, mostly walking. FBG 95-105, A1c below 6; glucose tolerance test was borderline.
• But weight drifted upwards but working on it.
• NAFLD brought under control with pravastatin.
• Metformin ER, 500 mg, started sept 2013 when A1c reached 6.5 despite diet and exercise regiment since early 2000s. A1c back down to ~6.0.
Advisor
1lainey
Total Posts: 323
Registered on: ‎01-01-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

[ Edited ]

The diabetes educator was reprimanding me about salt in my diet without even asking me what I ate; just assumed a high salt diet. 

 

But the GP is smarter than that; he told me that as we get older, high BP can be due to less flexible arteries...in other words its the nature of aging to some degree in some of us. 

 

 

Yes, stress and infection are going to cause some of the numbers you saw.  If a doc is going to diagnose it, they usually go by at least 2 sitting measurements (and in the early days, for me he would take my BP, then have me lay down and leave the room for 5 minutes and then take it again--usually took care of the "white coat" effect).   They can also do a continuous monitor for 24 hours or so to see if there are any patterns or if you are staying high when you sleep.

 

I see also that you are on synthroid.  Do not forget there is a connection between hypothryoidism (and other inflammatory diseases) and the above mentioned stiffening of the artieries.  I know, in many arenas it is associated with low blood pressure, because when you are hypo, your heart pumps with less force--had at it with the cardiologist over this, because he said it is not typical, and resolves with treatment (he ultimately acknowledged, that is true only 50% of the time though) however, it is also associated with high blood pressure.  Lack of thyroid hormone reduces the elasticity in the arteries (that is me also, I presented with both at the same time, and when the thyroid meds are off, my blood pressure swings up) and contributes to high blood pressure.  Make sure your levels are optimal there, and don't forget that Metformin will lower the TSH alone without affecting the Free T4 and Free T3, so you really want those to be in the upper part of the standard ranges.

 

Happy side effect of the metoprolol is that I get fewer migranes--it is often used off label for that.

 

In my mind, there are no reasons not to control your blood pressure--it's the primary driving force behind heart attack and stroke according to most studies.  The media (and your CDE) over estimate the impact diet has on these in my mind.

September 2014 A1C 5.9%
March 2014 A1C 6.0%
December 2013 A1C 6.2%
June 2013 A1C 6.0%
December 2012 FBG 142, A1C 5.3%
June 2012 FBG: 154, A1C 5.9%

No meds--normal weight, mod-carb diet, exercise
Super Advisor
TikTok2
Total Posts: 2,153
Registered on: ‎05-13-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

Thanks again.

 

As I read, I think meds would be a good idea, I shouldn't be avoiding them....so long as I can tolerate the side effects....for me, side effects are often the problem...reading more to so which have the least vs worst side effects.....

 

TikTok2

• Diabetes on both sides of my family.
• Assumed trouble metabolizing sugar as long as I can remember; migraines induced by hunger, very sleepy after meals high in carbohydrates from childhood. Learned how to avoid sugar and lots of complex carbs early on.
• Since early 2000s, "prediabetes" controlled through low carb diet and exercise, mostly walking. FBG 95-105, A1c below 6; glucose tolerance test was borderline.
• But weight drifted upwards but working on it.
• NAFLD brought under control with pravastatin.
• Metformin ER, 500 mg, started sept 2013 when A1c reached 6.5 despite diet and exercise regiment since early 2000s. A1c back down to ~6.0.
Super Advisor
TikTok2
Total Posts: 2,153
Registered on: ‎05-13-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

Also, I think one of my challenges will be my muscle relaxant zanaflex. It lowers my BP when I take it.....looking at drug drug interactions now...

TikTok2

• Diabetes on both sides of my family.
• Assumed trouble metabolizing sugar as long as I can remember; migraines induced by hunger, very sleepy after meals high in carbohydrates from childhood. Learned how to avoid sugar and lots of complex carbs early on.
• Since early 2000s, "prediabetes" controlled through low carb diet and exercise, mostly walking. FBG 95-105, A1c below 6; glucose tolerance test was borderline.
• But weight drifted upwards but working on it.
• NAFLD brought under control with pravastatin.
• Metformin ER, 500 mg, started sept 2013 when A1c reached 6.5 despite diet and exercise regiment since early 2000s. A1c back down to ~6.0.
Trusted Contributor
morrisolder
Total Posts: 10,537
Registered on: ‎11-28-2009

Re: High Blood Pressure: Which Meds do you take, What else do you do?

I high fived 1lainey's first post because she said most of what I was going to say...

 

First off, your 130-140/80-90 is very much in the  normal range according to the latest guidelines on blood pressure, which actually raised the targets for people with and without diabetes. As my kidney doctor explained it, yes, studies did show that people with the 120/80 target were developing fewer problems, so in the past targets were set there.  But analysis revealed that the people who were aiming for 120/80 and having less heart attacks and strokes, were not reaching those numbers--they were more typically in the 130-140/80-90 range. So the numbers you are seeing may be just fine, if that is where you pretty much consistently are.

 

Second off, sodium elevates blood sugar in only something like 15-20% of people, not everyone. And 70% of all sodium in the American diet comes from processed, manufactured foods. So if you are eating natural foods, cooking from scratch for the most part, you probably would gain nothing from trying to eliminated more sodium from your diet--in fact doing so could cause other problems. I am an example of that--it took me years to discover that the source of my excruciatingly painful nighttime calf cramps was not enough sodium. Once I started salting my vegetables, the cramps went away, and if I ever get one now, I get up and eat some salty crackers, and there are no more that night.  Used to be that if I had one, I would have 5 or 8 more cramps that night--not any more. I had already explored other possible deficiencies that migh be causing those cramps, and tried switching statins seveal times, blaming it on them, but in reality it was low sodium at times...

 

Lisinopril, captopril and other ACE Inhibitors are the preferred med for high blood pressure in diabetes because they attack high blood pressure in the kidneys directly, and that is one area where high blood pressure can be most devastatng for people with diabertes. Enough so that doctors often set lower blood pressure for people with diabetes than for the general population--high blood glucose is the other big cause of kidney disease. Only real side effect I have ever heard mentioned is a dry cough, but I have never experienced that.

 

One contra-indicated class of blood pressure meds for patients with diabetes is beta blockers, which have the side effect of hypoglycemia unawareness.  Especially if you are trying to keep normal levels, especially if you use insulin or any drug that spaks insulin production, these would be ones to steer clear of.  Part of our helthy funcitioning is to know when we are starting to go low, so that we can avoid going lower...

Morris

Diagnosed Type 2, with an A1c of 11.4 in 2003; averaging a 5.0 A1c since then with diet, exercise and Glipizide XL + meds for blood pressure and cholesterol. 
A bit dated, but scroll down on this page if you want to know more ...


Established Advisor
MariaFan
Total Posts: 3,869
Registered on: ‎12-21-2012

Re: High Blood Pressure: Which Meds do you take, What else do you do?

I take 2.5mG of Lisinopril in the mornings, but only for the kidney protection.

There have been times in the past where my BP has been really high,

but that was always after getting hurt to the point I had to go to the ER.

My BP's are usually in the 120-130 / 75-85 range.

 

I do have the dry cough associated with Lisinopril, but it's really no big deal to me.

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How do you like my newest Maria avatar? Isn't she lovely? :heart: :heart: :heart:

♫ ♫ Dancin' In The Moon Light, and Fighting The Good Fight ♫ ♫
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T2 - Official since 2011. Unofficial probably since 1980.
Hoping to stay in the 5% club.
Valued Contributor
marty1955
Total Posts: 8,481
Registered on: ‎05-12-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

Tiktok, after fighting high blood pressure since I was in my early twenties, I have been on several different medications during the period.  Lisinopril worked best for me and since losing weight and getting my thyroid levels under control I don't have a problem anymore.  My doctor has cut my lisinopril to 10 mg. as of October, and if they continue to stay at the range I am now, the medicine will be reduced to the minimum 2.5 mg. for kidney protection.  My last reading was 108/60.  I go once a month to have it monitored.  I will be going back to my doc in April, and she indicated if I was holding were I am at present, we would try reducing the Lisinopril dosage at that time.  She really likes to keep track of my blood pressure and there is no charge to drop by the office for a check once a month.

 

Salt issues, not eating pre-packaged foods helps with my sodium intake.  I certainly do not eat a low-sodium diet; it never seemed to make a difference in my control when I did before. 

 

Marty

"The road to success is always under construction."
- Lily Tomlin

01/2013 - diagnosed with T2 and hypothyroidism
A1c - 7.2
04/16/2013 - A1c 6.1
07/24/2013 - A1c 5.8 (bayernow)
09/21/2013 - A1c 5.6 (bayernow)
10/10/2013 - A1c 5.7
04/30/2014 - A1c 5.5
500 mg Metformin/1 per day
Low Carb
Beginning weight - 183
08/27/2013 - 143
10/03/2013 - 141
12/05/2013 - 138
Blood Pressure 12/05/2013 - 118/60
Blood Pressure 02/2014 - 106/54 (too low, medication cut to maintenance dose)
Blood Pressure 04/29/2014 - 110/65
T2 paternal grandmother, father, two sisters, my current and my ex husband

Super Advisor
TikTok2
Total Posts: 2,153
Registered on: ‎05-13-2013

Re: High Blood Pressure: Which Meds do you take, What else do you do?

Thank you all for the good advice. I think I'm better prepared for the visit with my GP. 

 

Not sure still if I want to start BP meds or not, but now have the knowledge I need to have an intelligent conversation with my GP.

 

I took my BP at home on saturday night when I still had the UTI. It was ~130s/80s? It was "borderline high".

 

Took it again yesterday evening, after the antibiotics had a chance to kick in. It was 110/60. My husband thought something must be wrong, so we did the other arm: 112/60. 

 

So maybe my BP like my BG fluctuates a lot depending on my overall health: infection (bacterial or viral, flaring from autoinflammatory stuff or not, etc). I've notice this for BG. Maybe now my BP is also an easy to record marker of overall health?

 

It would help explain the large variations I see.

 

 

TikTok2

• Diabetes on both sides of my family.
• Assumed trouble metabolizing sugar as long as I can remember; migraines induced by hunger, very sleepy after meals high in carbohydrates from childhood. Learned how to avoid sugar and lots of complex carbs early on.
• Since early 2000s, "prediabetes" controlled through low carb diet and exercise, mostly walking. FBG 95-105, A1c below 6; glucose tolerance test was borderline.
• But weight drifted upwards but working on it.
• NAFLD brought under control with pravastatin.
• Metformin ER, 500 mg, started sept 2013 when A1c reached 6.5 despite diet and exercise regiment since early 2000s. A1c back down to ~6.0.