Dr. Roccella: Many visitors to Sister to Sister's website are, of course, women and may have some questions about how blood pressure drugs might interfere with hormones. For example, should women who are taking contraceptives or those who are undergoing hormone replacement therapy be concerned?
Dr. Black: For the most part, blood pressure drugs have been carefully looked at and they don't interfere substantially with any major hormonal functions. However, there are a few exceptions. Some drugs increase calcium absorption, like diuretics. And there are drugs like spironolactone, which is another type of diuretic, that have some hormonal influences. Women who are thinking of getting pregnant or who are already pregnant should not use drugs like ACE inhibitors, or angiotensin receptor blockers.
Dr. Roccella: So Nancy, should women who are contemplating starting a family talk to their doctors if they are on the kinds of drugs Henry is talking about?
Ms. Houston Miller: I think it is important for physicians to know which medicines people are taking, and it's important to discuss the need for coming off those medicines if necessary during pregnancy.
Dr. Roccella: What kinds of side effects from blood pressure drugs do we usually see?
Dr. Black: We have a hierarchy of the drugs from the best tolerated down to the ones that are least tolerated, and I will try to focus on issues that I think are problems for women.
Drugs like angiotensin receptor blockers seem to be the best tolerated, and when we compare these to placebos it is very hard to see any difference in the complaints. Drugs that are called dihydropyridine calcium antagonists -- examples would be nifedipine and amlodipine and felodipine -- tend to cause edema, or swelling in the ankles. That is a particular problem for women. This is a dose-related issue that can be generally be dealt with by reducing the dose.
Drugs like diuretics can lower potassium, they can initiate gout in some people, and they can also cause some metabolic changes that can be an issue.
If you have diabetes, beta blockers and diuretics can make it hard to deal with. Alternatively, ACE inhibitors and angiotensin receptor blockers may actually improve the status of people with diabetes, especially with protein in the urine. And there are sympathetic blocking agents, which are drugs that work in the brain or the nervous system and can make you fatigued and tired, and so those are the things that some people have to deal with.
One of the things that I think is important, at least I've begun to realize it lately, is that a lot of the side effects we used to blame on drugs -- like nonspecific nausea, vomiting, fatigue -- we also see these problems in the study volunteers given placebo and so we attribute the problems to the placebo. And when we use very well-tolerated drugs like anagiotensin receptor blockers and ACE inhibitors, they may actually lower the rate of those side effects. So hypertension may not be asymptomatic after all. Some of the things that people used to tell us that we did not think were related to the condition, may well be.
Ms. Houston Miller: The other thing that I think is important for people to realize is that we are using some medicines that have side effects, such as diuretics, at much lower doses now than we did several years ago. If we can use these medicines at low doses and we combine them with others, we see fewer side effects.
Dr. Roccella: So you are telling me that patients shouldn't have to tolerate the side effects of blood pressure medication? That they should talk to their doctors about them and things can be done?
Dr. Black: They can conditionally be done. I think it is very important that the lines of communication be open; that you can say what's on your mind and your doctor or nurse is prepared to answer and work with you to find the best regimen. There are times, though, when you may have to tolerate some medication side effects because the consequences of not getting your blood pressure treated may be even more devastating.
Ms. Houston Miller: The other important thing along those lines is to make sure that, if at all possible, people don't just stop taking their medicines to avoid side effects. As Dr. Black has said, people need to have an open communication with their health care providers. Just knowing that we have somewhere between 100 and 150 regimens to consider, really increases the opportunity to get people on medicines that will control their blood pressure and without causing discomfort.
Dr. Roccella: What can you tell us about side effects like sexual dysfunction? We've seen studies that it is a barrier to controlling blood pressure because people stop taking medicines that are associated with this effect.
Dr. Black: I think the issue is much more out in the open than it was a decade ago, and one thing that is being appreciated is that ED, erectile dysfunction, and ED, endothelial dysfunction, go together. So a lot of the things that people used to blame their antihypertensives for are actually a function of their blood pressure and its effect on the tissues that line the arteries. We need to work hard to prevent that damage from happening early on, and appreciate that if you tell me that you do have problems with erectile dysfunction it can sometimes be reversible.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals