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Getting Off (Or Avoiding) Blood Pressure Meds

Posted 01/05/2015

If you’re currently taking a blood pressure medication OR your doctor has remarked that she’ll be keeping an eye on your “borderline” high blood pressure OR high blood pressure runs in your family and you have concerns about it, please read this Health Tip closely. The issues surrounding blood pressure are far more complicated than you might guess.

Importantly, your doctor, who we can safely assume intends the best for your health, may be basing her recommendations and prescribing your medication on what she may not know is actually some very controversial information. She simply may not be aware that she’s starting you on what could be decades of inappropriate medication for a condition you don’t really have…and one that isn’t even dangerous to your health.

In fact, based on new government guidelines in which your doc is paid less by insurance companies for failing to reach certain clinical goals (like getting your blood pressure down to a designated low number), she may be encouraged to prescribe more meds for your potentially non-existent elevated blood pressure. Read that sentence a couple of times and let it sink in. It means if your blood pressure is not at a particular “normal” level AND your doctor has failed to give you medication to reach that level, she can be financially penalized, even if your actual blood pressure level is totally harmless to your health. Tell me that’s not just a little bit spooky.

Part One: what exactly is “normal” blood pressure?
This simple question is actually fraught with controversy, backbiting, scandal, and truly egregious self-serving behavior on the part of highly placed–and highly paid–physicians, drug companies, and apparently neutral organizations like the Food and Drug Administration (FDA) and the World Health Organization (WHO). For an idea of how the answer to this question has shifted, if you have some spare time take a look at this piece, which examines the scope of change in high blood pressure treatment over the course of a decade.

If you remember what I wrote about statins and high cholesterol–that lowering the number for ideal cholesterol meant an increase of multiple millions of statin users–precisely the same sequence of events has occurred with high blood pressure meds.

Over the years there have been numerous studies, all but one financially supported by the pharmaceutical industry, to determine a risk-free blood pressure number. When I was first in training, I learned that blood pressure levels normally rose with a person’s age. The magic formula we were taught? The systolic reading (the top number) was 100 plus your age. The bottom number should be 90 or lower.

Thus, a healthy blood pressure for a 50-year-old could be 150/90. Basically, you started treatment when someone’s blood pressure was 160/100 or higher. I remember one professor saying he preferred 160/95.

But then a series of studies began to appear in the US and Europe saying that the risks for heart disease and stroke increased if that formula (100 plus your age) was followed, and the ideal blood pressure was reported as 120/80, with treatment beginning at 140/90. And here’s where the controversy began.

Change the number, create a patient
Although data did show that patients with consistent blood pressure higher than 140/90 were at some risk for heart attack and stroke, there was not much evidence that using more meds to drive the blood pressure further down–to that magic 120/80–really prevented much of anything. And it certainly increased pill taking, side effects, and symptoms due to blood pressures actually dropping too low.

From Big Pharma’s perspective, “change the number, create a patient” is an important phrase, possibly a central tenet:

  • Bringing total cholesterol down to an ideal number anywhere below 200 with an LDL (the bad cholesterol) below 70 hits the financial jackpot. These strict guidelines will increase the number of potential statin users from 12.8 to 48 million.
  • Adjusting “ideal” blood pressure from 160/100 to 140/90 added 13.5 million new drug users. Trying to medicate people with 140/90 BP to even lower levels will add tens of millions more pill swallowers.

Added to the problem of changing the standards of what constitutes high blood pressure and what does not, doctors are well aware that most people get anxious in the doctor’s office and this itself drives up blood pressure. Called white-coat hypertension, this phenomenon has resulted in tens of thousands of utterly unnecessary blood pressure prescriptions.

I don’t mean now to deliberately trigger your TMJ, but it turns out that virtually every lead investigator of the studies that pushed blood pressure “normals” to lower levels had financial ties to the pharmaceutical industry, as did (and does) the FDA and WHO.

My take on normal blood pressure
So what’s normal? Most doctors agree it depends on the individual’s situation.

Let’s call 145/95 (taken at home, not in the doctor’s office, over a number of days) borderline high blood pressure.

If there are no other risk factors (smoking, overweight, diabetes, previous heart issues), I start treating at this point or anything higher with salt restriction and stress reduction, including yoga, tai chi or meditation. If there are risk factors such as those just listed, I’ll prescribe a medication and discuss the lifestyle changes outlined below.

Very high blood pressures, like 160/110 or higher, do require prompt pharmacological intervention.

Part Two: which medication?
Here’s where the infighting among physicians gets nasty. It turns out that every study that had drug money behind it recommended one or more drugs that were newly released at the time and therefore high-priced: beta blockers initially (like Inderal), then angiotensin-converting-enzyme inhibitors (ACE inhibitors such as Lisinopril), angiotensin II receptor blockers (ARBs such as Cozaar), and amlodipine (Norvasc).

But each of these had side effects and were often prescribed in various combinations, increasing the number of possible side effects. Also, driven by that artificially low magic number of 120/80 or lower, some people simply felt poorly having such low blood pressures. The meds didn’t magically place you right at 120/80. Sometimes they overshot the goal. For example, a blood pressure of 90/60 can make many an adult feel woozy and lightheaded.

(This from a patient: “My dad is on three blood pressure meds. He has to stand up real slowly or he gets lightheaded and once fainted.”

The only study with no drug money behind it, the ALLHAT study (short for Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), found that the oldest of the blood pressure meds, water pills called diuretics, were the very safest and had the very best outcomes for stroke and heart attack prevention.

Yes, there was fury.

Physicians receiving financial largesse from Big Pharma looked mightily for flaws in the ALLHAT study. The drug companies ran full-page ads in the Journal of the American Medical Association basically tweaking ALLHAT data in an attempt to prove their branded drugs were just as good as diuretics. But they weren’t. Diuretics were best.

With this background, what should you do?

  1. If you’re already taking blood pressure meds, work with your doctor when it comes to medication adjustment. Quitting or reducing blood pressure drugs is not a DIY project. If your physician doesn’t recommend going off your medication, ask him or her if you can be switched to a diuretic.
  1. If you don’t have your own blood pressure measuring device, buy one. It must be one that measures from your upper arm (not your wrist or finger), and if you’re obese be sure to get an extra-wide cuff. Take your blood pressure three to four times a week at the same time of day. Record all readings and bring them to your doctor. This will eliminate the white-coat hypertension issue.
  1. Seriously live by the DASH diet, which (don’t be shocked) emphasizes veggies, fruits, whole grains, fish, and poultry and limits salt, sugar, and red meats. Nibble celery, proven clinically to lower blood pressure.
  1. If you’re in the group of patients with severe high blood pressure–diastolic (bottom number) of 110 or higher–and your blood pressure is controlled on meds, stay on them. If you’re on several blood pressure medications and your at-home readings are good, your doc may at least be able to trim the number of meds you take.
  1. If you have mild high blood pressure and are on medication, or you’re borderline and your doctor is considering putting you on medication, be proactive. Lose weight, stop smoking, begin regular exercise, and reduce your salt intake. Learn stress reduction techniques such as yoga, meditation, and tai chi. Consider getting (and using!) a portable Resperate unit (which costs about $99 online), the only biofeedback device FDA-approved for high blood pressure.
  1. If, after your best efforts, you can’t budge your BP below 145/95, try taking two natural products in addition to your medication: Vasophil, containing the amino acid arginine, precursor of nitric oxide, which opens blood vessels (start with one capsule twice daily, increasing to two capsules twice daily if needed) and CoQ10 (UBQH 100 mg daily).
  1. If you do need a prescription med, start with a diuretic (Hydrochlorothiazide 25 mg daily or Dyazide one daily or Furosemide 20 mg daily).

Just don’t be a victim of the several superficially unbiased (but actually highly biased!) organizations that have their best interests, not yours, at heart.

Be well,
David Edelberg, MD

Leave a Comment

  1. Dr E says:

    Hi Eric
    Older patients can be VERY sensitive to prescription drugs. His 150/104 is decidedly high but his medication dose was probably too high as well.
    I would suggest starting at 1/4 his previous dose. If he was at 5 mg., get some 2.5 mg and use a half tab of these. Check BP at least every other day both lying down and standing. Increase by 1.25 mg a week (don’t go higher than original dose) and when numbers are good, remain there

  2. Cindy says:

    Hello, is it necessary to wean off of HCTZ?

  3. Patricia mays says:

    Dr. I am a 51 yr old female and I am on 4 blood pressure medications…this is worrisome to me. Can you give me any suggestion on how to go about talking with my docter about this…

  4. scott isom says:

    Thanks you for your help, I have been at 125/82 for years and still on blood pressure pills. I will work with my Dr now to get off of them.

    Thanks for your information!


  5. A Fashina says:

    I prayed God help and reward you greatly. Your article has helped in great depth. Very many thanks

  6. Gina says:

    Have you ever heard of Losartan causing muscle or joint pain? My hip and knee pain has been horrible since starting Losartan 100 mg. Dr. rolls her eyes when I mention this.

    Thank you so much for the informative articles regarding blood pressure. Really opened my eyes !

  7. Dr E says:

    Hi Gina
    This is from a website listing COMMON side effects of Losartan
    Cozaar (losartan) is an oral angiotensin receptor blocker (ARB) prescribed for the treatment of hypertension. Side effects of Cozaar include:

    stomach pain
    muscle cramps
    leg or back pain
    sleep problems (insomnia)
    tiredness, and
    cold or flu symptoms such as stuffy nose, sneezing, sore throat, fever, and cough

    Tell your doctor to memorize it and stop rolling his/her eyes

  8. Kathy says:

    Hello I have been on Labatol 200mg 3 x a day since and procardia xl since 2/4 after an emergency c section within 48 he’s I developed high blood pressure…. After getting released I have been on the pills until 4/12/17… I have been off labatol since 2/12 and procardia since 2/7/2017…. Do they cause any withdrawal symptoms? After using them?

  9. Dr E says:

    Hi Kathy
    No withdrawal symptoms BUT should be tapered rather than abruptly discontinued to avoid a rebound upswing of blood pressure

  10. Shanna says:

    Thank you very much for writing this article!!!
    I have a question for you- how can I safely stop taking hctz? I am on 25 mg and my bp is 110/70. Since starting on the meds I have lost weight, been exercising frequently and also take magnesium. A dr told me to stop taking the hctz but when I tried I swelled up within a day so started taking again 🙁
    I would really appreciate any advice you could provide on how to safely stop the med. Will my body be able to safely process water again??
    Kindest wishes!!

  11. Dr E says:

    Hi Shanna
    Cut it in half (12.5 mg) and take that dose daily for a week, then every other day for a week. Then just use it as needed for fluid retention

  12. Shanna says:

    Thank You Dr E,
    Can decreasing the hctz to half dose cause heart palpitations? I started taking a half dose on Monday but am noticing some mild swelling and irregular heart rate and some palpitations.
    Do you think I should get this checked out?

  13. Dave Allen says:

    My blood pressure was 140/90 my doctor put me on 50 mg of low Sartain now my blood pressure is 120/70 but I’m also taking 4500 mg of citrulline will that help my arteries and can I possibly reduce my losartan if not do you still think the citrulline is good for my arteries

  14. Dr E says:

    Hi Dave
    My own blood pressure stays at 140/90 and my cardiologist just shrugs and doesn’t write an rx. You could probably reduce to 50 mg of Losartan and follow the DASH diet

  15. Shanna says:

    Hi Dr E! Thank you again for writing this article! It has helped me a lot. Thanks for your suggestion to wean myself off of the HCTZ. I went down to half a pill and was experiencing irregular heart beat for 2 wks due to my body adjusting to handling extra water again but luckily 2 wks later that has subsided. My bp is still low 97/76 when I check it at home or 120/80 in dr office so I am going to go off the med altogether but am planning to wait until I get back from a trip next wk as I figure a long flight isn’t the best time to adjust to extra water again. I’m thinking I will go down to a quarter pill and then nothing since I had a reaction going from a whole to half. Crazy all the side effects are of these meds that people are taking who don’t really need them. It’s amazing that walking every day can be the type of perscription many of us need. I am already feeling much better and less dehydrated even going from a whole pill to half.
    Thanks again!!!

  16. Marilyn Overcash says:

    Thank you so much. This is the best article I have ever read. I am taking Losartan and diltalzipam and feel horrible. I know the diltizapam has made me gain at least 20 pounds. Do you have any advice about this?

  17. Dee says:

    I love this article. This all rings true for me based on my own research. I just started taking hydrochlorithiazide 12.5 daily for hypertension 100/160. I’m a 57 yo African American female. I want to eventually eliminate all medications by losing weight( btw my bmi is 24.5) and reducing salt, sugar and “bad fats”. I was told African-Americans have higher rates of hypertension. What is your take on this idea?

  18. Dr E says:

    Hi Marilyn
    The villain is most likely the diltiazem. Talk to your doctor about switching you to a med from a different family or going off it altogether

  19. Dr E says:

    Hi Dee
    Your hydrochlorthiazide dose is really low but I don’t know where your blood pressure was when you started it. You might ask your doctor about taking half tablets (6.25 mg) and see if your blood pressure stays low.
    At 6.25 mg your doctor may decide you really don;t need anything

  20. Chuck says:

    Hi Doc, I am a 42 year old male. Over the past two years I have made some amazing changes to my overall health! I used to be 200lbs (I am 5’10’). I excersize regularly and eating healthy, except when I endulge I sometimes go overboard. My current weight is at 180lbs, I run at least 3x a week and trying to incorporate strength training. I am working on a half-marathon, so you get a big picture of my physical activity. I have been finding my blood pressure averages around 150/90 and sometimes 160/100 when I’m stressed. If I sit and breath for my next reading I can get it to 140/90! I started my health change journey because I did not want to end up on meds. I have also had high cholesterol. For a while I was able to get my BP to 120/70! But the high readings are back! It’s become frustrating and I’m concerned that my doctor will want me to take meds! I am taking coq10 l-Argenine and hibiscus tea (it seemed to help before). So, question is what do I do? I really don’t want to go on meds, but I don’t want to be unsafe. How much time do I have to try and correct this again? I have no symptoms by the way. I do drinks 3-4 cups of coffee too. Ok. Hoping to hear from you. Thanks.

  21. Dr E says:

    Hi Chuck

    Read about this product. It actually works for your level of blood pressure. Available direct from company or from amazo


  22. Josephine says:

    Thank god there’s somebody out there telling you the truth

  23. This information was very helpful. Thank you.

  24. Jon says:

    Two weeks ago I drank little too much alcohol, nothing extreme though. I got little hangover the next day, then I started too feel little dizzy and heavy over the chest, this stayed for two more days, the third day I had my BP checked and it was 180/110, went to the hospital and got medicine that I put under my tounge. Next day the pressure was up to 140/100, that day I saw a doctor he subscribed me to Benicar HCT 20mg/12,5mg, BP is well down usually around 120/80, but my head feel dizzy, any recommendation would be well appreciated.

  25. Victoria Grant says:

    Thank you, I know that this is the right approach for me. It puts my mind at ease, constantly fighting with my Doctor has become a nightmare, worst than the diagnosis.

  26. Dr E says:

    Hi Jon
    Most likely the rise in blood pressure occurred because of alcohol and hangover. That said, I wouldn’t abruptly stop the medication but work with your doctor to reduce the dose and then perhaps discontinue it altogether. Don’t do this w/o physician supervision–it is possible that you do need BP meds after all

  27. Yvonne Worsdell says:

    Am currently coming off almond opine I.e. Stopped. Am having withdrawal symptoms tired etc but not as bad as symptoms on the drug after 2 years. According to your article I wonder if I even needed a bp pill.

  28. Dr E says:

    Hi Yvonne
    Just make sure you or your physician is following your blood pressure during the weeks after you’ve discontinued your medication. Remember, not everyone can go off BP meds–some people simply just need to be on something

  29. Judy Baldwin says:

    I have been taking lisinopril 5 ml sometimes 10ml for a year. When I first started I was 25 pounds heavier. I have now lost all that weight and exercise and started feeling really lightheaded… Because I think the medicine was too much. I got off the medicine six days ago. My blood pressure’s in the 120s /70’s

    How long does it take to get lisinopril out of my system? I still feel lightheaded pretty consistently through the day.

  30. Dr E says:

    Hi Judy
    Keep yourself well hydrated, and, for no more than a week, be more generous with your salt than you’d probably been advised to do. The lightheadedness should clear.
    Congrats on your excellent self-care

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