High blood pressure

High blood pressure

A year ago, an over-65’s health check (I am 70) showed that I have high blood pressure: around 169/81 with a pulse of 52. I was prescribed Amlodipine 5mg tablets and my blood pressure has dropped to around 145/73. But I suffered several unpleasant side effects, the worst being shortage of breath, especially when climbing hills, plus some muscle fatigue and leg cramps.

It got to the point where I felt I might have to give up riding with my club. (I do a road ride of 40 miles or so every weekend and a mountain bike ride of about 20 miles every Thursday.) When I mentioned this to my doctor, she suggested coming off the tablets for a couple of weeks. I did and felt 10 years younger; I could easily keep up with the fastest riders in the group. I think this shows that Amlopidine is not suitable for me. Is there anything else I could use for my blood pressure? I feel that my doctor does not understand the effects of these pills on cyclists.

WH Jackson

Hypertension (high blood pressure) is a common medical problem which is important as it increases the risk of other conditions including heart attack and stroke. It usually refers to a blood pressure above 140/90. Treatment is through a combination of lifestyle factors - such as a healthy diet, regular exercise, not smoking and maintaining a normal BMI - and medication.

Those medicines used for hypertension tend to be grouped together based on their mechanism of action. Amlodipine is a calcium-channel blocker. Other frequently used classes of drug are ACE inhibitors (e.g. lisinopril and ramipril) and thiazide diuretics (e.g. indapamide and bendroflumethiazide). Beta-blockers (e.g. atenolol) and alpha-blockers (e.g. doxazosin) are also used although not usually as first-line treatment.

All medications have side-effects but many of these are relatively minor and it is important to remember that a particular side-effect will not affect everyone taking a given drug. As you mention, some side-effects are not too troublesome and can often be tolerated. However, given the problems that you have experienced with shortness of breath while taking amlodipine, it would seem sensible to try another drug.

NICE provide some clear guidance on treatment of hypertension. In your age group, the next drug to try would be an ACE inhibitor such as lisinopril or ramipril, assuming there are no contra-indications. There is always an element of trial and error in the process as it is not always possible to predict which of us will get troublesome side-effects with any given medication. It is, however, usually possible to find one or more drugs which are both effective at controlling your blood pressure and acceptable to you in terms of adverse effects.

Dr Matt Brooks

 

This was first published in the April / May 2014 edition of Cycling UK's Cycle magazine.

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