Have you recently been diagnosed with high blood pressure?
Is your doctor recommending that you take Hydrochlorothiazide but you are concerned
about the possible side effects?
If so, then this video is for you.
Keep watching to learn a little more about what side effects to watch out for and why
this can be an important medication for you.
Welcome to Family Med, I'm Dr. Richardson and this is your home for practical and accurate
information to help your family make healthy decisions.
This is the channel that focuses on bringing better health to your home.
On today's episode we are going to be talking about one of the most common medications that
we use to treat high blood pressure called hydrochlorothiazide.
To help us learn more about this medication I'm going to tell you the experience of one
of my patients who I recently started on this medication.
To protect her privacy we'll just call her Mary.
Mary is 52 years old and came in to me for her routine physical.
She's actually been a better patient than most and comes in for her usual checkups.
She has been trying over time to have a better lifestyle, she's been putting some effort
into her diet but has been struggling getting her exercise in.
We noticed that over the past couple years her blood pressure has been creeping up.
I talked to her a little bit about her parents and siblings and turns out that both her Father
and two of her sisters also have high blood pressure and are currently being treated for
it.
When I saw her in the office her blood pressure was 160/100.
She just had a pretty stressful day, as she was running late, had almost gotten in an
accident as she was coming to the office.
We let her sit for several minutes to calm down but when we repeated her blood pressure
it was still 153/96.
So with her current elevated blood pressure and the prior ones that we have been seeing
over the past year or so I diagnosed her with blood pressure.
At this point she was kind of resigned to it and wanted to learn a little more about
what she should do about it.
So, we had a great discussion about blood pressure and why it is so important to treat
it.
I told her that the reason we care about high blood pressure is because of the impact that
it can have on your overall health.
You see, high blood pressure is the leading cause of cardiovascular disease to include
heart attacks and strokes, as well as it plays a significant role in chronic kidney disease.
Oftentimes, we refer to high blood pressure as the silent killer.
Its called this because it typically doesn't have any symptoms.
When you take your blood pressure you get two numbers, the top number is called the
systolic blood pressure-this is the pressure your heart exerts on the vessels when it contracts.
The bottom number is called the diastolic blood pressure that's the resting pressure
in your blood vessels when your heart isn't beating.
Both numbers are important.
For most people we diagnose high blood pressure when your numbers are over 140 on the top
and 90 on the bottom on a consistent basis.
So in Mary's case with her blood pressures being 153/96, he was at an increased risk
of having a heart attack or stroke.
This certainly was a concern for her especially because she saw her Grandmother have a stroke
and had watched her suffer the last few years of her life from the effects of it.
She really wanted to know what to do to help decrease her risk of this.
She was hesitant to want to take anything for it though especially because she really
was feeling well otherwise.
I told her that she wasn't alone in that concern.
In fact, it's one of the harder things that I have to do is help people understand how
important it is to treat blood pressure, especially when you aren't having symptoms.
I told her that you don't want the first symptom to be a stroke.
That seemed to get her attention so she asked a little more about what would need to be
done.
We had a great discussion about diet and lifestyle changes.
We talked about how she needs to be exercising 5 times a week, avoiding excessive salt in
his diet, watching the refined carbohydrates and focusing on getting lots of fruits and
vegetables in his diet and ultimately working on some weight loss.
She felt that there were some things that she could do better with her lifestyle but
overall felt that she had been trying pretty well with those things.
She wanted to know what else could be done.
I explained to her that its very common that even with proper diet and exercise that you
can still have issues with high blood pressure.
Sometimes we need some extra help in controlling it so we aren't at such high a risk for the
complications from high blood pressure.
So ultimately I recommended that we start her on Hydrochlorothiazide to help control
her blood pressure.
Hydrochlorothiazide or oftentimes we call it by the abbreviation of HCTZ, is a medication
that has been available in the united states for over 50 years and is still one of the
safest and most effective medications to treat high blood pressure.
It's used principally to treat high blood pressure but is also used as a general diuretic
to reduce excessive swelling.
This is a medication that has been available in the United States since 1995.
It was first released under the trade name of Cozaar but has been generic since 2010
so is typically just referred to as Losartan.
It is used principly to control blood pressure but is also used to decrease how much fluid
is in the body for those with congestive heart failure, treat symptomatic swelling or edema
in legs and is even used to decrease risk of a certain kind of kidney stone.
Hydrochlorothiazide belongs to the class of medications called Thiazide Diuretics.
Thiazide diuretics like HCTZ work by blocking electrolytes like Sodium and Chloride in a
certain part of the kidney from being absorbed back in forcing water to leave the kidneys
as urine.
Basically it takes extra fluid from the blood and makes you pee it out.
By taking out the extra fluid from the blood it helps to lower how much volume is there
and lowers the blood pressure.
But the best part is not only do they help lower your blood pressure but they have also
been shown to help decrease the risk of heart attack and stroke and they can be quite effective
in most people.
This is why I felt this would be a good choice for Mary.
Mary wasn't a big fan of taking medication but knowing about how important it was to
treat her blood pressure she started to warm up to the idea.
She still had some concerns about taking them.
She was worried about whether she could even remember to take it.
This is always a concern with medication but Hydrochlorothiazide is pretty easy to take
as you only need to take it once a day.
It comes in a tablet of 12.5, 25, 50 mg.
Most studies have shown that the safest doses though for this medication is 12.5 and 25
mg.
I usually don't prescribe more than 25mg a day.
Another concern thats he had was whether it would be something that she had to stay on
her whole life.
This was a great question and one many don't like the answer to.
It's important to understand that with hydrochlorothiazide and any other blood pressure medication, it
only works while you are taking it.
We don't have anything that that will cure high blood pressure.
I explained that I have people come in all the time with their blood pressure high after
we originally had it controlled telling me that they stopped the medicine because we
fixed it.
Unfortunately, this isn't the way it works.
Unless you have some underlying lifestyle issues that are causing your high blood pressure
and you fix those, you need to stay on these medications.
Don't stop them unless you discuss it with your doctor.
Now, if you do make some significant lifestyle changes and your blood pressure starts to
drop then under the direction of your doctor they may be able to pull back on how much
you are taking or even get off of it.
This isn't the norm though and unfortunately, sometimes we just have high blood pressure
and in order to prevent that heart attack and stroke you need to stay on your medication.
So at this point I think I had her a little more convinced that this may be the route
that she wanted to take however she still was concerned about any side effects.
Fortunately for most people this is the great news about this medication.
Hydrochlorothiazide is usually well tolerated.
It's not very often that I have a patient want to stop it because of side effects.
That being said, any medication has a potential for side effects and HCTZ is no different.
I explained to her that the most common side effects that we tend to see with hydrochlorothiazide
are a some depletion of your electrolytes, sometimes this can cause some muscle cramps.
It can cause some dizziness, diarrhea, abdominal pain, headache, decreased appetite, sensitivity
to the sun and a feeling of weakness.
The most common one that I see is that it just makes you urinate more.
That's the whole point of taking it so it should be expected however if your lifestyle
makes it difficult to go to the bathroom often then you may have a problem with this medication
The other side effect that I see more often is dizziness or feeling light headed.
This usually is a sign that the medication is working too well.
If this happens typically you may notice that when you stand up you get that head rush feeling
and may feel like you are going to pass out.
If this is happening, concentrate on standing up slower, check your blood pressures and
bring those into your doctor so you can talk about it.
Sometimes all you need to do is adjust the dose.
There are more some more serious albeit rare reactions that you should be aware of and
watch for.
The more significant side effects to watch for are significant electrolyte imbalnces
like very low potassium or sodium levels.
It can put you at risk for pancreatitis, certain severe skin rashes, certain kind of anemias
and kidney failure.
All of these are very rare but is why its important that you followup closely with your
doctor.
We usually like to get semi frequent blood work done while on these treatments to make
sure that you are not having any of these problems.
So just like you, Mary, after hearing about some of these possibilities was a little nervous
about taking the medication.
But I'll tell you just like I told her.
You have to step back and look at the big picture.
The risk of these side effects is very small, some of which I've never seen.
So Don't let the fear of a rare side effect put you in danger of the very real risk that
untreated high blood pressure brings.
It would be the same as saying that you don't want to drive to the hospital when you are
sick because you might get in a car crash.
As long as you are paying attention to how your body is responding and following up closely
with your doctor while taking them you should be just fine.
That seemed to do the trick to help Mary be more comfortable starting on something like
this, but she still had one hangup.
She was worried because he had heard about how expensive medications can be.
Now Luckily I was able to calm her fears about this as well.
Hydrochlorothiazide is usually very affordable.
Most placed you can get a 30 day supply from between 4-5 dollars.
So Mary finally decided that this was the right course of treatment for her.
On the follow up visit her blood pressures dropped from 153/96 to 133/78.
She had a significant drop and was feeling a lot better.
She especially liked the fact that she wasn't retaining as much water and felt a lot less
bloated than she had before.
Subsequent blood work showed that her kidney's were doing just great in handling the medication.
Overall hydrochlorothiazide can be a great medication for most people.
It was for Mary, but like most medications they aren't for everybody.
If you are thinking about it for yourself there are a few groups of people that should
be cautions about taking it.
Those who should be cautious of taking it are those who have a significant allergy to
sulfa drugs, those who have significant kidney disease, severe liver disease, a history of
Gout, those who have lupus or are already prone to electrolyte disturbances.
Work with your doctor to find the right one for you
If diet and lifestyle changes have not been enough to control your blood pressure and
your doctor recommends that you take hydrochlorothiazide as part of your treatment regimen, hopefully
you have a little more confidence in using this as a part of your treatment plan.
This certainly isn't an all inclusive and in-depth discussion of everything that could
be told about this medication.
That's not what I'm trying to do here.
My purpose in sharing this information is to help give information that you can think
about and discuss with your own doctor.
Please don't take this as direct medical advice.
Take everything you learned today and discuss it with your doctor in how it applies to your
own situation.
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Now don't go anywhere, because if you are looking at ways that you can make that start
in your diet and lifestyle changes to treat your blood pressure click here to watch simple
steps you can take to start your diet journey.
If you are looking for another option to treat your blood pressure click here.
So until next tine, this is FamilyMed with Dr. Richardson and remember to take care of
your body because it's the only one you have.