I am on treatment for high blood pressure. I know that some medications cause side effects. What should I look for?

If you feel unwell and are taking tablets, do not stop or modify your treatment in any way, but contact your doctor. He will advise what changes or modifications are necessary. This is an important point to remember because a sudden stoppage of treatment can produce what is called a 'rebound effect' in the level of blood pressure (it shoots up).

Seek your doctor's advice if you experience any of the following symptoms, but do not alter your treatment on your own.

• headaches

• visual disturbances (blurred vision)

• shortness of breath

• chest pain

• altered ability to concentrate

• memory loss

• passing more urine at night

• sexual problems/erectile dysfunction (impotence)

Remember that some of these symptoms are just as likely to be due to your blood pressure rising as to it being overtreated, so you may need to change, reduce or increase your tablets.

I have heard that blood pressure pills can affect your sex life - is this true?

The short answer is sometimes. The usual complaint is of men failing to get an erection firm enough or lasting long enough for sexual intercourse. Blood pressure itself can cause this problem and only occasionally are the drugs used to treat it, e.g. diuretics, incriminated. If it is drug-induced it will occur in the first 2-4 weeks of therapy and a different drug can then be tried. The least likely drugs to cause male erectile dysfunction (ED) are the AII antagonists (see Table 2.2) and the alpha-blockers. Female problems with lack of arousal have been reported with beta-blockers. Both men and women can get sexual problems as a result of heart disease and sometimes its treatment; if you have a problem, talk about it with your doctor or practice nurse. There is more on this subject in Chapter 8.

While I am taking my tablets, can I lead a normal life or is there anything I should avoid doing?

Although treatment controls blood pressure effectively throughout the day, it is only sensible to avoid as much as possible any events or circumstances that increase your blood pressure, such as highly emotional or stressful situations (see the section Stress below) Keep your weight under control (Chapter 9), moderate your alcohol, fat and salt intake and give up cigarettes if you smoke; you should then be able to live as normal a life as possible, including a normal sex life. Above all, you should not consider yourself an invalid - you are not!

I am told that I have high blood pressure and need treatment, but I don't seem to have any symptoms. If I do not feel unwell, why should I need it?

Very often high blood pressure does not make you feel ill. This is possibly because the increase has been gradual over such a long time that you have adjusted to it. However, all the evidence shows that, if high blood pressure is left untreated, you have a greater chance of stroke, heart attacks and complications in the kidneys and eyes. When blood pressure is treated, there is overwhelming evidence that these risks are substantially reduced. Therefore, it is important, and in your interest, to take your medication exactly as prescribed by your doctor, even though you may feel quite well.

Now that I have been prescribed tablets, how long will my treatment last?

The treatment for high blood pressure, whether by lifestyle changes or drugs or both, continues for life, but as many of the medications used in its treatment need to be taken only once daily, interference with your normal lifestyle can be kept to a minimum in the majority of cases. Sometimes, if you have reached your target weight, you may have your tablets reduced or stopped, in order to see if you still need them. Ask your doctor if this is worth a try for you.

I don't mind taking one tablet a day, but one of my friends has so many that she rattles. Will these tablets be all that I need to take?

Most blood pressure patients end up on more than one medication. With some patients other factors or conditions may complicate the situation and treatment for these may also be required; you may then have to take several tablets a day. For example, if you develop angina, the tablets may need to be changed to relieve you of your chest pain (see the section Treatment in Chapter 3). If you develop diabetes, specific diabetic tablets may be needed. We try to tailor the treatment to the individual, aiming to keep your quality of life as good as possible - so if a diuretic causes gout, we can change to a beta-blocker, and so on. We try to give you the minimum of inconvenience, but also to keep you in good health.

My blood pressure seems to be resistant to many drugs and I have now been put on spironalactone. How is this different?

Spironalactone is a diuretic (water tablet) that antagonises a hormone called aldosterone. It can be very useful when the blood pressure is proving difficult to control. Kidney function needs to be monitored, and as it retains potassium caution is needed if used with ACE inhibitors or AIIs. The commonest side effects are stomach upsets and swollen breasts, mainly in men (gynaecomastia), which can be painful. Erection problems in men, and period changes in women, can also occur.

What should I do if I forget to take my tablets?

or most people, there is no need to worry, as the blood pressure will only rise slowly, so you can get back on schedule the next day. If you are on a beta-blocker and also have angina, you should take the medication immediately you realize that you have forgotten it, as a means of catching up.

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