When it comes to hypertension (HTN), many physicians strive to meet guidelines set up by the American College of Cardiology (ACC) and the American Heart Association (AHA). According to these organizations, “Normal BP” is anything below 120/80. “Elevated BP” is 120-129/<80 and “Stage 1 Hypertension” is 130-139/80-89 and requires “both nonpharmacologic and pharmacologic therapy.” If blood pressure doesn’t stay below 130/80 after several months the doctor should “consider intensification of therapy.” That can lead to multiple BP meds as this reader reports.
Beware Multiple BP Meds:
This reader was put on medications that could be causing hair loss and a dry (unproductive) cough.
Q. For years, I have been taking metoprolol along with lisinopril, amlodipine and losartan for high blood pressure. I have occasional bouts of anxiety in which my heart races. What has me really upset, though, is that I am losing my hair at an alarming rate.
I see that this might be a consequence of beta blockers like metoprolol. I want to stop this BP drug, but I’ve read that you can’t stop such meds suddenly.
I have also developed a dry cough that wakes me up in the middle of the night. Is this also related to the metoprolol?
Multiple BP Meds and Interactions:
A. Four blood pressure medicines may be excessive. In particular, we are concerned about combining an ACE inhibitor (lisinopril) together with an ARB (losartan). This combination may increase the chance of complications, including kidney problems, excessive potassium levels and blood pressure variability (Archives of Internal Medicine, Oct. 8, 2007).
Hyperkalemia and Multiple BP Meds:
Most people do not have their potassium levels routinely monitored. But if this essential mineral climbs too high in the blood stream it can lead to something called hyperkalemia. That can be dangerous if not deadly!
We stumbled upon a deadly drug interaction several years ago that involves the common antibiotic called co-trimoxazole (trimethoprim + sulfamethoxazole aka Bactrim or Septra aka TMP-SMX or TMP-SMZ). This antibiotic is commonly prescribed for UTIs (urinary tract infections and skin infections to name just two).
Canadian researchers discovered that when co-trimoxazole is added to ACE inhibitors such as lisinopril or ARBs like losartan or valsartan, potassium levels can climb rapidly. When potassium levels get too high, they can cause life-threatening heart rhythm disturbances.
This patient was not taking co-trimoxazole thank goodness. But combining an ACE inhibitor like lisinopril with an ARB such as losartan can lead to hyperkalemia. That is quite worrisome.
You can learn a lot more about how drugs like lisinopril, losartan and co-trimoxazole can lead to hyperkalemia at this link:
A Deadly Drug Interaction Often Ignored by Doctors and Pharmacists
Hair Loss and Beta Blockers:
How could hair loss be a drug side effect? This is one of the fascinating mysteries that has not been well explained. We do not know the mechanism whereby many medications cause this adverse reaction. What we do know is that beta blockers can do this.
Many health professionals perceive this as a minor complication. Our readers think otherwise. Here is a link to an article that reveals the impact of drug-induced alopecia (hair loss).
Hair Loss Side Effect from Beta Blockers Is Devastating
Bottom line: beta blockers like atenolol, metoprolol and propranolol can cause hair loss. To learn more about why multiple BP meds that include beta blockers can be challenging, here is a link. You will also learn why you can NEVER stop a beta blocker like metoprolol suddenly! Always consult the prescriber if you think you are taking multiple BP meds that are causing side effects.
Bump in the Road for Beta Blockers
When People Take Multiple BP Meds It Can Be Hard to Know the Culprit:
The reader who asked the question about metoprolol and hair loss also wanted to know about this:
“I have also developed a dry cough that wakes me up in the middle of the night. Is this also related to the metoprolol?”
Metoprolol is not likely to cause a cough, but that is a common adverse reaction of lisinopril and other ACE inhibitors. Here is a link to insights on the lisinopril cough:
Why Don’t Doctors Recognize Lisinopril Cough?
Why do so many doctors ignore the cause of a lisinopril cough? It would be as if a mechanic ignored the check engine light on your dashboard. It is NOT OK!
While a cough is less common with losartan, it can happen. Many health professionals don’t realize that ARBs like losartan and valsartan can also cause a cough. Learn more at this link.
Final Words:
Please ask your physician to reevaluate your regimen. To help you prepare for that conversation, you may want to consult our eGuide to Blood Pressure Solutions. This online resource can be found under the Health eGuides tab. It also has a number of nondrug ways to help control hypertension.
Please share your own blood pressure story in the comment section below.
