What is the best treatment for borderline labile hypertension? I’m 64 years old and am presently taking 20 milligrams Monopril and 180 milligrams verapamil each morning. My blood pressure can range from 150/93 in winter to 120/80 in summer. I cycle on a stationary bike three to four times weekly for about 40 minutes. I also play singles tennis three to five times weekly. Is there a better type of medication for me?
There are now so many very effective drugs to treat hypertension that it is impossible to say what is best. All drugs have some side effects, which may be more troublesome in some individuals than others. Effectiveness may also vary between individuals, and African Americans may benefit more from some medications and diuretics, than others. Also, some drugs have other beneficial effects that a physician may want to bring into play.
A group of drugs known a alpha adrenergic blockers, terazosin and others, may help men with prostatic enlargement urinate more effectively, and may reduce insulin resistance in some diabetics. ACE inhibitors, of which the Monopril that you are taking is an example, seem to provide extra protection against kidney disease, especially in diabetics. Calcium channel blockers, to which the verapamil that you are taking belongs, can provide side benefits in patients with angina or heartbeat irregularities.
The only drugs that have been shown in controlled studies to reduce long-term mortality, as opposed to bringing down the blood pressure, are hydrochlorothiazide, a diuretic, and beta-blockers, such as atenolol and propanolol. These are among the oldest hypertension treatments, and therefore studies showing a benefit on mortality have been possible.
It is quite likely that drugs such as monopril and calcium channel blockers will also reduce mortality (although short acting nifedipine (Procardia), a calcium channel blocker, has been shown to have a bad effect on mortality. The long-acting variety of nifedipine (Procardia XL) does not have this deleterious effect).
Your doctor needs to take into consideration your entire medical history and lifestyle when selecting the appropriate drugs, and may have to change drugs or dosages until you hit on the best combination. Don’t hesitate to tell your doctor of any side effects you experience, or any other problems, such as difficulty urinating. The drugs that you are taking are very standard and are a very effective treatment for hypertension.