Warfarin and blood pressure medications

[Patricia1]

I'm following a thread on the Atrial Fibrillation Support Forum where I commented that I was taking Warfarin and medications for high blood pressure. Another member has just contacted me saying that her GP refused to put her on Warfarin because he said that Warfarin should not be used with medications for high blood pressure. She also said that she has looked for info about this on the Internet and came up with the same. Any comments?

[Rellim296]

Well, news to me! Any more specific details about which high blood pressure medication is supposedly unsuitable?

[Hidden]

Hi Patricia,

I am assuming you are in Britain and so my comments are made on this basis.

That's news to me - but hey - I might not have received the correct advice ! Before I was diagnosed with AF in Jan 2010 I was already on Simvastatin 40 mg ( for Cholesterol) and Ramipril 10 mg for high blood pressure.

Once diagnosed with AF I was put on Warfarin and Bisoprolol by my cardiologist at the time. No comment was ever made about mixing these meds. Since then I've twice had to come off Warfarin (under hospital supervision) for two separate medical procedures and then go back on Warfarin after each. No comments have ever been made.

I am still on all these meds at the moment, I control my AF with a combination of lifestyle, diet and meds with no problems at all (touch wood).

I would do a search of the NICE website about this with the view to challenging your GP. I have never seen this on the NICE website.

Have to say there are many GP's around who are still in prehistoric times and prescribing asprin as a front line anti coagulant - despite recommendations from NICE against this in that asprin is no defence against a stroke originating from an AF event. So it would be no surprise if your GP had developed some misunderstanding.

John

[BobD Volunteer]

Well I have been on both amlodopine and losartan for high BP as well as warfarin for ten years. This GP has some strange ideas. If you have AF , then hypotension is a bad thing as is lack of anticoagulation. Aspirin is about as useful as a chocolate fire guard for stroke prevention so if you have a suitable Chads or CHADSVASC score then you should be anticoagulated. Read up the fact sheets on the main website (AF Association) and go fight your corner. would be my advice. As John says many GPs are still in the dark ages.

How is the knee now John by the way?

Bob

[Hidden in reply to BobD]

Hiya Bob,

Knee seems to be pretty good thanks Bob, a bit of stiffness but no pain, and when I push the exercises I get a bit of a niggle. I feel ready to do without the crutches now and walk solo. Generally fed up with being stuck in doors and really feel a need to get more walking in. See Consultant tomorrow ( 29th) at which point I'll know where I stand. (in a manner of speaking - lol).

Did you ever get my tome on warfarin changes also additional comments on knee surgery?

Cheers

John

[BobD Volunteer in reply to Hidden]

Yes thanks John Very helpful.

[howesgilly]

As far as I am aware the risk is actually HAVING HIGH BLOOD PRESSURE and being on warfarin due to the increased risk of haemorrhagic stroke. However if you have a well controlled blood pressure with medication there is no problem.

[PeterWh]

Look on USA website drugs.com and then interactions checker

[marionclaire]

oh dear i am on warfarin and bp meds 2 years now coversyl, biopersol and warfafarin so far so good. no problems for about 8 months, touch wood.

[seasider18 in reply to marionclaire]

bisoprolol is OK with warfarin.

ncbi.nlm.nih.gov/pubmed/115...

[Barb1]

Near heard of that. I have been on both for 5 years. In my case the losartan and bisoprolol are to help my heart work more efficiently not because I have high BP.

[Halpin]

Good Morning Patricia. I take warfarin and blood pressure tablets. I have been talking them for some years now in addition to Beta blockers to regulate my heart. I have never heard of your Doctors comments before but in the first instance I would check with your local Pharmaist as they have more knowledge about drugs than your normal GP. Then irrespective of the answer from the Pharmaist I would look for a second medical opinion. It's your life and up to you to ensure that you protect it as best as you can. Am interested in the result you finally arrive at. Stay safe. James

[dgex2010]

Hi there, have been on blood pressure tablets for years and since being diagnosed with PAF in 2014 am now also on Warfarin and Bisoprolol - so far so good - so let`s hope your GP`s misinformed! Good luck with that one and all the best for 2016.

[ILowe]

Where did your GP get that information from? Over 20 years ago they were prescribing the whole range of blood pressure tablets for people on Warfarin. On the contrary: my consultants (note the plural) have all wanted me on the BP stuff BECAUSE I was on Warfarin for artificial valve then AF. The reasoning is, for me, they must take less risk.

The one book this GP should know backwards and consult daily is the British National Formulary. I believe that patients in UK can get free access for limited views. When I looked at a recent edition, I could not even find the possible interaction listed.

On the other hand. Why do you want blood pressure tablets? There is a growing body of evidence that for mild hypertension, there is absolutely no need for them: on the contrary, the need has been artificially created by drug companies to medicalise normal people and sell more medicines.

[seasider18 in reply to ILowe]

I take it that you are on warfarin for your AF as you have an artificial heart valve. Doctors and consultants are aware that NOAC's are contra indicated for patients with mechanical heart valves. Despite all of the makers saying that NOAC's are also contra indicated for patients with tissue valves cardiologists want to prescribe them for me saying that it is only because they have not been tested on tissue valve patients and they being Gods can overlook that. In fact one trial of NOACs for tissue valve patients was halted due to due to brain bleeds in patients.

drugtopics.modernmedicine.c...

FDA says healthcare professionals should promptly transition any patient with a mechanical heart valve who is taking dabigatran to another medication. It also notes that the use of dabigatran in patients with bioprosthetic valves “has not been evaluated and cannot be recommended.” Warfarin is the only oral anticoagulant indicated for thrombosis prevention in patients with mechanical prosthetic or bioprosthetic heart valves.

Section 1: Questions relating to indications/appropriateness of NOACs

My patient has AF and a prosthetic heart valve - is he eligible for a NOAC?

No - NOACs are not indicated in patients with rheumatic mitral stenosis, mechanical prosthetic heart valve or who have had a valve repair or a tissue valve replacement.

ggcprescribing.org.uk/media......

[ILowe in reply to seasider18]

Yes. mitral valve (which predisposes to AF) then AF, hence on lifetime warfarin. I am very happy with it. I am self testing and self dosing and would not hesitate to over-rule the advice of any medical professional for my case. The main comment from my cardiologist was interesting. Warfarin has been known for decades, and its use over decades is well known. Why be one of the long term experiments?

Back to the original question, I can confirm that I have been on several blood pressure tablets + warfarin, and their compatibility has been known for decades! But many believe now that treatment is NOT needed for 'mild hypertension' and, the best medicine, when needed, is a simple diuretic. See the material by Dr Malcolm Kendrick for instance.

[seasider18 in reply to ILowe]

Most people did well on warfarin but did not like the inconvenience of INR testing. It should be a available at times to suit working people.

Diuretics for some reason all gave me pelvic pain.

[ILowe in reply to seasider18]

"Should be available at all times". I agree. Along with a few other easy tests, there should be walk-in labs, anytime, anyone. Working people would be prepared to pay a small contribution to say charity to get a quick test at a convenient time in a convenient place. I have long thought that pharmacists could easily be trained to take blood. Nowadays, they could administer the Coaguchek finger prick or similar, and they are quite capable of doing the dosing.

"Diuretics give pain..." Well, the good news is, if you only have mild hypertension then tablets are not usually needed. I have stopped mine, though I check regularly to see if there has been any change. NB, it is change which is interesting, not the absolute level of the readings.

[seasider18 in reply to ILowe]

In some parts of the country INR testing is only done at pharmacies.

bics.nhs.uk/patient-informa...

[PeterWh in reply to seasider18]

Round here not done at GP's but by Anticoagulation service using phlebotomists.

[seasider18 in reply to PeterWh]

Our local hospital discontinued it. They also stopped phlebotomists from doing blood tests at local surgeries.

Going to the hospital for INR testing was time wasting as each visit took about two hours with a wait to be tested. Another wait for the result to come back and then to see the nurse.

After my aortic valve replacement when I first went into AF I was going twice a week until my INR had settled enough to be referred for testing at my GP's surgery.

[PeterWh in reply to seasider18]

The Anticoagulation service takes blood at four hospitals and then back to the lab for testing. For me I use the local memorial hospital clinic as so convenient. Less than 2 miles away, no parking charges, less than 10 minutes in there!!!

[ILowe in reply to seasider18]

At last. some common sense. "Specially trained" makes me laugh. I do it myself, after watching the Coaguchek video, and experimenting to get it habitually right. Dosage, I had one minute of comments at hospital, and have since then read up on it. It is really really easy, and phamacists who are the drugs specialists understand dosing better than most. I hope for the good of others that local solutions like this catch on.

[seasider18 in reply to ILowe]

The nurses at my GP practice hope that it does as they have 300 patients who are on Warfarin. One has a Monday afternoon devoted to it and both more or less all day Wednesday.

Housebound patients have been given coagucheck monitors and have set times to phone in their results.

[seasider18 in reply to ILowe]

I registered to use BNF quite a few years ago when my wife retired and no longer brought previous months editions home. You just need to stretch the truth slightly that your job has a need for prescribing information but actually I now refer more to drug.com.

[ILowe in reply to seasider18]

There is a new system for the BNF -- old registrations do not work. I think it says somewhere that patients can also access it for limited use. Indeed, why not. Afterall, we are in the business of personal health care decision making.

[seasider18 in reply to ILowe]

I just re-registered sometime last year. I've not noticed the limited use option. I also used to subscribe free to the BMJ but a problem developed when they moved their file server to Athens and I changed my E-Mail address

[gillyflower13]

Patricia1 if it helps at all i am nearly 80 and have had af now for years. After many years of different medications and hospital stays i have been advised to discontinue warfarin and take aspirin! Effects are less drastic to our bodies.

[Patricia1]

Thank you for all your replies. I have sent a copy of my post and your replies to the lady who contacted me and she said that she would let me know the outcome when she sees her GP in the new Year. I will update this post when I hear from her