Blood pressure medication

[50568789]

I've been on Ramipril and Bendroflumethiazide for years to manage hypertension, associated with T2 diabetes, and subsequently AF came into play, with betablockers and Rivaroxaban. But my blood pressure still kept creeping up, so the GP threw Doxazosin into the mix. This got the BP down to a better level, but I was peeing all night, so earlier this year the GP changed it to Tamsulosin, also to benefit benign enlarged prostate, and to be taken in evening as opposed to Ramipril in morning, I suppose not to lower BP too much in one go. So far so good (although still frequent pee breaks at night). The thing is......my RLS has come on leaps and bounds and is driving me nuts. I need all the sleep I can get, and I'm not getting it. To me the chief suspect is Tamsulosin. Options seem to be to stop it, and see what happens. Or take it mornings instead, along with Ramipril, and see what happens. Or go through the rigmarole of trying to get an appointment with a GP, and see what happens (what do you mean by RLS, they'll say). Any thoughts?

[BenHall1]

Hi,

Not sure if you have read the NHS definition of Bendroflumethiazide .... so forgive me if you know it but ..... "Bendroflumethiazide is a type of medicine called a diuretic. It's used to treat high blood pressure (hypertension) and the build-up of fluid in your body (oedema). Diuretics are sometimes called "water tablets" because they make you pee more. This helps get rid of extra fluid in your body".

So my personal adventure has been ..... between 2007 and Jan2010 my party bag of drugs was Ramipril, Simvastatin and Bendroflumethiazide. Ramipril for high BP and Simvastatin for Cholesterol. I never asked why I was on the Bendro ! On 6 Jan 2010 my BP went weird on me, dropping from around 136/80 ish down to 76/50 in a few hours. Saw my GP immediately, got sent to A & E and was diagnosed with paroxysmal AF. During my 6 days in hospital my Cardiac Consultant decided on the way forward as being medication. In sorting out my new party bag of drugs he dropped Bendroflumethiazide completely. I have never taken it since.

So when I was discharged back to the care of my GP my new party bag of drugs became, Ramipril (BP), Simvastatin ( Cholesterol), Warfarin my anticoagulant, Bisoprolol (5mg) my beta blocker. Bisoprolol I was told by the Consultant was being prescribed for HR control, although I have since learned it can assist with BP control - can't see any evidence of that with me though. Then my GP at the time in a regular medication review in 2014 added to the party bag Felodopine, to assist with BP control.. So for me my BP has been my problem child for years. After some 13 years on Bisoprolol I have just recently changed this to Nebivolol (2.5mg) following discussions with my GP and my Surgery Pharmacist. The reason for this was Bisoprolol making me so tired and wanting to sleep for England, not just dozing off BUT a full blown sleep. A QOL issue for sure.

Then I copped another problem .... got up one morning for work and pee'd, urine was a real red colour. Long story short, referred to Urologist Consultant result, a slightly enlarged prostate .... he decided to treat this with medication and on reviewing my party bag of drugs he prescribed Finasteride (5mg). So, now I take Ramipril, Finasteride and Felodopine first thing in morning AND Simvastatin, Nebivolol and Warfarin just before bed in the evening. Seems to work. Usually wake up once during the night for a pee but thats all. I'm now 78 and still drive double decker buses part time, sometimes they rope me in for a full 11 hour shift on a tourist bus route means I can handle two x 4 and half hour parts of the shift with a only one call of nature comfort stop - in my break.

Have you ever thought to discuss your medication, independantly of your GP, with a Pharmacist. Where I am most larger Pharmacies, like Boots, do have consultation facilities available and they maybe able to advise you better. By the way I haven't had an AF event thanks to meds and diet, for at least 18 months - maybe closer to 4 years - can't remember when.

Apologies for the length of this and my rambling and I hope it helps you. Good luck.

John

[Tigger_2 in reply to BenHall1]

There are four main groups of medication for hypertension. There may be others, but I remember them by ABCD

A is Angiotensin Coenzyme Inhibitor, B is Betablocker, C is Calcium Channel and D is Diuretic.

There are many variations within each group for example Bisoprolol and Atenolol and Losartan and Ramipril. our GP will choose what's best for you. Ramipril for instance, can cause a cough for some.

In my experience, GPs are better prescribers than hosoital doctors. My last prescription from hospital, increased Bisoprolol, is making my already slow erratic heart beat worse to the point of blacking out. No-one else can understand why they did it, but that's how it is.

[50568789 in reply to BenHall1]

Good on yer! Thanks for the info. I think the safest plan for me is to rattle my GPs cage and ask for a proper review.

[Ppiman]

Both doxazosin and tamsulosin are very similar (i.e. "alpha blockers") and are used to help relax the neck of the bladder when benign prostatic hypertrophy (BPH) is making peeing difficult; the latter is said to be a bit more selective on the bladder and prostate and to have less effect on the heart and BP. Evidence shows that tamsulosin can be taken at any time of day and to have no difference in effect on night-time peeing. Doxazosin isn't a drug used much to reduce blood pressure these days, I was told, being mainly used for BPH.

I was moved a while back from doxazosin to, first alfuzosin, and recently to tamsulosin as the cardiologist I saw didn't like doxazosin because of its cardiac effects. Since I moved to tamsulosin, my night-night peeing has increased but that might be just a coincidence as I tried switching back for a few nights and it made no difference. I could do without it as I have insomnia, too.

Evidence shows that blood pressure meds are more effective when taken at night.

I can't see how tamsulosin is causing RLS but that seems to be such a difficult complaint to deal with such that I doubt anyone knows quite what sets it off. My elderly friend has it sporadically and he has tried everything he knows over the years to reduce it, to no avail. It drives him nuts, too!

Steve

[2learn]

Hi, i take tamsulosin in the morning then ramipril and flecanide at night, you could try it that way.

[50568789 in reply to 2learn]

I assume that's working for you? I told GP my AF was now becoming intrusive (cardiologist's words on care pathway after echo cardiogram) and need to add extra control e.g flecainide. GP said not their decision, would have to refer it back to cardiologist. Hopefully the process will now start and I might be able to add flecainide into the mix one day.

[2learn in reply to 50568789]

seems to

[50568789]

Thanks for that, very helpful. I've managed to speak to GP and agreed to stop tamsulosin for a week or so to see if any effect on RLS, and blood pressure which I will also monitor. I am also on the RLS forum and there is quite a bit of adverse comment about tamsulosin, although RLS triggers are manifold and very hard to pin down. If my tamsulosin trial is inconclusive, I will then stop statins for a while to see if they are implicated - there is a body of thought that they are on the suspect list as well. All this might not get me anywhere, except maybe higher blood pressure and cholesterol and less urinary control while off the meds, and back to square one with RLS but with other avenues to follow.