High blood pressure can be a 'silent killer.' So why do so many people avoid medication?

Prescription medications are a major component of the American lifestyle. According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, 49% of Americans took at least one prescription medication in the past 30 days, 24% took three or more, and 13% took five or more. In nearly 70% of physician office visits, the main purpose has to do with prescription drugs, and one of the most prevalent prescriptions is blood pressure medication.

There is no doubt that prescription medications for blood pressure are effective and can greatly reduce the risks of stroke and heart attack. Even so, and with all the emphasis placed on the importance of prescription medications in our healthcare system, patient adherence is abysmal. According to recent research studies, adherence, which means not only taking your medications but also taking medications exactly as prescribed, is as low as 50%.

So, what can we do?

Why high blood pressure is known as the 'silent killer'

When it comes to high blood pressure, there is little incentive to take your medications faithfully. Why not? When you have pain or other symptoms, it’s obvious and you seek relief. On the other hand, if you have high blood pressure, there probably is no indication, even if your blood pressure is sky-high.

Here is an example.

Years ago, my lab at the University of Louisville offered screening for folks who intended to start a vigorous exercise program. The screening was comprehensive, including blood tests (cholesterol, triglycerides, glucose, etc.), an assessment of body fatness, and a treadmill stress test supervised by a nurse and a cardiologist. Prior to the stress test, the client reclined on an examination table for a resting EKG and blood pressure.

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On one memorable occasion, the nurse measured the blood pressure of a middle-aged male who by all external appearances seemed to be in pretty good shape. She then asked the cardiologist to take a reading, and he did, then repeated it.

I watched as the cardiologist asked, “Sir, are you aware that you have high blood pressure?”

The response was, “Really? I thought it was gone.”

The man went on to explain that his doctor had prescribed medication to bring down his blood pressure, and he took it as directed. The medication worked well and brought his blood pressure down to the desired level, so he stopped taking it. In other words, he figured his blood pressure medication worked like an antibiotic. Take it for a while to wipe out the high blood pressure then stop.

As I recall, his blood pressure was amazingly high, with a systolic pressure well above 200 and a diastolic pressure of 130. (For context, normal blood pressure for most adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80.) But more importantly, there were no symptoms of any kind, even though such high pressure was wreaking havoc on his cardiovascular system.

The lack of symptoms, even with extremely high pressures, is why they call high blood pressure the “silent killer.”

Why do people stop taking blood pressure medication?

Regarding adherence, in this case, it was due to a complete lack of understanding of the problem.

Other factors also can impact the lack of adherence to blood pressure medications. Oftentimes there is the need to take more than one medication, which can complicate things. The reason for multiple meds is that high blood pressure can come from various causes, and it’s difficult to pinpoint the exact cause initially, plus there may be more than one cause. Causes include: One, the heart may be pumping too rapidly and too hard. Two, the blood vessels may not be able to adjust properly by expanding or contracting when necessary. And, three, there may be too much fluid in the vessels. Each of these causes requires its own specialized medication and may require more than one.

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Adherence is less likely when you have to take meds more than once a day, when they must be taken at a particular time or when there are multiple health problems and each has its own medication.

A huge problem is side effects. When side effects occur, too often the patient will simply quit taking their meds, allowing blood pressure to climb. And worse, because patients don’t want to disappoint their doctor, they may not confess, leaving the doctor in the dark to wonder why the meds are not working. This can lead to a stronger dose and/or additional meds.

Why you need to talk to your doctor about medication side effects

Poor adherence and the bad health implications of not taking your blood pressure meds as prescribed underscores the need to partner with your doctor. This means communicating openly and honestly. If side effects occur, your doctor needs to know so that the dosage can be adjusted, or another medication prescribed instead. This may require several visits to get your meds right, but it’s worth the effort. And please know that your doctor will welcome your cooperation and determination.

My mother’s high blood pressure problem is another good example of what not to do. Throughout most of her adult life, she was considerably overweight and her doctor prescribed blood pressure meds accordingly. However, later in life, she discovered that she was pre-diabetic which inspired her to lose a lot of weight. Even so, her doctor did not adjust her meds, and in fact, at one point, she was on the original dose of four different blood pressure medications. She also was on cholesterol meds and several others.

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Eventually, my sisters and I convinced my mother to see another doctor.  He was surprised at all the medications she was taking, and like me, believed they could be cut back substantially. But how? He suggested that he take her off all meds and that she returns to his office every day for a checkup to see what meds she really needed. Amazingly, she didn’t need any of them, and many years later, on the day she died at age 93, she was free of all medications.

The bottom line is that my mother’s health would have improved greatly, and she could have avoided many of the complications she experienced if she had partnered openly and honestly with her doctor.

Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.