I think that situation with blood pressure medications is crazy. Just think. When a patient is admitted to a hospital, doctor makes medication reconciliation. Doctor usually orders to continue blood pressure medications, but make a note, "Hold blood pressure medications if SBP is less than 110 or pulse is less than 60. I remember a patient who was in hospital with infection. He also was on blood pressure medications. These blood pressure medications were held during entire hospitalization because his blood pressure was always less than 110. Infection was treated, patient discharged, doctor ordered to continue all blood pressure medications at home. But that patient was hypotensive even without them! And of cause, doctor did not write an instruction for the patient to check his blood pressure at home and not to take meds when his blood pressure is too low.
After a started my home care job I became move convinced that blood pressure medications in doses they are ordered can do a lot of harm. A lot of people who are on blood pressure medications, particularly elderly, are hypotensive. But when I call MD regarding low blood pressure in my home care patents, doctors usually ignore my calls. Many elderly who are on blood pressure medications never check their blood pressure. Some do but it does not make a difference, because even if his/her blood pressure reading is 80/40 they still take their blood pressure medications, because "doctor told them to take pills very day without any exceptions." I remember my patient in home care who checked her blood pressure on regular bases and kept a record. She had symptoms of hypotension every time her systolic blood pressure dropped below 120. I called doctor many times asking him to order parameters for that patient. But doctors do not want to order such parameters for their patients who are at home even though a patient is able to monitor his/her blood pressure at home. In a hospital setting doctors have no problem to order parameters to hold blood pressure medications. I guess if doctors start to give such parameters to their patients who are at home, Big Pharma will lose a lot of money.
I also work in hospital. We often admit patients who fell at home. Most of the time they are elderly on blood pressure medications whose blood pressure upon arrival to hospital is in low 100's or less. I have never seen patients with status post fall whose blood pressure was 125-135/60 or so. It looks like that hypotension secondary to blood pressure medications or dehydration secondary to Furocemide is the main reason of falls among elderly. I started to doubt that blood pressure medications in the dosage they are ordered really prolong life. And I do believe that if doctors give their patients parameters when not to take blood pressure meds at home, the number of falls at home would decrease. But doctors are under Big Pharma control. And Big Pharma is too greedy...
Yes, I do understand diastolic hypertension with diastolic BP above 100 is very dangerous. I do understand that systolic BP above 200 is dangerous. But is it right to label systolic bp 140- 145 in elderly as hypertension and put pt on bloodpressure meds for the rest of his/her life, without instruction to monitor BP on regular basis and not to take it when BP is lower than 110?
Feb 26, '13
I agree completely, but it is not only a problem with patients at home. Had a resident in ltc facility on 4 bp meds. Wonder of wonders bp would by 80's over 40's. MD would stop all bp meds., and not order any bps be monitered. Checked bps weekly anyway---nursing judgement. Bps started to be 180's over 90's. MD put back on all 4 meds again, without perameters, or even an order to moniter bps. Went through this scenario 3 times before finally getting MD to order one bp med with parameters. Resident doing well at this time----but if not for constantly updating MD who knows what would have happened.
Feb 26, '13
Well, some people are on BP meds because of cardio and kidney protection. (Beta blockers and CCB good cardio protection. ACE & ARB for kidney) A systolic of 110 isn't exactly low. That patient with a Systolic of 80 probably needs BP med reduction but meds may be there because of past heart attack or protecting kidneys.
I would give meds if systolic was 110 unless order specifically said not to as in the case you mentioned, that isn't exactly too low. I don't start getting worried until I see less than 90 on systolic.
Feb 27, '13
I have HIGH BP. But in the hospital, or for one period during an extended home illness, I became hypotensive and my meds were not indicated at those times. My BP can vary greatly during periods of relative low activity.
My docs just give me orders based on my BP/circumstances. I think a lot of docs are amenable to that, maybe they just don't know how necessary it is...
Feb 27, '13
How right you are about doctors and their committed marriage to the pharmaceutical companies.
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