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ARE ALL ANTIHYPERTENSIVE DRUGS "IMPOTENT"?
O P Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Hypertension is the most common diagnosis made by the GP and the patient is sentenced to life time drug therapy on a single reading of the blood pressure! This is very unfortunate for the patient. I want to draw the attention of the doctors that in my opinion, most of the drugs used in the treatment of hypertension are impotent.I see many doctors doubling the dose of the drugs and adding 2 or 3 drugs, trying to control the BP without reducing the weight of the patient or the sodium intake or the alcoholic intake and without advising a brisk walk daily to reduce the BP (with so much faith in these drugs). In my practice I do not trust 100% in drugs which are introduced to me to lower the BP in a hypertensive patient. Thus I use any drug which comes to my pen in any dose as long as the patient follows other instructions mentioned above and has not come for a "complaint" and the detection of hypertension is an incidental finding.
I am confused because of the following observations:
1.I have been using betablockers like propranolol in young women having very frequent attacks of migraine when their normal systolic BP was 100 mm or even less. They should have developed severe hypotension (if these drugs really reduce the BP!!), instead bradycardia is always noted.2.By now I have used alpha blockers like prazocin not only in the dose of 1 mg but very often 2 mg and quite often 5 mg dose in elderly patients having symptoms of prostatism. This has neither caused any postural hypotension nor any other symptoms of hypotension to warrant omission of this drug.
3.ACE inhibitors like ramipril have been shown to prevent all the serious complications of heart, brain and the kidney in severe diabetic patients when used in a dose of 10 mg/day. I have started using this dose because of very convincing statistical evidence brought out in the "Hope" study. Since our allopathic medicine is based on statistical evidence, I have been prescribing 10 mg tablets (and not 2.5 or 5 mg which the doctors prescribe for BP) to all moderately severe diabetic patients.
In a number of these diabetic patients the BP was 110/120 when I put them on this tablet and explained to them the usefulness of the idea of giving them this tablet. Not one of these patients have complained of any symptoms due to fall of BP!!
4.In the past I often used serpina as a tranquilliser with patients having normal BP and the BP did not fall.
In the above circumstances how can I accept that the above drugs produce a fall of BP and should be prescribed in lowering the BP?The explanation might lie in the following observations :
i)Off and on I take 1 gm of paracetamol to relieve migraine headache. I also suffer from knee pain due to osteo-arthritis specially on the days when I have played more tennis. I do not prescribe nor take any NSAID group of drugs for the knee pain of osteo-arthritis because of their side effects, but the safest drug which I do prescribe to some of these patients with severe knee pain is paracetamol in a dose of as much as 4-6 gms per day which is quite safe even when taken for a long time.I wish to draw the attention to the fact that the day I had migraine (and also moderately severe knee pain), the migraine headache subsided but the knee pain did not respond. On the other days, whenever I played too much tennis and I got severe pain I swallowed 1 gm of paracetamol which gave me relief. Thus the same drug is working "selectively".
ii)My obsesrvation years back when I worked on the statistical data on the deaths following penicillin injection, was all the deaths had occurred in patients when penicillin injection was, really speaking, not indicated or could be substituted by other oral anti-biotics.
Vice versa in those days, in the OPD clinics of the V.D. Department where the nurses used to inject penicillin to patients having syphilis (to as many as 40-50 patients per day), never faced a single anaphylactic shock nor did a single death take place!
My conclusion was that if penicillin injection is given to a patient when it is indicated, you need not fear anaphylactic shock or death!
Should the above observations possibly explain the impressions created in my mind about the drugs used in treating hypertension!!
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