You and your parents are among the almost one-third of Americans who have high blood pressure or hypertension. Fortunately each of you has been diagnosed and treatment has been commenced. This is important because blood pressure that is too high can lead to strokes, heart attacks, heart failure, blood vessel aneurysms, blood vessel disease of the limbs and sudden death. High blood pressure can even complicate pregnancy and cause problems for the baby as well as the mother. When high blood pressure is added to the other risk factors that science has identified (elevated age, gender, impaired sugar tolerance- insulin resistance syndrome-diabetes, cigarette smoking, family history of early cardiovascular disease, obesity), the likelihood of catastrophe increases.
There are actually two different questions here. Why do you have different doctors? And why did each doctor choose different medications. These questions may be actually related to one another.
Perhaps you picked your primary physician due to your insurance plan, or by prior experience with your physician, gender, age, clinical experience, doctor’s personality, distance from your home or work, or a host of other factors. The goal of course is to find someone to be on your side, to help with health issues in your life, to prevent problems when possible, to treat problems when necessary. We each need someone that we are comfortable with and trust.
With respect to medications for blood pressure, the answer may be similar in that they must prevent problems when possible and treat problems when necessary for the most part by lowering the blood pressure. The drug must be comfortable to take (not ten times per day), and reliable. Approximately 200 such medicines exist in the US. Some of these are available as combinations (think of Tylenol sinus being different from regular Tylenol); to make things more confusing, many drugs are called by their generic name, others by a brand name, and some are “branded generic” names. This can cause some problems when people aren’t aware that the drugs are the same.
The goal is to get your blood pressure into a normal range without side effects, while improving chances of avoiding the problem caused by chronically high blood pressure. Doctors and patients are continuously assaulted by claims that one blood pressure agent or another works better to do this job and a myriad of studies are quoted. Whether or not a patient or a physician accepts the claims of one pharmaceutical company or another, there are other factors that may need to be considered:
- Chronic constipation (may be worsened by calcium channel blocking drugs)
- Migraines (may be prevented by certain calcium channel or beta blocking drugs)
- Kidney disease (may, depending upon severity be a reason to take, or not to take angiotensin rector blockers or converting enzyme inhibitors)
- Insurance issues
- Genetics (some families or races have genes that are more or less responsive to certain medicines)
- One size does not fill all
- Doctor preference
- Sample availability
- Affable or convincing salesperson
- Ease in recalling drug name
- Prior experience with certain medications
- Economics (doctors are people too. If the insurance payer economically punishes physicians for using more expensive drugs, they won’t be used)
- Recent medical literature