Hi guys, my name is Sanjig uptime, a consultant cardiologist in York. Today I wanted to do a video on blood pressure and in particular I wanted to do this video on those people who have been diagnosed as having high blood pressure but who can't seem to tolerate blood pressure medication. So every time they give them a blood pressure tablet they get horrible side effects, they can't take the blood pressure tablet, they feel awful, then they go back and the GP gives them another blood pressure tablet and that doesn't work, that causes side effects and soon every single tablet that they're given they develop side effects to so they can't take any tablets, their blood pressure continues to remain up and this causes them a great deal of anxiety because they think oh my god what's gonna happen to me, my blood pressure is so high and I can't seem to take any tablets and it's horrible for these people because they feel so incredibly anxious. So I thought I would do a video on what to do if you have high blood pressure or if you've been told you have high blood pressure but can't seem to tolerate any tablets. Alright so I hope that you find this useful. The first thing to say is that up to 10% of patients who have high blood pressure are unable to tolerate medications for blood pressure so you're not alone alright. The second thing to say is that when I say 10% I mean that these 10% can't tolerate up to five or seven different blood pressure tablets so these are people who are intolerant to multiple agents. So if you are one of those people what do you do? Well we know a couple of interesting facts about these patients patients who don't tolerate multiple medications for blood pressure one they have a higher prevalence of four-fold higher prevalence of anxiety so they have an anxiety disorder you know a lot of such patients and the second thing it's worth knowing about is that they have a four-fold increase in gastrosophageal reflux and this is relevant because maybe some of these tablets that they're taking by mouth because they have reflux etc that can precipitate the reflux and that may be one of the reasons why people don't tolerate some of those medications. So they have a higher prevalence of anxiety they have a higher prevalence of reflux so if you're someone who's not able to tolerate those medications it may be worth asking yourself that do I suffer from anxiety and do I have reflux. The second thing to just then say is that of course then if you do suffer from anxiety and you are not tolerating the medications then of course your anxiety will get much worse because you're worried about your blood pressure. Remember the blood pressure in the short term is rarely ever dangerous unless it's very very high. The main really the main benefit of lowering the blood pressure is then the long term all right so just because you can't tolerate any medications at the moment please don't panic you know there are ways of getting around it and this is what I'm going to discuss. Now the first thing I would always recommend is if you have high blood pressure or if you've had high blood pressure that you have a 24-hour blood pressure monitor because the blood pressure will fluctuate all right so if you take it in the morning you have higher stress hormones the blood pressure will be higher if you've done it because you've been stressed at work the blood pressure will be higher if you're feeling anxious about your blood pressure being taken then that will also make your blood pressure higher so you cannot rely on isolated values you have to get a 24-hour average and therefore it's always a good idea where possible to get a 24-hour average and rarely will you find that on a 24-hour average will the blood pressure be as high as you think it to be isolated values are always much higher so when you do a 24-hour average it's generally lower than what you think okay it may not be normal it may not be what is considered normal but it may probably not be as high and that's important because it'll calm your anxiety down that your blood pressure is really not that high. The second thing I would say is it's always a good idea to see if there's anything in your lifestyle which can make your blood pressure come down naturally so for example if you are stressed during mindfulness etc will help your blood pressure come down if you carry extra weight the exercise in will bring your blood pressure down if you don't sleep or if you have sleep apnea then that can also affect blood pressure and if you treat that the blood pressure can come down so those are just kind of things that you should do anyway because they're natural ways by which the blood pressure can come down. Then I think it's worth saying well if you do get reflux it's worth treating the reflux okay so treating it by you know going and getting seen and getting that treated as a good idea because it may allow you to tolerate your medications better. Let's say you do all that and you still can't tolerate the medications. Here are a few tips that may allow you to tolerate medications a bit better and most of these tips are from a paper that was published in the Journal of Clinical Hypertension. This was published in August 2015 and the lead author is a guy called Sotiris Antunio. I'm going to put the link at the bottom of the video and I'll put it on my Facebook page but basically what these guys did is they looked to see if there were any strategies that could be used to bring down blood pressure in patients who are intolerant of lots of medications. What they say is that the first thing is that most of the intolerance, most of the side effects seem to be a dose-dependent side effect. I the higher the dose the more likelihood of getting side effects. So what they say is that actually if we used very very small doses but instead of using small doses of one agent if we use a mixture of small doses of two or three agents that is going to be far more effective at bringing your blood pressure down then are very high dose of only one agent because you're more likely to get side effects with a high dose of one agent than you are with low doses of multiple agents. So going down to very low doses but having a combination of different blood pressure tablets may work for you. The second thing then to say is that it is also known that some people are actually allergic to the capsule you know in which the medication is put. So if you take liquid form and many of the blood pressure medications can be taken as a liquid some people seem to tolerate that a lot better. So just taking it in liquid form may work. The third thing they suggest is even if you can't tolerate it orally sometimes you can get these patches for blood pressure lowering patches of various medications can be delivered trans-dermally but trans-dermally by wearing a patch and that may allow some people to tolerate blood pressure lowering medications a lot better. So that's another option. Then it is also worth knowing that actually you know there are other options available if none of these things work then there is something called renal denervation where you can actually use a catheter to affect the nerves around the kidneys and that can bring the blood pressure down. That's a very specialised thing and you probably want to go and see an expert who in resistant hypertension to see whether you would be suitable for it. It was very much in favour three or four years ago and then a study came out which didn't show as much of a benefit from it and therefore it then sort of went out of favour but there are some centres which are still doing this and that would be another option. So I hope these are tips that may be useful. I certainly don't think you need to be excessively worried about your blood pressure. There are ways to bring the blood pressure down. Most of all it's really important to minimise your anxiety about the blood pressure and try and lead a healthy lifestyle. But of course taking small doses of lots of tablets is better, taking it in liquid form and finding out if you can get the medications in liquid form maybe better treating your reflux maybe a good thing and transdermal patches for blood pressure may be good and if that doesn't work then you could always consider this thing called renal denervation. So thank you so much. Thank you for all the support. Thank you for all the love you give me. I'm very appreciative. The seminar that we did in York was a big success on the 28th of April. We plan to do another one on the 8th of September so if you're interested please get in touch via my Facebook page which is your cardiology one. We are hosting a seminar in New York from the 4th and the 5th of August and if you happen to be there then I would love to see you. You can access this on www.healthyheartweekend.com. Thank you so much and all the best. Thank you. Bye.