Blood pressure above 200 - help can't take meds due to side effects

[notyetretired]

Looking for some advice for my elderly father. He is 80 and with very high blood pressure of 200-205 over 75 or 80. It's been going on for quite a while and he was given amlodipine to suppleent his existing bp meds but it just doesn't agree with him. Makes him feel sick, and go to the toilet 5-6 times per night which means he can't get sleep so a real catch 22. Lack of sleep really affecting his mental and general health.

He also has Type 2 diabetes, has small vessel disease/vascular changes (brain), osteoarthritis and liver disease (non alcoholic fatty liver disease).

He's tried what seems to have been a range (at least 4-5 different) meds for bp but apart from the one he is on, he just can't tolerate the others.

Any advice?

Is he on any blood thinners?

IMO, his doctors need to determine why it is that high. Once they address the underlying cause, it should lower naturally. Check his diet to make sure he is not ingesting too much sodium, and is getting enough potassium via fruit, vegetables, etc. Increase activity if he is sedentary.

On aspirin for previous angina.
Can't increase activity levels due to mobility issues.
Been having high BP for a good 50 years probably but stubbornly high lately. Also on metformin.

Is his diet healthy? If you are not sure, it may be quite helpful to check sodium content for everything he eats/drinks. A (young) relative ended up with extreme hypertension and was hospitalized. It was determined that his daily prepared food consumption was the culprit, he was consuming much too much sodium. He stopped, started eating low sodium, and everything normalized.

GP is aware and has been aware for a long time but prescribing BP meds that don't agree with him.

Eats a very healthy diet, low sodium, low carb, high (healthy protein).

Just need some advice on good meds that may not necessarily be first line treatments.

My DH’s bp was running over 200 last year- not sure it’s useful to you as he’s younger- and he was put on ramipril with propranolol as a ‘rescue’ when he feels it spiking.

Has he tried Lercapedanine? Or a combination of two or 3 meds at low doses? That's often more easily tolerated than one high dose.

I think it's very common for BP to rise with age.

@SockFluffInTheBath sounds interesting. He's was taken off ramipril ages ago (even though tolerated) as due to some concern at that time that it would interest or affect something - I can't remember now. I'll look into proprananol.
@MrsPelligrinoPetrichor thanks no he hasn't. He's always been very high really 140-160, 180 the last 3-4 years but now 200/210 which seems v high given already has had tia and with ischaemic / small vessel changes.

Oh, I see. Is the gp willing to refer to a cardiologist? That may be best for your father as they have so much more specialized experience with difficult cases.

I tried 5 or 6 meds before they put me on Lercapedanine,I had terrible side effects,really debilitating but tried Lercapedanine and was absolutely fine. I've found out since it's a newer drug but quite expensive so not always first choice for obvious reasons but is really well tolerated.

Not an expert on the meds, but a BP this high is alarming. It will be further damaging his organs, including brain and heart.

Small, non-medical remedies that could help somewhat:
sardines;
fresh fruit & veg;
steady breathing exercises;
gentle outdoor exercise, even if it's twice round the back garden.

It's a bit too high. You haven't said which meds are ruled out so can't advise properly. Take him back to the GP.
There's an algorithm for hypertension.
In terms of side effects it's a case of risks vs benefit so it's up to the GP to find the safest med as BP is too high currently.

Very difficult to advise without knowing his past medical history, what he has previously tried or what his renal function/U&Es are.
As others have said he could try other medications in the same class. For example Amlodipine is a calcium channel blocker, there’s lots of calcium channel blockers and some are better tolerated such as Lercanidipine like a PP suggested.
Calcium channel blocker is first line for his age, next step would be to add an ACEi/ARB such as Ramipril but sounds like they were ruled out? After that you’re looking at a diuretic like Indapamide. Another alternative could be Doxazosin.
Really though his own GP should be best placed to suggest alternatives and if they can’t they should be asking for advice from cardiology

Ive been on different combinations over many years for high BP. It can be a real trial and error job especially as you get older and your tolerance to different drugs can change.

currently I take
Felodopine, Candesartan, Bisoprolol, bendrofluethamide (sp). The doses have been juggled about but this is the best combination in terms of managing BP and side effects.

I think the GP needs advice from a cardiologist as they will be used to having to juggle around with drugs for different and related conditions . I hope they get it sorted. Some can really make you feel rotten.