Hypertension out of control - Look before you leap

One of my patient, 50-year old Mrs L has been hypertensive for several years. Owing to her intolerance to many anti-hypertensive drugs, she was finally put on an angiotensin receptor blocker  (ARB) which is quite an expensive drug. Her blood pressure seemed to have been controlled for a period when suddenly it was found to be elevated during the last two visits. Her present drug was at its maximum dose and I was thinking of adding another class of antihypertensive to the current regime to bring down her undesirable rise in blood pressure.

Having some time to spare, I decided to engage Mrs L in a conversation. I complimented her on her clear skin which previously was pitted by acne. Then I asked her whether she had been taking any other drugs beside her existing anti-hypertensive. She was at first rather hesitant and reluctant to disclose, then she blurted out that yes she had been on a four month course of antibiotic on an advice of a Dermatologist for her acne and that she had also seen a Gynecologist who prescribed her a combination of an androgen and an oestrogen ( Diane 35) to balance, according to him, her deranged hormonal state. She was supposed to take the drug for several months. No wonder the nice skin and the effervescent personality!

All those drugs were prescribed after her anti-hypertensive regime which had so beautifully controlled her hypertension and sadly, this was undertaken without my knowledge. I was disappointed of course, but did not really show it to her. I informed her that her blood pressure had risen and so as her pulse rate (tachycardia) during the last two visits to my clinic. The hormone medication could have caused the blood pressure to rise and that she should stop it. And next time please refrain from using other medications without my knowledge.

Drug-induced high blood pressure is not uncommon  among post-natal women on oral contraceptive pill (OCP) and if detected early, the blood pressure normalizes following cessation of the hormonal treatment.

She might not need an extra medication should her blood pressure revert to the earlier level on the present anti-hypertensive regimen after she has stopped the hormone therapy. High blood pressure is certainly not conducive to the health of the heart, the kidney and the brain as well as the eye. She has to choose between  a flawless face or well internal organs. She decided to choose the latter.

I am monitoring her blood pressure to see whether it comes down following the removal of the hormone. In the meantime,  I am not going to rush in by adding another anti-hypertensive drug as it may be unnecessary.