I commonly see patients on medications for blood pressure or other cardiovascular conditions. These medications may be necessary for at least the short-term and sometimes long-term. Whichever the case, it is always important to optimize the body by reducing risks to the potential side effects.

Here are three questions I like to consider when a patient comes in on this type of medication or with high blood pressure:

1.  What is the root cause of the high blood pressure?

Not everyone who is prescribed a medication for their blood pressure or cholesterol is destined to taking it for the rest of their lives. A good place to start is to identify what may be contributing to the elevated levels. Factors to consider include genetic predispositions, nutrient deficiencies, environment, and lifestyle:

• Chronic systemic inflammation
  • Increased BMI
  • Sedentary lifestyle
  • Chronic infection
  • Nutrient deficiencies, such as magnesium
  • Inability to cope with stress (adrenal dysfunction/elevated cortisol)
  • Hormonal imbalances (thyroid or estrogen)
  • Smoking and alcohol
  • Environmental toxins such as mercury

2. Are you on the right medication to treat your blood pressure?

If you are currently taking a beta blocker for your blood pressure (metoprolol, atenolol, propranolol), there may be a better option. The use of beta blockers has been associated with increased fatigue, cognitive slowing, constipation, depression, and erectile dysfunction.

Although this medication is necessary in certain circumstances, beta-blockers are no longer recommended as one of the top five first-line therapies for blood pressure management. The most recent guidelines for blood pressure management, the JNC-8, now recommends this medication as a third-line therapy.

Many patients were prescribed these medications many years ago and have continued to use them today. If you are on a beta-blocker, consider discussing with your provider whether this is still the best option for you.

3. Is your medication contributing to nutrient deficiencies?

Common blood pressure medications may deplete the body of important nutrients. Here are a list of the most common medications and the nutrients most at risk. Consider asking your health care provider to test your nutrient levels and/or supplement when appropriate.

Medication Class	Common	Nutrients at Risk
Beta Blocker	Metoprolol, atenolol, propranolol	CoQ10 Melatonin
ACE Inhibitors	lisinopril (Zestril), ramipril (Altace), enalapril (Vasotec)	Sodium Zinc
ARB	Losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan)	Zinc
Calcium Channel Blockers	Amlodipine, nifedipine, diltiazem, verapamil	Potassium Vitamin D CoQ10
Cardiac Glycoside	Digoxin	Calcium Magnesium Phosphate Thiamine
Loop Diuretics	Furosemide (Lasix), bumetanide (Bumex), torsemide	Calcium Magnesium Potassium Pyridoxine Sodium Thiamine Vitamin C Zinc
HMG-CoA Reductase Inhibitors (Statin)	Atorvastatin, Rosuvastatin, Simvastatin, Pravastatin	Carnitine Copper CoQ10 Essential Fatty Acids (EFAs) Selenium Vitamin D Vitamin E Zinc
Thiazide Diuretics	Chlorothiazide, Hydrochlorothiazide	CoQ10 Magnesium Phosphate Potassium Sodium Zinc
Thiazide-like Diuretic	Chlorthalidone	Magnesium Phosphate Potassium Sodium Zinc
Potassium sparing Diuretics	Triamterene, spironolactone	Calcium Folic Acid Zinc

It is helpful to keep an ongoing conversation with your health care provider regarding your blood pressure management, risks and benefits of the medications, and learning to identify the root cause. 

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.