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Medication for hypertension

Discussion in 'I care for a person with dementia' started by CeliaW, Mar 27, 2015.

  1. CeliaW

    CeliaW Registered User

    Jan 29, 2009
    5,654
    Hampshire
    I wonder if anyone has any info on possible reasons or instances when medication for longstanding (and quite significant) hypertension has been stopped by a GP "because when they took the blood pressure it was fine!"

    Sorry this is a bit long..

    Mum was seen by a different GP to usual (she is in Care) as I had raised the query whether a) she was having TIAs as she had had episodes of slurred speech and one carer said at one point she did seem to be leaning more to one side - no idea if related to the speech issue and b) I had queried if she had had a recent Full Blood Count as she has a long term history of anaemia and no cause found but previous GPs had said that she was likely to need to stay on some form of iron supplement for the greater part of the time. When talking to the CH Manager I asked how her BP was (prior to the Dr being asked to visit) and said I wondered if it was still being controlled OK as it had been quite difficult to get to an acceptable level previously. I was told they don't do Blood pressure checks as they arent trained but she would ask the GP.

    I know that, on occasion, medication needs to be adjusted either up or down and in rareish cases it can be stopped. However, I asked what review and blood pressure checks would be done and was told there was no plan to review and maybe they could ask the GP to check it in 3/12 or so if I was really bothered...

    The Dr said Mum looked fine, doubted she was anaemic and so wasn't going to bother with a FBC.

    There were other issues too but these are my main queries. I was told I could speak to the doctor if I wasn't happy (and I have put in a request for a call) and I left it at that for that conversation as I wanted to check my facts although I didn't think that type of good practice guideline would have changed since I was actively nursing (plus I still read online journals etc)

    I phoned and spoke to a Cardiac Nurse at the BHF who was amazed and said as I did - if her blood pressure is good, then its the medication working. She went into further medical detail but suggested I needed to ask the GP what the rationale is as, with the information I had shared she could see no logical reason. I then told her Mums age and she went a bit quiet and said hopefully they don't have any ulterior motive. Mum is a 103 - she still has a fairly good quality of life in some areas - she can hold a conversation, sing songs, enjoy music and has a good sense of humour and pretty good recall for longer term issues in some areas. However, some of the home staff say "Well...she is 103... " and then tail off into this dismissive little laugh. I accept she is 103 but as I said, as long as it doesn't cause her distress, then whatever age someone is - the emphasis should be on maintaining their abilities and health and not writing them off because of their age. Mostly she gets good care I feel and a lot of the staff are very kind and caring with Mum but they obviously don't like any intervention and I was basically told if you don't like it then look for another placement. I think it was said in the heat of the moment by the manager as she wasn't happy that, although I was very polite, I said I wasn't happy with the decisions made. But its an implied threat - if you comment/ disagree or complain about any aspect or decision about your Mums care then the sanction of removal is there!

    So sorry this is so long (and believe me I have edited it down several times!) but I want to get armed with any info I can re the medications and so am asking here in case there is something unusual that I haven't been able to find out although I would have expected the Cardiac Nurse would know and she did look up things whilst we were talking and obviously didn't find a reason.

    Thanks for reading this far ...
     
  2. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    It does seem strange.
    I think you have to ask the GP concerned his (her) reasoning, why was it not stopped on the past when presumably her BP was 'fine'/what additional factors were taken into consideration?
     
  3. Grey Lad

    Grey Lad Registered User

    Sep 12, 2014
    5,737
    North East Lincs
    I just wonder what they regard as an acceptable blood pressure reading? Our experience has been that all medication is hit and miss. Some has given Maureen considerable side effects and not controlled her blood pressure.. However, we always think that one reading is meaningless and on occasions a 24 or even 36 hour monitor has been in place to see what average readings have been. If it were me I would request that your mum's G P monitors her blood pressure over a considerable period of time and then decides if she needs medication or not.
     
  4. CeliaW

    CeliaW Registered User

    Jan 29, 2009
    5,654
    Hampshire
    Thanks Nitram and Grey Lad

    Much to my surprise, the GP has already rung me and was very helpful and it would seem the care home manager has been a little economical with her facts. Only one of her medications is being stopped, the bendroflurazide as she felt with Mums weight loss and the fact that her BP was low end of normal, that it was probably not beneficial. She is still on Atenolol, Lozartine and Aspirin. Apparently the Care Home don't consider them blood pressure tablets - but I am still not sure where the all her Meds have been stopped has come from so will need to check that out.

    She had checked Mums previous FBC and it was normal and upper end of range and she saw no reason to think there might be a change. When we checked the date, that was 2012 when Mum was still at home and taking Ferrograd as prescribed - when she pointed out the results on Mums notes, the CH hadn't said that Mum hadn't moved there until August 2013 when the Ferrograd was stopped.

    Re Mums weight loss, the care home hadn't mentioned about Mum saying re nausea and the possibility that she was getting acid reflux or their initial suggestion that they would ask if Mum should go on Omeprazole at least short term to reduce acid production and see if that would help.
    She also agreed to speak to the community dietician to see if she felt Mum would benefit from a visit as she wasn't aware that Mums significant weight loss had been in the last three - four months.

    She also agreed that it was very reasonable to take these steps to maintain Mums quality of life etc and fully understood where I was coming from. She said she was not Mums regular GP and this was the first time she had seen her and so she was glad to have the additional information. Hopefully she will follow through on this but I can't fault her attitude and response.

    So its still a watching game - I feel much better about it (maybe get some sleep tonight) and will keep it all under review - its been a worrying time for the last 24hrs and that is an understatement - its so hard at a distance too.

    PS - to those who know my previous posts from some years back - I am pleased to say that, on the whole, my sister and I get on better than previously and in fact she asked me to deal with this as I had more knowledge / ability. Previously she would have said "just because you were a nurse, doesn't mean you know anything!"

    I think I need a large drink now.....
     
  5. notsogooddtr

    notsogooddtr Registered User

    Jul 2, 2011
    806
    I am on medication for raised blood pressure and was told that I would be on them for the rest of my life.My son is a dr and he said this is correct.My BP is fine when checked but that is because the meds are working
     
  6. nitram

    nitram Registered User

    Apr 6, 2011
    18,830
    Male
    North Manchester
    " She is still on Atenolol, Lozartine and Aspirin. Apparently the Care Home don't consider them blood pressure tablets -.."

    I suggest you point the Care Home to https://www.medicines.org.uk/emc/ and ask them to search on Atenolol and Losartan (sp?).
     
  7. susy

    susy Registered User

    Jul 29, 2013
    806
    North East
    Is she still actually being given the other medications? I do hope so.
    My dad is prescribed cream, he lives at home but the carers are supposed to apply it after his shower... One carer applies it and logs it in the care plan. The others don't log it so I don't know if they are putting it on???? I don't get to see the carers, the carer who does log it has written in capitals that this needs logging.... It does, my mum doesn't want to rock the boat but I seriously want to kick ****!!! If he isn't getting his cream his skin is dry and itchy and will break down. If he is why on earth are they not documenting it.

    Anyway, back to you, age certainly shouldn't be a barrier and I'm quite frankly shocked at the threats from the care home manager. That's awful and there is really no need. Hope you are ok. Glad the GP was so helpful.
     
  8. CeliaW

    CeliaW Registered User

    Jan 29, 2009
    5,654
    Hampshire
    Thanks all. Yes, I will be checking what she is actually having. My sister is going to see Mum Monday and will check when she visits as well. I forgot to say the GP said that she had said Mum would need her BP checked in a month when she was at the CH "but maybe it slipped the managers mind"

    I was really happy with the GP because although I felt quite comfortable discussing the medical issues because of my nursing background, I came away feeling that anyone could have felt at ease chatting with her as she was open and friendly and listened. I wonder if they could clone her?!

    I am now going to have that large drink and who knows, maybe some sleep tonight.

    Thank you all, this forum is great and, although it turned out ok I knew I would get support.

    Have a good evening ☺
     
  9. Kevinl

    Kevinl Registered User

    Aug 24, 2013
    4,740
    Salford
    My mother was taken of some blood pressure medicine in her mid 80's after having taken it for more than half her life. She collapsed several time in the street and in church and it was eventually decided her blood pressure was too low, I was told at the time this isn't uncommon as you age. I think it was a beta blocker and Periprendol (?) that he stopped.
    K
     
  10. CeliaW

    CeliaW Registered User

    Jan 29, 2009
    5,654
    Hampshire
    Hi Kevin, that's interesting. Luckily it appears sorted but it wasn't as much the stopping of "all the BP meds" that concerned me because I knew there could be reasons I was unaware of (though would want to know) but that it was, apparently, going to happen with no ongoing monitoring or review - which went all against my knowledge and understanding re hypertension and medication.

    I shall be keeping a close eye on developments.
     

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