6 Blood Pressure Medication Questions To Ask Your Doctor

Andrea Spyros 0:00

Ever think you’re going to remember that important health question when you visit the doctor and then you blank when you get there? Yeah, we totally get that. And today we’re going to give you the exact questions you need to ask your doctor about your blood pressure and give you a helpful download that you can take with you on your next visit. Welcome to the Brain podcast. This is where we translate medical science and turn it into practical actions that you can start today. Science-driven behaviour designed and built to protect your brain for the long term.

Dr. Kar 0:34

I am Dr. Shabnam Das Kar. I’m a functional medicine doctor and trained in behaviour design and a certified tiny habits coach. I help people improve focus, get rid of brain fog and prevent dementia down the line.

Andrea Spyros0:50

And I’m Andrea Spyros. I’m a behaviour design consultant, and actually I’m an expert in how to stop procrastination. I harness the power of high-performance habits to increase engagement, resilience and well-being, and I host workshops for many organizations around the world. So today we’re going to talk about six questions to ask your doctor during your next visit about your blood pressure. We are going to talk about each one in detail, and then we’re going to give you a helpful download at the end. So no need for you to scramble to get a pen and paper. We will have a download for you after this. So let’s talk about the six questions. First question is what is my target blood pressure?

Dr. Kar1:38

Andrea, that’s such an important question and it is the, the challenge is now worldwide blood pressure control has been very poor and one of the reasons is there are numerous other reasons. One is of course a lot of people with high blood pressure or hypertension do not have symptoms. So unless they measure their blood pressure, they don’t know that they have a problem. And the other big problem is confusion about what the thresholds should be for blood pressure. Now few years ago this was in 2017 there was a very well known paper which came out. So instead of going into all the details, I’m just stating that for most people the threshold for normal blood pressure is the upper number is 120 and the lower number is 80. Now there are a bunch of other factors. I mean your doctor, whatever Andrea and I are going to talk about is not medical advice. This is for your information only. So whatever your doctor decides, because some people have complex health histories, they are dealing with multiple health conditions, they have kidney disease. So number one is when you meet your doctor, talk to your doctor and ask what should be your blood Pressure level now here, you know, Andrea, where I get a little, you know, this thing is doctors knowledge all over the world is not the same. So some people are not aware that the threshold now is 120 by 80. In fact, there are some papers suggesting that women probably need a lower number. But, you know, I was in India recently and you know, people, when they know that I’m interested in blood pressure and I have hypertension myself, so they’ll talk. Oh, my doctor says, you know, when I check my blood pressure in the morning and if it is high, I should take an extra pill and my eyes are like almost popping out. There is no way that that is standard blood pressure treatment.

Andrea Spyros3:45

Oh, my goodness.

Dr. Kar3:46

Yeah, it was like. And I said, no, you need, like. I didn’t know what to say. Actually. I said, you need to find another doctor.

Andrea Spyros3:54

Right. What’s the tactful way of saying that? And we. I want to point out to our listeners, you are a doctor, but you’re not our listener’s doctor.

Dr. Kar4:01

No, another, another person, you know, he’s in his 50s and he said, my doctor says that 140 by 90 is quite okay for someone my age and someone who’s from India. I said, no. 140 by 90 ideally requires two medications. So again, I mean, I, I didn’t quite tell him that you need to change your doctor, but I’m sure he was smart enough to understand.

Andrea Spyros4:28

We can hope. And this is why it’s important to say to your doctor, first of all, to have a trusted health care professional, right, who, who does understand what is current in the professional health field and then can apply that to you. Which is why what should my target blood pressure be? Is an important question for you to ask your doctor, given whatever’s going on for you. If you’re healthy, normal male, female, you made 120 over 80, maybe correct for you, if you have multiple issues, then there might be a different number that you are targeting. But either way, you and your doctor need to be on the same page so that you can get the care that you need.

Dr. Kar5:19

Yeah. Another thing I want to mention, Andrea, is because sometimes it is hard to get an appointment with the doctor, sometimes pharmacists can help as well. So if you’re uncomplicated hypertension, talk to your pharmacist because sometimes they have more time to explain things to you.

Andrea Spyros5:36

Right, Right. And this is. And, and there’s some important things to do. If you are taking your own blood pressure, it can be different. If you’re talking, if you’re standing if you know, there’s a lot of different things. And we have addressed that in our other podcasts on blood pressure.

Dr. Kar5:56

So bone blood pressure measurement is the most important. And we have another podcast. I think we have one or we are going to record one, because that is so important. It deserves an episode all by itself.

Andrea Spyros6:08

Exactly. Exactly. So knowing your target blood pressure is the first question to ask your doctor when you walk in. Second question is either reviewing the medications that you’re on. Hopefully you have a list that if you don’t review the medications you’re on, review the dosages. So you’re asking, what medications am I on? What medications? What are the dosages of those medications? What are they doing? Meaning what are they for? And are there any interactions? Right. So you want to be on the same page as your doctor. Hopefully you have your own list, and you should check it against your doctor’s list to make sure you’re both on the same page. And. And that your doctor doesn’t think you have one medication that you don’t or you don’t have a medication that you do. So talk about this a little bit. Why is this important?

Dr. Kar7:03

So very important. Number one is, again, this is where a nurse practitioner or a pharmacist would also have a role. Because, Andrea, sometimes see straightforward hypertension. No other complications. It should not be a problem. But sometimes people meet multiple specialists, and one specialist may have prescribed a medication the other one does not know about. And sometimes, Andrea, I also see in my patients like someone has prescribed something to them, but they have not filled that prescription. They are not taking that medication.

Andrea Spyros7:37

There you go. And that’s where communication is so important. Great. We hope that the doctor or pharmacist or the nurse practitioner or whatever health care professional would say, I see that you are, you have a prescription for this. Are you taking it and are you taking it regularly?

Dr. Kar7:53

Yeah.

Andrea Spyros7:54

But it’s also important for you to say, hey, you know what? I have this prescription. I didn’t fill it, or I filled it, but I haven’t been taking it regularly as part of this conversation. That’s. So that there’s. You’re on the same page as your healthcare professional.

Dr. Kar8:12

Yeah. And another thing is, you know, this is actually so important whether someone is taking the medication. That’s the first question to ask if your blood pressure is not at target. Like, are you taking all the medications you’ve been prescribed?

Andrea Spyros8:27

Right.

Dr. Kar8:27

And another important thing is, you know, and a lot of this, like I said, you need a team sometimes because the Pharmacist can check certain things like drug, drug interactions. Right. And when we are talking about sometimes some which may seem like a blood pressure pill, like for example a beta blocker, but it may be used actually for heart condition or something else. So Andrea, like you mentioned, you know, why am I taking this? And in the handout you will be able to, you know, write down all that and not have to remember everything.

Andrea Spyros9:02

Right. And sometimes people forget. They, especially if you are on multiple medications, it. You can forget why your doctor has prescribed that for you. It can just become part of your routine, which is fine. But also if you want to pull back at times and say, okay, let’s look at this as a whole. What am I taking? Why am I taking that?

Dr. Kar9:25

Yeah. And sometimes, you know, information in the doctor’s notes or the pharmacy may not be updated. It happened to me sometime back, like I was prescribed something and I had some side effects after which I had to stop that medication. And my pharmacist is telling me you are still on this. I said, no, I’m no longer on that medication.

Andrea Spyros9:45

Right, right.

Dr. Kar9:46

I don’t know why we don’t have the notes here. I said, I don’t know.

Andrea Spyros9:51

Right. And that’s where it’s your own agency in, in keeping track of your health is really important because you are the one closest to it. Yeah. And, and I’ve seen so many, I’m not even a doctor, I’m just a, you know, regular person. I’ve seen so many times where the communication with the healthcare provider things have been missed. My mother in law had a persistent cough for months and months and months. It would interrupt her speech, it would interrupt her, her sleep. And it was only. And she kept going to the doctor and the doctor like, it’s this, it’s that, it’s the other thing. And finally she happened to get another doctor. Her doctor was, was out and the other doctor had a fresh perspective.

Dr. Kar10:39

Yeah.

Andrea Spyros10:40

And looked at all the medication she was on, listened to what she had to say and said, oh, it’s oh, guess what? That’s a side effect of this medication that you started taking two months ago. Right. Whereas the doctor who prescribed it did not put those two and two together. Yeah.

Dr. Kar11:00

It’s those end medications that are ending in Prill. Not, not amlodipine. So similar thing happened with my father. Like he, his feet were very swollen. And I said, don’t you notice your feet are swollen? Like, and for someone who’s older, you know, that is something that needs to be investigated. He Said, oh, yeah, I’ve been wondering because my, I don’t fit into my shoes so easily.

Andrea Spyros11:22

Oh, my goodness.

Dr. Kar11:24

And I thought what had happened and I said, okay. Then of course, the review and everything. And so now I think again, this is, you know, one more thing for anyone to do. If you have any new symptom after you start a medication, and we will talk about side effects, bear this in mind that some of the commonest things could be a side effect of some new medication you are on. And it doesn’t have to be blood pressure medications. It could be any other medication too.

Andrea Spyros11:52

Right.

Dr. Kar11:53

So keep that in mind. So, and Andrea, we talked about knowing blood pressure thresholds, knowing what medications someone is on and then reviewing them, checking the drug interactions with the pharmacist if the doctor doesn’t have the time. And also there is something else that I tell my patients sometimes is to check online is sometimes some medications cause nutrient depletions. So we will talk about that in detail on what to do. Exactly. But first check whether there are drug interactions, drug supplement interactions, and any new possible nutrient depletions that can be caused. We’ll cover that. Another. Another episode.

Andrea Spyros12:37

Right.

Dr. Kar12:37

What’s the third thing we’re talking about, Andrea?

Andrea Spyros12:40

The third thing is that, and it goes along with this multiple medications. Is there a third question is, is there a combination medication that I can take? So sometimes maybe you got one thing and then, and then later you got another one and then you got another prescri. And because you’ve got them at independent times, no one’s pulled back to say, hey, wait, I’m taking all these medications. Is there a combination pill that will do the same job?

Dr. Kar13:10

Yeah. So the combination pills have been actually game changing for some people because, Andrea, you are probably one of those disciplined people who have no problems taking medications. I don’t have problems taking multiple medications either. But there are people, and this is not a judgment. It’s like some people are like that. It’s like I’ve had patients telling me, oh, I’m on three medications for my blood pressure. I said, yeah, average is 2 to 3, you know, so one is if you are struggling with compliance, you’re not able to remember all the medications. You are on three medications, talk to your doctor. Because some, depending on which country and which healthcare system, sometimes there are medications available which are, which have like a combination of all the, let’s say you’re on three different medications and for blood pressure there are different classes of medications. So if you are on three different medications, it may Be that there is one combination pill which has all of them and these are, which have gone through clinical trials. It’s not like some doctor thought, I’m going to combine this and this into one.

Andrea Spyros14:18

It’s not a home potion that the

Dr. Kar14:20

doctor is like another. Another important thing is sometimes people may have side effects with higher dosage of a medication. Studies have found that if they take a combination pill of three different medications, number one is what is called pill burden. The number of pills don’t go up and the dosage of each medication in the combination is less than if they were taking it individually. So my point is there are numerous ways to manage blood pressure, so there’s no reason for anyone not to be at blood pressure target.

Andrea Spyros14:56

Right, right. And, and, and that. And sometimes it takes a little experimentation of what’s fit for you. This is not a one size all approach. The whole brain podcast is about matching yourself with the right actions. Whether it’s medication and diet and exercise, whether it’s multiple medications, whether it’s combination pill for, for, for all of it. It’s a, it’s what’s a fit for you. We’re going to empower you. Questions you need to ask with the information that, that will make you aware. And then it’s up to you to take it to the next level to find the fit for you. Right. We’re not anything. Should we move on to the fourth, the fourth one?

Dr. Kar15:39

Yes. I think we’ll just recap the first few. So first, yeah. Blood pressure threshold. Then what medications are you on? Interactions between them. Then the third thing is, can you get a combination pill if you find it overwhelming to have like three, four different pills? And very often, Andrea, it’s not that people are only taking blood pressure medications. They’re also taking maybe something for cholesterol and something for, you know, diabetes. It’s like. Right.

Andrea Spyros16:09

Supplements or. Yeah. Like many things that people want to take. And it can become burdensome. Even if you’ve got a great pill selection system, even if you’ve got the best containers, you can, it can, it can feel overwhelming. Yeah.

Dr. Kar16:25

Actually most of these pill containers don’t do for me because I have like supplements and medications, so I need bigger ones.

Andrea Spyros16:33

Right. And the thing about the pill containers is they don’t always, you know, they can have morning and evening, but that’s not always enough.

Dr. Kar16:43

Yeah.

Andrea Spyros16:43

And that leads to our fourth question, which is what is the optimal time to take my medication? Yeah.

Dr. Kar16:49

So the optimal time. And as always, it’ll need a separate, you know, episode on it. So India and I will do that. But the most important message in that is taking the medication rather than choosing a specific, like, is it morning, is it going to be evening, is it going to be midday? So taking the medication is more important than finding the perfect time, you know, for it. And we’ll go into the details about, you know, how sometimes, doc, your doctor may recommend a different time for a particular medication that’s for another episode. But Andrea, let’s say here’s someone who’s struggling with taking their medications. What would you suggest to someone like that from our, you know, putting on your behaviour design hat and our Tiny Habits?

Andrea Spyros17:37

Exactly. Well, and I think I want to make your point, like circle and star it. And that is the most important thing is to take your medication consistently. The, you know, the medication can’t help you if you’re not taking it. It’s like people, what’s the best exercise? For me, the best exercise is the one.

Dr. Kar17:52

Yeah, right.

Andrea Spyros17:53

Like if, you know, maybe running is fantastic for most people, but if you can never get yourself to run, then that’s not a great exercise for you. Same thing for the medication. Before you move on to what’s the best time to take it, find a good time that you can take it. And here’s how to think about it. Think about, first of all, does it need to go with food? Right. And if it does need to have some food in your stomach, then think about the meals that you have that you’re very consistent. If you’re not a breakfast eater, don’t time your medication with breakfast. If you always eat lunch, that’s a great time. If dinner, if dinner is what your consistent meal is, then time it after dinner, have your pills near where you have dinner in the first place. Right. So many people will have it in a medicine cabinet in their personal bathroom, but they don’t. Very few people I know well, I don’t know anybody who eats dinner in the bathroom.

Dr. Kar18:45

Right.

Andrea Spyros18:47

Bring your medication to your kitchen somewhere or wherever you prepare your meals. And then you might have to have two habits. One is going to be taking it out at the beginning of the meal. So when you walk into the kitchen to get the meal, you’ll take the medicine out of the cupboard, Right. And then after you sit down with me, after you finish your meal, think about what the last thing you do is. Do you rinse off your plate? Do you just set your plate on the counter? Then maybe you put your medication or you put your plate where your medication is and that will remind you to take it. So if you think about what the last thing you do when you finish your meal, whatever that is, the very last thing, close the dishwasher, something like that, the very last action, and then have your next action be picking up your pill bottle or taking your pills out of the little pill container that you have, something like that, you’ll be more likely to consistently take your medication, Right?

Dr. Kar19:47

Yes. And I’m sure all of you have noticed that Andrea and I did not say that you need to set up an alarm on your phone.

Andrea Spyros19:54

Right, Right. Because when that alarm goes off, you might not be in the right place. And it’s more important to. To plan your habits or your medication near an action that you always already do right away.

Dr. Kar20:10

Yeah.

Andrea Spyros20:11

Spyros20:11

And. And once you can do that, you’ll be more consistent in doing that. And then you can play around with it. If you find dinner doesn’t work for you, then maybe it’s lunch. And like I said, you might have to have a couple habits. One habit is putting your pills out in a little dish or bringing the bottle out. And the other habit is actually taking the pills. And you can actually get help with all of this@tinyhabits.com join where you can get an email, a real live human coach via email to help you set up these habits. So the best, the optimal time is to take your medication is when you will consistently take your medication.

Dr. Kar20:51

If you are struggling with consistency and if you are consistent, then we’ll talk about that on another episode. So you need to watch out for that.

Andrea Spyros20:59

Yes. And then you’ll be able to time it a little bit better. And obviously, if you’re having any, you know, if you’re taking a medication and you are sleepless or things like that, then you probably want to adjust your timing, but we’ll talk about that. So you can adjust that once you’re consistent. So the next question, number five is how soon should I expect a change in blood pressure after adding a medication? And this is where I think our incidence, at least in the US I don’t know how it is in Canada with you. We really kind of want, I took the pill. Why isn’t, you know, pressure down? Right.

Dr. Kar21:35

Yeah. So I usually tell my patients that. So different medications work in different timelines, so to say. Some may work right away. So you start taking the medication next day, you check your blood pressure and. But usually most doctors will wait for two to four weeks because, and I tell my patients, I said, okay, you started a new medication. Don’t check your blood Pressure for the next two weeks. Because I don’t want that, you know, email.

Andrea Spyros22:04

Why isn’t it down? Why isn’t it down?

Dr. Kar22:06

And it creates more anxiety, which is useless because unless some certain amount of time has gone, I cannot change that medication. Like, that’s not fair. Like, I haven’t given enough time for the medication to act. So. And again, you need to ask your doctor also, like, whatever I’m. We are talking about today, you need to check with your healthcare provider. So, yeah, two to four weeks. Most doctors would wait. And so it’s important to know when something is supposed to change. Like as you said, you know, some people are like, I started the medication today. Why aren’t, why am I not seeing any change in my blood pressure at night?

Andrea Spyros22:45

Right, exactly. And we don’t often know as we don’t often really realize that things aren’t as instantaneous as we want them to be. And so understanding from your doctor and then also you’re getting on the same page as your doctor. If your doctor thinks it’s four weeks and it’s week number five and nothing’s changed and you understand it’s. Or you can follow up and you can say, hey, nothing’s changed or hey, it has changed, and then you know it’s working, you can move forward with confidence.

Dr. Kar23:14

Yeah. Awesome.

Andrea Spyros23:17

So the sixth and final question is side effects, new symptoms. So specifically, ask about side effects. What side might. I see.

Dr. Kar23:30

So here is where different people look at it in different ways. And you have to know your patient. Well, like some of my patients, I tell them, I said, I’m not going to tell you what the side effects are because you’re, you’re going to sort of imagine that you already have them. And some patients have told me, Dr. Good, you didn’t tell me about the side effects because I’m someone who’s like always watching, is there something wrong? Is there something going on? So what I do is I tell them that if you find that anything is different, regardless of what, because most people will go and check on, you know, on the Internet or using one of the LLMs. And if you don’t find in that list, even then, if you find there’s any symptom that is bothering you which you didn’t have before you started the medication, regardless of like, whether it was just the next day or two days later or one week later, most importantly, don’t just stop the medication and not tell your doctor. That is Andrea, that is unfortunately so common. And you won’t believe I have had patients telling me this doctor is not good because he gave me a medication which caused this side effect. And, and in countries like India, like you don’t you are not very comfortable with one doctor. You can easily go and meet another one very easily. Unlike in the US and Canada where you have to wait for an appointment and you know you can’t meet a specialist so easily. So number one is don’t stop the medication without meeting your healthcare provider. More important even if you do stop the medication, please, please, please tell the person because the healthcare provider can give you an alternative. See not having blood pressure at control is not acceptable. There are too many medications available which you know some combination your healthcare provider will be able to figure out for you. So don’t just stop the medication and not tell anyone.

Andrea Spyros25:30

Exactly. And that’s and that’s where good communication comes in. I think the theme of this podcast is good communication between you and your healthcare provider. So if you’re the type of person who thinks if I know the side effects I’m going to see the side effects then your job is to just be aware of any new symptoms that you have. If you’re the type of person that feels calmer by hearing from the doctor what could happen so you can spot it then you can ask this question. But either way stay on your medication until your you have confirmed with your healthcare provider. Sometimes things are just temporary might just be very short lived thing.

Dr. Kar26:14

Sometimes you may also your doctor may tell you that you need to get certain blood tests done because your electrolytes levels may have changed. So communication. Andrea, you I always say you know your middle name should be Clarity. So most important you need to tell your healthcare provider and if your doctor is busy talk to your pharmacist. They can also help or your nurse practitioner.

Andrea Spyros26:40

Right. And a lot of times there will be you know there’s now there’s so many ways you can email you can right that you can get an answer sooner rather than later. You don’t necessarily have to wait to go into the office so to to you will get do you want to share do you want to share the.

Dr. Kar26:57

Oh yeah,

Andrea Spyros27:00

yeah. There’ll be a downloadable checklist that you can take into your and it’s going to include these questions. What is my target blood pressure? A review reminder to review the medications that you’re on what they do in any interactions. If there’s a combination pill that could simplify your regimen when the optimal time to take your medication is if you’re already being consistent the timeline for expecting your blood pressure to change and then what to do if you experience side effects. And they’ll, it’ll be very handy for you to, to take into your office. So basically you have a few actions that you’re going to need to take and that’s writing down your personal blood pressure target after you confirm it with your healthcare provider so that you don’t forget. Everybody thinks they’re going to remember and then later they not. And to make another thing is to make your own medication list that you can take into your doctor. And then do we want to go over the, the other electrolyte panel and things like that or should we.

Dr. Kar28:07

No, I think we’ll keep that for another one. So we already we mentioned that sometimes side effects you may need to get your blood, your doctor will tell you to check your blood for certain, you know, some things and again you need to follow up. So there are some one time actions. Andrea, what would you recommend one of the. Some of the one time actions that people. And what is a one time action? I mean, we sometimes use our language.

Andrea Spyros28:32

Well, one time actions, things you just do one time. And the beauty of one time actions is that you can put them on your calendar and you can set a reminder for a good time time. Right. So when it’s convenient for you, you could look at your calendar right now and say, oh, you know what, I’ve got some time this afternoon. I’m gonna, I’m gonna print out the download and I’m gonna fill it in. Or you know what, this weekend I think I have some time. I’m gonna put that on my calendar to make a medication list and do that or send an email to my doctor about confirming the medications that I’m on. Right. So one time action is something you just do one time. You can put it on your calendar when you have enough time and that gets done. Other things are habits or things you need to do consistently like take your medication. You’re going to design for those differently by putting them in the right spot like we talked about. The right spot at the right time and then setting yourself up for success. But basically the medication list and writing down your personal blood, filling out the checklist too, once you’re at the doctors, those are all one time actions that you can do and that will set you up for success in the future. Then you just can have your records in line so that you and your doctor are always on the same page. And hopefully your blood pressure will be smoothly and seamlessly reduced so it can be optimal for you. And you know what that is. Any final thoughts?

Dr. Kar29:57

No. I think we’ve covered a lot today.

Andrea Spyros29:59

Yeah.

Dr. Kar30:00

So sure people will find it helpful.

Andrea Spyros30:03

So thank you for listening. Please like, rate, share and subscribe, and you can find us wherever your favourite podcast platform is. And you can find them all on Dr. KarMD podcast. That’s D R K A R MD.com/ podcast. Cheers.

Dr. Kar30:23

Thank you, and bye now.