3 Tips for Safely Using Blood Pressure Medication

Dr. Frank Shallenberger, MD

January 27, 2020



If you suffer from very high blood pressure, many doctors will insist you begin taking medication to bring it down. In some cases, this might save your life. Or at least prevent a debilitating stroke.

But all too often, medications can cause problems – unless you know how to take medication for high blood pressure. Here are three tips for using medication to lower your blood pressure without all the side effects.

Most people agree that an ounce of prevention is worth a pound of cure. I certainly do. But when cures are necessary, I’m more of an outlier. I’ll usually take a pound of natural remedies over an ounce of prescription drugs. I have a healthy skepticism about most drugs. I think they’re less effective and come with more side effects than their manufacturers want you to believe. But I do also believe certain drugs actually can do more good than harm – if you use them right.

Yes, there are times when I recommend prescription drugs to my patients. And you might need them too – especially if you have high blood pressure. This condition affects millions of Americans. And it can lead to deadly diseases. So it’s important to get it under control.

Lifestyle changes can help. But sometimes they don’t work quickly enough. You might still need to try medication to reduce your risk of a crisis.

If you do, I hope you’ll take steps to help the drugs work as effectively as possible with few side effects. And if you strategize properly, you may be able to avoid being on the drugs long-term. Let’s start with what to take. Then I’ll tell you when to take it. Finally, we’ll discuss what to take with the drugs – and how it could help you wean yourself off the medication more quickly than your doctor will think possible.

Tip #1: The “Triple Pill”

First, what drug should you take for your high blood pressure? There are several options. I like three of them – in the form of a “Triple Pill.” Let me explain.

According to research presented at the American College of Cardiology’s 67th Annual Scientific Session, this pill could help patients more quickly and easily get a handle on their blood pressure – without an increase in side effects.

This medication, aptly named the Triple Pill, combines three common blood pressure medications: telmisartan (20 mg), amlodipine (2.5 mg), and chlorthalidone (12.5 mg). What I like about it is that the doses of each of these medications is pretty low compared to standard treatment doses of the medications administered individually. And it seems to work.

Researchers recruited 700 participants to test out the pill. Their average age was 56, 58% were women, their average blood pressure was 154/90 mm Hg, 59% were not treating their high blood pressure, and 32% had diabetes or chronic kidney disease.

The researchers divided the participants into two groups at random. One group received the Triple Pill. The other group received whichever blood pressure medication the doctors thought would be most effective.

By six months, the researchers wanted the participants to lower their blood pressure to at least 140/90 mm Hg if they had no other health issues and at least 130/80 mm Hg if they had diabetes or chronic kidney disease. The Triple Pill group far outperformed the standard care group, reducing their blood pressure by 8.7 mm Hg on average compared to 4.5 mm Hg for the other group.

In fact, by just six weeks into the study, 68% of the Triple Pill users had hit their targets, while only 44% of the standard care group had done so – a 53% reduction in high blood pressure risk for the Triple Pill group.

It’s true that blood pressure medications can have side effects. That’s one of the reasons I prefer to use natural remedies to lower blood pressure, if possible. But tripling the number of medications didn’t triple the side effects. In fact, the rates of participants who needed to try a new treatment due to side effects were 6.6% and 6.8% for the Triple Pill and standard care groups, respectively.

The researchers are now moving forward with determining whether the Triple Pill could be a cost-effective solution for helping people manage their blood pressure. If you’re on blood pressure medication, ask your doctor whether you can give this one a try instead.

Tip #2: Take Your Medication at the Right Time

Whether your doctor can get you on the Triple Pill or wants you to stick with your standard course of treatment, new research suggests that you can make your medication more effective by taking it at the right time.

Of course, you need to take your daily medication, well, daily. And many people choose to take medication when they’re most likely to remember it. For a lot of us, that’s the morning. But researchers are finding that might not be what’s best for your blood pressure.

In a large study of 19,084 patients, researchers looked at when the patients took their blood pressure pills. On average, the researchers followed the patients for over six years. And even when they controlled for age, sex, type 2 diabetes, kidney disease, smoking, and cholesterol, the results were shocking.

It turns out that taking blood pressure medication at bedtime reduces your overall risk of experiencing or dying from a heart attack, stroke, heart failure, or coronary revascularization by a whopping 45% compared to taking the medicationin the morning.

The participants had to follow a normal routine of sleeping at night and being active in the day. So it’s not clear yet if these findings apply to people who work night shifts. But the vast majority of us don’t.

Other research has found that your average systolic blood pressure when you’re sleeping is the biggest predicator of your cardiovascular disease risk. And it seems that taking your blood pressure medication right before bed helps reduce this risk factor most effectively. Yet most blood pressure medications don’t come with instructions on the best time to take them.

If you’ve been taking your meds in the morning, talk to your doctor about the best way to switch to a nighttime routine. You may need to make the adjustment slowly. And do make sure you establish a good habit so you remember to take your pills.

Taking your pills at night rather than in the morning truly could save your life. In fact, the researchers found that this simple swap lowered patients’ risk of dying from heart or blood vessel problems by 66%. Of course, if you consistently forget to take the drugs if you aren’t pairing them with your morning coffee, for example, this risk reduction won’t apply to you. But I think the difference is significant enough that it’s worth making a concerted effort to switch. Put your pills by your toothbrush or set a reminder on your phone to help you remember.

Tip #3: Look for Nutritional Deficiencies

Finally, there’s one other thing I want you to remember to take if you’re struggling with your blood pressure. This is especially true if you’re frustrated because you eat right and exercise but just can’t seem to get your blood pressure under control. Many people don’t realize that there are several nutrient deficiencies that can lead to high blood pressure. And one of them is especially powerful if you’re already taking blood pressure drugs.

This nutrient deficiency is that of the amino acid l-arginine. L-arginine helps in the formation of a substance called nitric oxide. Nitrous oxide is what causes the blood vessels in the body to dilate or widen. This is increases blood flow and decreases blood pressure.

When researchers gave l-arginine to a group of volunteers with high blood pressure, they found that the nutrient caused a significant dilatation of their blood vessels. And the dilatation brought their blood pressure down.

In another controlled study, researchers wanted to assess the effects of an arginine-enriched diet on blood pressure. They gave six healthy subjects either a placebo capsule or one containing l-arginine. Not surprisingly, those who received the l-arginine were the only ones to have a decrease in blood pressure.

So why would l-arginine be effective if you're already on blood pressure medication? Studies have shown that combining l-arginine with these drugs results in a much more effective treatment than just the drugs alone. If you're on blood pressure drugs, talk to your doctor about taking l-arginine with it. Make sure you do this under the supervision of a doctor, as he may have to lower your medication dosage.

Many of you might have heard the rumor that taking l-arginine can result in cold sores. But I can assure you that this is an extremely uncommon occurrence. I have used a lot of l-arginine over the years in hundreds of patients and have never seen one case of it.

A good starting dose of this extremely safe amino acid is from 2,000-3,000 mg. Take this amount two to three times per day. Note that since l-arginine and the drug Viagra both increase nitrous oxide levels, you should not take this nutrient with Viagra unless under the guidance of a physician.

High blood pressure isn’t something you should take lightly. It can lead to very serious conditions and even death. But I don’t take the decision to put my patients on prescription drugs lightly either. When I do, I want those drugs to do what they’re supposed to do. And, if possible, I want to wean patients off them over time.

If you’re on blood pressure medication, it might be time to check in with your doctor. Make sure you’re taking the best form. Ask about the Triple Pill. Unless your doctor specifically tells you otherwise (and can tell you why), take your medication at bedtime. And talk to your doctor and an l-arginine supplement too. It may be enough to help get you off the medication altogether. But that’s a decision you need to make with your doctor. Experimenting with blood pressure medications on your own can be dangerous. But optimizing how you use these drugs – with proper guidance – could save your life.




Calver, A, et al. Dilator actions of arginine in human peripheral vasculature.ÿ Clin Sci.ÿ 81(5):695-700, 1991.

Pezza, V., et al.ÿ Study of supplemental oral l-arginine in hypertensives treated with enalapril + hydrochlorothiazinde.ÿ Am J Hypertens.ÿ 11:1267-70, 1998.

Siani, A., et al.ÿ Blood pressure and metabolic changes during dietary L-arginine supplementation in humans.ÿ Am J Hypertens.ÿ 13:547-551, 2000.

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