Moving Medications instead of Taking More

I met a patient for the first time during an appointment to evaluate his high blood pressure. I could tell from the look on his face and the sheer number of medication bags, bottles and papers that he needed guidance. He knew it was dangerous for his blood pressure to be high but he was fearful his medications might be causing it to drop too much. One time his blood pressure had dropped during dialysis and he felt awful. To prevent it from happening again, he would hold those medicines if he felt his BP was too low. He also said he was unsure when to take some of them. I went through all of his bags and bottles and noted there were some differences from his list including several medications for lowering blood pressure he was taking late in the day.

His physician had planned to increase his blood pressure medication based on his blood pressure log. However, once I explained the patient had been holding some of his pills the physician agreed to change the dosing schedule instead. Together we streamlined the medications by moving some of the blood pressure pills to the morning instead of right before bed. We gave him instructions on when to hold his medications and suggested he add a daily pill box to keep them more organized. Careful assessment and education avoided an increase in medication! At his next appointment, he was proud of his much improved blood pressure readings as well as his increased confidence to manage his own blood pressure