Healthy Trucking

How blood pressure medicine works, Part II

Last month, we talked about diuretics or fluid pills. The next class of high blood pressure medications we will talk about are ACE inhibitors. ACE is short for Angiotensin Converting Enzyme, which is a potent substance released from the kidneys to regulate the flow and pressure through the renal arteries. As blood flows through, it is filtered and urine is made.
     ACE can cause extreme elevation in blood pressure if there is narrowing of the arteries going to either kidney. If a person has a narrowing of the artery going to the kidney then ACE drugs are not indicated, since they can cause elevations in substances called electrolytes, such as potassium (K) that can stop the heart dead in its tracks. This is why your doctor checks your blood work before and after starting an ACE drug.
     ACE inhibitors and its close cousin, ARBs (Angiotensin Receptor Blockers), are the drugs of choice for a driver with high blood pressure and diabetes. Both of these drugs protect the kidneys from the complications of these devastating diseases.             
ACE inhibitors and ARBs are often combined with Hydrochlorothiazide (HCTZ). The latter in small amounts helps to mobilize fluid that accumulates in the body during the course of a day. Drivers often notice swollen ankles at the end of a 700-mile run. Thus, you may be on Lisinopril 20/HCTZ 12.5 which is a combination that is very effective. Benazepril (an ACE) in combination with Amlodipine (Lotrel) is a trucking doctor’s favorite when we need to lower a pressure quickly. Enalapril and Diovan/HCTZ are just a few of the ACE/ARB class of antihypertensive drugs
     ACE/ARB with HCTZ does not require K+ (potassium) replacement as does pure diuretics such as HCTZ alone, Lasix (Furosemide) and Torsemide (Demadex). Most doctors do not use the latter drugs for blood pressure control. Diuretics are used for heart failure and dependent edema not related to other treatable causes. ACE/ARB drugs are almost never used with K+ replacement. Make sure you question your provider if they give you a K+ supplement with an ACE/ARB type drug.
     This all sounds complicated, but you Kings of the Highways and Queens of the Interstates need to know what medical folks are doing to you. Know your numbers and sign up at any PDMD for the Wellness Program that is recommended three months prior to a driver’s DOT exam. This gives your family doctor or PDMD provider valuable information to tune you up so you can pass your DOT exam and get on the road to good health.
     Dr. John McElligott is the founder of Professional Drivers Medical Depots (pd-md.com), a planned nationwide network of medical clinics located at truck stops and travel centers.