Do I hold the 50mg daily dosage?

Blood Pressure Medication Management with BP 114/66

For a patient with blood pressure of 114/66 mmHg while taking 50mg daily of an antihypertensive medication, the dose should be held or reduced to prevent hypotension and associated adverse effects.

Assessment of Current Blood Pressure

Your current blood pressure reading of 114/66 mmHg indicates that:

• Your systolic blood pressure (114 mmHg) is within normal range
• Your diastolic blood pressure (66 mmHg) is approaching the lower end of normal range
• This reading suggests your current medication dose may be resulting in excessive blood pressure lowering

Recommendation Based on Guidelines

The American College of Cardiology Foundation/American Heart Association guidelines indicate that:

• Blood pressure targets should generally be <140/90 mmHg for most patients 1
• Lower targets (<130/80 mmHg) are recommended for high-risk patients with diabetes, chronic kidney disease, or cardiovascular disease 2
• Your current BP of 114/66 mmHg is well below even the more aggressive targets

Action Plan

1. Hold the 50mg dose temporarily if you're experiencing any symptoms of hypotension such as:

   • Dizziness or lightheadedness, especially when standing
   • Fatigue
   • Blurred vision
   • Weakness

2. Contact your healthcare provider promptly to discuss:

   • Dose reduction (likely to 25mg daily)
   • Potential medication adjustment
   • Monitoring schedule

3. Monitor your blood pressure at home:

   • Take readings in both sitting and standing positions 2
   • Document readings for your healthcare provider
   • Watch for orthostatic hypotension (drop in BP when standing)

Risks of Continuing Current Dose

Continuing the 50mg daily dose with your current BP reading could lead to:

• Orthostatic hypotension (drop in blood pressure when standing)
• Increased risk of falls, especially if you're elderly
• Reduced organ perfusion
• Decreased quality of life due to medication side effects

Important Considerations

• Medication changes should never be made without consulting your healthcare provider
• The specific antihypertensive medication you're taking affects the approach (beta-blockers, ACE inhibitors, and calcium channel blockers have different protocols for holding doses)
• Abrupt discontinuation of certain antihypertensive medications (particularly beta-blockers) can cause rebound hypertension 2

Follow-up Plan

• Schedule a follow-up appointment with your healthcare provider within 1-2 weeks
• Continue monitoring your blood pressure at home
• Report any new or worsening symptoms immediately

Remember that medication adjustments for blood pressure control should be done gradually over weeks to months to maximize effectiveness while minimizing side effects 3.