Certain blood pressure medications can make your blood pressure fluctuate. Alpha-blockers and alpha-2 agonists are not commonly prescribed as first-line treatments, due to this BP variation.

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Some blood pressure medications are associated with variations in blood pressure readings, which may increase mortality risk. J Art/Getty Images
  • Frequent variations in blood pressure readings are associated with an increased mortality risk.
  • Some blood pressure medications are associated with fluctuations in blood pressure readings.
  • Blood pressure variability could indicate that it’s time to switch your blood pressure medication.
  • If you have concerns with the type of blood pressure medication you’re taking, ask your doctor about other options.

If you have high blood pressure (hypertension), fluctuating readings are a warning sign that you might need to change medication.

While some blood pressure variation is normal, frequent readings are associated with certain adverse health outcomes. Your blood pressure medication can affect blood pressure variation; if it is, it’s something to keep an eye on.

While alpha-blockers and alpha-2 agonists have been linked to variations in blood pressure readings, these blood pressure medications are no longer commonly prescribed. Alpha-blockers and alpha-2 agonists are only added to existing therapies in certain situations.

“Alpha-blockers and alpha-2 agonists are not considered part of our first-line antihypertensives,” Dr. Michael E. Ernst, clinical professor at the University of Iowa College of Pharmacy and researcher on blood pressure variability, told Healthline.

“They tend to have more side effects than the first-line classes. Therefore, they are not usually used as a monotherapy, but are usually reserved for adding to other antihypertensives when the existing regimen fails to achieve the goal blood pressure.”

Prior research from 2016 revealed a link between large variations in blood pressure and increased mortality risk. However, that research didn’t associate these fluctuations with blood pressure medication.

Then, during the 2018 American College of Cardiology Scientific Session, researchers warned that alpha-blockers and alpha-2 agonists were more associated with blood pressure variability than other commonly used medications. This research hasn’t yet been published in a peer-reviewed journal.

According to researchers, that variation in blood pressure was linked to an increased risk of death.

“The less variation in your blood pressure as you visit your doctor’s office over time means you will do better long term,” Dr. Brian A. Clements, lead study author and internist at Salem Internal Medicine in Utah, told Healthline in an earlier interview.

Over 10,500 people with at least seven blood pressure readings participated in this study. The participants were enrolled between 2007 and 2011 and were followed for at least five years through June 2016. The researchers recorded both blood pressure variation as well as the blood pressure medication used by each participant.

The study authors advocated for physicians to prescribe other blood pressure medications to decrease mortality risk for their patients.

Dr. Clyde Yancy, chief of the Division of Cardiology at the Northwestern Feinberg School of Medicine and former president of the American Heart Association (AHA), told Healthline that alpha-blockers and alpha-2-agonists “no longer appear to have an appropriate role in the treatment of hypertension.”

“Given the new options we have to control high blood pressure, there’s no longer a necessity to use what now is an obsolete therapy,” he said.

A growing healthcare trend in the United States emphasizes maintaining healthy blood pressure through lifestyle changes.

In 2017, the American Heart Association and the American College of Cardiology updated their high blood pressure guidelines for the first time in 14 years.

High blood pressure is now defined as 130/80, whereas previously it was 140/90.

That announcement made waves, putting a staggering 46% of U.S. adults into the high blood pressure category.

While that’s not news anyone wants to hear, Yancy emphasized that we are now in a better place to treat high blood pressure through means that both patients and doctors can get behind.

“The good news is that we can start very simple and say, what are the lifestyle things you can do at home so you can avoid medical therapy if they work? Let’s just keep it like that,” Yancy said.

“If they don’t work or you’re at high risk, we’ve got more choices now than we ever had before with fewer side effects and with evidence.”

If you live with high blood pressure, other approved medications are considered safer and more effective than alpha-blockers and alpha-2 agonists. These include:

“We know that the thiazides, the diuretics, these very inexpensive drugs are incredibly effective. That really is a backbone of therapy. They have withstood the test of time,” Yancy said.

But, he emphasized, “It’s no longer just about the drugs and certainly the two drugs on the table now, the alpha-blockers and the alpha two antagonists, they’re done.”

If you take your blood pressure at home, the top number is for systolic blood pressure. This is how much pressure is exerted against arterial walls when the heart beats.

The lower number represents diastolic blood pressure. This is how much pressure is exerted against arterial walls between heartbeats.

Clement recommended the following tips to get accurate and consistent blood pressure readings:

  • Sit or lie down for 15 minutes before taking a blood pressure reading.
  • Don’t do anything that might cause stress before taking a reading.
  • Make sure to use a blood pressure cuff that fits. It shouldn’t be too large or too tight.