Hypertension, or high blood pressure, in most cases is a lifelong disease, which means it requires daily pills. This can be frustrating for many patients; it could be due to the cost, because you don’t think there is a need for taking those pills if your blood pressure is consistently good, or because you have some side effects because of the medication. No matter what the reason, do NOT stop taking the pill without your doctor’s approval.
You may not realize it, but it is your pill that’s keeping your blood pressure under control. Of course, you are enabling this further by eating well, staying active, and through other non-pharmacological means. However, the mainstay of anti-hypertensive therapy is still your pill.
If you miss one dose, chances are that nothing will happen. You might feel a little ‘buzz’ or you may feel ‘high’.
If you miss more than one dose, you might experience headaches, nausea, nervousness, increased heart rate, etc. This usually occurs between 1.5 to 3 days after the last dose, but it may occur earlier. In some cases, a phenomenon known as rebound hypertension may occur. (1,2) This means your blood pressure may rise quickly to levels that occurred before you started the treatment—or even higher! It could also, less commonly, lead to an angina.
If you are taking more than one pill and you stop taking all of them, the aforementioned symptoms can be even more severe. Angina, heart attacks, and even death have occurred in people who abruptly stopped taking a beta blocker. (1)
On the other hand, people who do not stop the medicine per se but miss a lot of doses have a higher risk of complications. A study (3) showed that they tend to go to the hospital for hypertension-related complications (especially heart failure) more frequently. On rare occasions, some of them have experienced mini strokes and/or vision loss.
What to do when you miss one dose
If you miss just one dose, what you do about it depends on when you remember it. Normally, if you remember it within 10 hours, you can take the pill and then continue the next pill at your regular schedule. However, if you remember it too late in the day, wait until it’s time for your next dose and then take one pill. Do NOT take two pills to compensate for the missed one, as it can lower your blood pressure too much.
How to avoid missing pills
More than half of patients with hypertension miss at least one dose a year. (4) What is your reason for skipping a dose? Is it the cost, the side effects, or the number of pills? Whatever it is, talk to your doctor. There are many medicines available for hypertension in the market, and it is often possible to switch to another medication that suits you instead.
- Reidenberg MM. Drug discontinuation effects are part of the pharmacology of a drug. Journal of Pharmacology and Experimental Therapeutics. 2011;339(2):324-8.
- Corrao G, Rea F, Ghirardi A, Soranna D, Merlino L, Mancia G. Adherence with antihypertensive drug therapy and the risk of heart failure in clinical practice. Hypertension. 2015;66(4):742-9.
- Karachalios GN, Charalabopoulos A, Papalimneou V, Kiortsis D, Dimicco P, Kostoula OK, et al. Withdrawal syndrome following cessation of antihypertensive drug therapy. International journal of clinical practice. 2005;59(5):562-70.
- De Leeuw PW, Fagard R, Kroon AA. The effects of missed doses of amlodipine and losartan on blood pressure in older hypertensive patients. Hypertension Research. 2017;40(6):568.