Grapefruit juice // Beta Blockers
 

A well known UK newspaper ran a story in their health section today about grapefruit juice reducing the effect of some beta blockers, notably atenolol, talmolol and celiprolol, frequently prescribed for control of hypertension.

a) If you're taking any of these it's worth remembering.
b) No mention was made of the beta-blocker I'm taking which is bisoprolol fumerato. If anyone hears mention of this in connection with drinking grapefruit juice (which I love) please PM me - thanks.

Beta blockers are quite an old fashioned, (although effective), treatment for hypertension. We recently recieved some guidance from our medicines managment folks, to "review" our patients who were taking this class of drugs for hypertension. (Not to be confused with those who were taking it for other reasons, eg angina.)

The review involved bringing the patient in routinely and discussing alternative treatments which may be more effective, with less side effects. I must say, most patients had been taking this drug for years, without problems, and they chose to remain on it.

I've not heard of grapefruit juice interacting with beta blockers, but I know it can be a problem with other drugs used in this field, including statins and calcium channel blockers.

PS don't stop taking your meds without first chatting to your doc.

Cheers, ginge.:)

An observation on Hypertension: we have a very good friend, an elderly retired German surgeon, his brain packed with 50 years of practical observations. A year or so ago he said that in his opinion, a moderately elevated blood pressure which had been constant for most of a patient's adult life posed no threat to one's health in old age provided it didn't increase, in contrast to a varying blood pressure. Quote: "It is YOUR blood pressure and your cardio-vascular system has developed in accordence with that blood pressure". This has now been confirmed by a UK medical study.

On the other hand, my own GP flies into a frenzy if one's BP goes over 150/90 which is why I'm on betablockers. It's true that they do smooth out the peaks in heart rate as well as blood pressure under stress, but I've put on a lot of weight due to my reduced metabolism. Even such activities such as shovelling snow for six hours a day for five days the week before last didn't cause much of a weight loss (although it was fun in retrospect and made me happy that I could do it with no aches and pains afterwards).

And right, I don't propose stopping the beta-blockers. At least I now have an excuse for my paunch !

Your retired German friend may have a point, as I believe that there is some emerging evidence to suggest that variations in bp are indeed dangerous.

Your GP could be in a frenzy for several reasons- he's probably seen the effects of stroke first hand- it is disastrous.

His pay may also be linked to reducing your blood pressure to an "acceptable" limit !

When we start pushing the limits, we do seem to reach a wall of diminishing returns, but the evidence for treating blood pressure (you mention 150/90mmHg) is fairly well established.

For example, if we had, say, 100 patients who had a bp of 150/90, we know that if we didn't treat them for hypertension, then 10 would come to grief in the next ten years. (I made that figure up,but we can make an estimation). If we treated those 100 patients, and reduced their bp to a lower limit, then we know that only 5 would come to grief over the next 10 years.

The problem is, we don't know which 5 come to grief, and which 5 we save.

And we have to poison (sic) 100 patients to get the benefit.

A bit of a simplistic viewpoint, but not far from the truth.


Of course the things that make a big difference are stopping smoking, and choosing different parents.:}

Good health.

No grapefruit
 

I've always had relatively high BP, when I had a scare (per my GP) my BP was 168/88.
Got stuck on Perindopril last BP was 132/72, still no grapefruit, and stop smoking, stop drinking, and keep off the purines or the gout will come back !

Still smoking & drinking, limited purines, no falling over or gout:ok:

Just go for pure orange, tomato or juice your own (carrot, apple, ginger & garlic) stuff, good fun picking the bits out of a juicer:{

Very interesting, gingernut, and very thought-provoking.

I've never been lower than 145/90 since I was in my early twenties, so that's 'my' BP. I do counter it with mild aerobics and mild weights at the gym every morning plus I've never smoked and I drink very much in moderation.

On beta-blockers my BP is around 135/80 these days, so no problems there.

But just to show how misleading all of this can be: my wife has a resting heart rate of around 60 and a usual BP of maybe 120/60. So she turns up at an MD who doesn't know her, he checks her BP, it's 135/80 and he says "you're fine". She replies, "no, that's high for me !" and he smiles indulgently.....

There isn't a DIN standard human being, is there....

OFSO,
It is not just Beta blockers affected by grapefruit juice. I was on Amlodipine ( a calcium channel blocker) for my so-called hypertension, and that carries a warning on the information sheet to avoid grapefruit juice.
My normal BP was around 140/90 for a long time, which my GP considered borderline, and just advised taking more exercise, avoiding salt, and generally watching my diet. After developing a kidney stone last October, the duty doctor measured my BP at 255/152, and immediately put me on 5mg Amlodipine. That was fine for a while, but then the dose was increased to 10mg, which led to swollen ankles and a severe allergic reaction with urticaria.
It took some steroids to clear that up, and I'm now off the Amlodipine, and onto diuretics!
Funnily enough, I had no symptoms with my normal BP, only when I started taking the medication!. I think I agree with German friend.

I'm on Atorvastatin for my cholesterol and that also says on the box to avoid grapefruit...just as well as I can't stand the stuff!

There's an interesting report on BBC text on health (page 1030 for them what can get it) about people taking beta-blockers have been found less likely to develop certain forms of cancer. Hmmmm. As ever the report winds up "...more research is necessary..."