What Can Happen If You Stop Taking Your High Blood Pressure Medication?

High blood pressure is a serious condition, but one which typically has no symptoms until a lot of damage has been done. Because of this, it is often hard for patients to comply with their medication regimen. With no returning or worsening symptoms when you forget to take a pill, remembering to do so becomes much more challenging.

There is often a feeling that it is "no big deal" if you miss the occasional dose, or stop taking the medication altogether. However, high blood pressure medication is typically taken for life, although some drugs need to be discontinued or changed during pregnancy. Some people may also be able to taper off the medication or stop it completely if they successfully make significant lifestyle changes that cause a substantial improvement in their blood pressure.

What happens if I skip a dose?

If you skip a dose, you should take it as soon as you remember unless it is approaching the time for your next dose. Missing a single dose is less harmful than overdosing.

It helps to take your medication (meds) at the same time every day and to connect it with another part of your routine. This might mean taking day meds in the morning with breakfast and keeping night meds next to your toothbrush. In addition to taking your meds at the same time of day, it may also be useful to take them at a certain time of day, which could be recommended by your doctor. One major trial¹ showed that taking your meds at bedtime significantly reduced your risk of a heart attack.

What if I stop taking them for a few days?

It's important not to stop taking your pills,  even for a few days, without consulting your doctor. In some cases, they may ask you to discontinue your meds for a short period so they can assess what your blood pressure (BP) would be without them.

However, it is more common to reduce your dosage to see if you don’t need to take as much. This is done in the hope that you will be able to reduce your dosage and assess the impact of lifestyle changes.

Full discontinuation is most often for when your blood pressure has dropped too low due to illness, and this will only be until you recover.

Some blood pressure medication causes withdrawal symptoms that are typically mild, but can occasionally be serious. The latter form is known as "withdrawal syndrome,"² which is overactivity of the sympathetic nervous system that can cause the following symptoms:

• Headaches

• Anxiety

• Tachycardia

• Agitation

• Nausea

• Rapid increase of blood pressure to pre-treatment levels or even higher. In people with very high blood pressure, this can cause a hypertensive crisis.

• Myocardial ischemia

The last two events are rare but can be serious. Because of this, it is very important not to run out of medication. Make sure to request a refill at least a week before your medication is due.

Switching to a 90-day plan can be more convenient for some people. If you are traveling, take enough medication to last through not just the trip but two to three days after the trip, in case you get stranded somewhere. If flying, never check your medication in your luggage. Getting an emergency prescription can be challenging for domestic travel and nearly impossible overseas.

Typically, minor withdrawal symptoms will resolve once you start taking your medication again, with no other treatment needed.

If you can't afford your medication, don't cut pills in half or drop frequency to stretch it out, as reducing your dosage could cause your blood pressure to go out of control. Consider any options available to help you pay for the medication or look for cheaper versions.

What are the consequences of stopping taking your medication altogether?

It can be very tempting to simply stop taking medication if you feel fine and your blood pressure results look good. Unfortunately, the reason you feel fine and your blood pressure looks good is due to the effect of the medication. As with many chronic conditions, lifelong medication is often needed to maintain your blood pressure in the normal range.

Not taking your medication can cause your blood pressure to go out of control. This can cause a large number of problems, including:

• Permanent damage to your arteries.

• Increased risk of aneurysm, which most often form in the aorta, but can develop anywhere. If an aneurysm bursts, it causes life-threatening internal bleeding.

• Increased risk of coronary artery disease, which can lead to chest pain, irregular heartbeat, and potentially a heart attack.

• Enlargement of the left side of your heart, which also increases the risk of a heart attack. 

• Heart failure caused by a weakening of the muscle.

• Increased risk of stroke.

• Vascular dementia, which is caused by limited blood flow to the brain.

• Mild cognitive impairment.

• Kidney scarring and potentially kidney failure; the latter of which may require dialysis or a transplant.

• Retinopathy, that is damage to the blood vessels in the eye, which can lead to blurred vision and potential vision loss.

• Choroidopathy, that is fluid buildup under the retina, which can lead to distorted vision.

• Damage to the optic nerve.

• Erectile dysfunction and female sexual dysfunction (decrease in arousal, vaginal dryness, difficulty achieving orgasm).

This damage is slow and happens over years and, by the time it shows any symptoms, such as blurred vision, the damage has already been done. Not taking your meds significantly reduces your chance of keeping your blood pressure under control.

Talk to your doctor if you think you might no longer need your meds because you have made enough lifestyle changes. They can do tests to establish your BP without the meds and whether you can stop taking meds or reduce the dosage.

Do not stop taking your medication because of side effects without talking to your doctor first. You need to work with them on the best medication regime for you.

What happens if you take too much medication?

If you're not sure whether you took your medication or not, it's possible to end up taking a double dose. The consequences depend on the specific medication you are taking. Here are some side effects of overdoses of common blood pressure medications.

Beta-blockers

• Difficulty breathing

• Blurred or double vision

• Irregular heartbeat

• Lightheadedness

• Rapid or slow heartbeat

• Shock from extremely low blood pressure

• Heart failure

• Weakness

• Nervousness

• Drowsiness

• Excessive sweating

• Convulsions

• Confusion

• Fever

• Coma

Yes, you can fall into a coma. Beta-blocker overdose is serious, and if you or a family member overdose, go to the ER.

Thiazide

• Weakness

• Dizziness

• Dry mouth

• Extreme thirst

• Nausea

• Muscle pain

Amlodipine

• Dizziness

• Hyperglycemia due to reduced insulin release

• Abdominal pain

• Nausea

• Oliguric renal failure

• Pulmonary edema

• Refractory shock

• Death

ACE inhibitors

• Extreme hypotension

Besides this, only very mild overdose symptoms are noted. If you overdose on your ACE inhibitors, you will be monitored. In severe cases, ACE inhibitor overdoses can cause your blood pressure to drop to levels that can cause fatality, and some people require hospitalization and IV fluids.

You should talk to your doctor about overdose symptoms on your medication and make sure that anyone you live with knows about them. Always keep your blood pressure medications out of the reach of children and pets.

Will you ever be able to stop taking your medication?

As there is no cure for high blood pressure, most people will take meds for life. However, others may be able to stop or reduce the dosage if they successfully lower their blood pressure through lifestyle changes.

Although other lifestyle factors also matter, one common contributory factor in reducing high blood pressure is weight loss. As obesity has a major negative impact on blood pressure, reaching a healthy weight might be enough to lower your blood pressure to the recommended range. It is important to note that these lifestyle changes need to be maintained for life to keep your blood pressure under control.

Other positive lifestyle measures, including smoking cessation and making dietary changes, also play a role in normalizing your blood pressure.

In some cases, doctors may stop blood pressure medication in older and extremely frail individuals, especially those in nursing homes. This is because the risk-benefit ratio can change, i.e., the potential side effects of the drugs become more dangerous than the risk that hypertension imposes. Somebody who is extremely frail is at a higher risk of falls. Blood pressure-lowering medications can lead to postural hypotension and dizziness, increasing their risk of falls.

Another reason you might stop taking medication is if an underlying condition that causes high blood pressure is resolved. For example, obstructive sleep apnea can cause secondary hypertension. You may need medication for a while, but your blood pressure can return to normal after your sleep apnea is brought under control using a CPAP machine or other methods.

Secondary hypertension is potentially curable depending on the cause. However, this is not always the case.

What if you are pregnant or trying to conceive?

Some blood pressure medications are not recommended during pregnancy. ACE inhibitors, for example, can cause congenital disabilities. Because of this, sometimes people will stop taking the medication when they are trying to conceive.

Unfortunately, high blood pressure is also associated with adverse pregnancy outcomes, including:

• Slowed fetal growth

• Placental abruption

• Preterm birth

• Preeclampsia

Preeclampsia is a very serious condition that can result in the death of the mother, the fetus, or both. Preeclampsia can increase the risk of future cardiovascular disease.

Because of this, it is very important to talk to your doctor before attempting to conceive or if you become unexpectedly pregnant. Your doctor might cease or switch you to a different medication that is safer for the baby. You will also need more careful prenatal monitoring, including watching for symptoms of preeclampsia such as severe headaches, changes in vision, shortness of breath, and decreased urine output. Preeclampsia may result in the need to deliver your baby early.

You are also at a higher risk of needing a cesarean section if you have high blood pressure.

Again, do not stop taking your blood pressure medication to become pregnant without talking to your doctor first. If possible, try to hold off on conception until you have switched to a pregnancy-safe regimen that works for you. Your doctor may also put you on low-dose aspirin at 12 weeks, as this has been shown to reduce the risk of preeclampsia in people with certain risk factors.

Should you stop taking your blood pressure medication before surgery?

Some blood pressure medications, such as angiotensin receptor blockers, can elevate the risk of your blood pressure dropping while under general anesthesia.

However, you will typically only be asked not to take the medication on the day of your surgery. Recent studies have shown that it is better to resume the medication soon afterward. Make sure that you have your medication with you when you are admitted, and advocate for yourself. Sometimes, if you are transferred to a different unit, your prescriptions may fall through the cracks and not be resumed. Make sure you have a friend or family member ready to remind staff about your meds.

Talk to your surgeon or anesthesiologist about your blood pressure medication, when you should stop taking it, and when to resume. You should also talk to them about any other medications you are taking, as well as any supplements.

How long do blood pressure meds stay in your system?

Typically not long. While some drugs stay in your system for days, others wear off in a matter of hours. This makes it particularly important to avoid skipping a dose.

While most modern blood pressure meds are designed to be taken once a day, they still may wear off through the day, and your doctor will work with you on the best time to take the medication. This will often be at night, but if you experience side effects that keep you awake, they may switch the time for that medication to the morning.

The lowdown

You must take any medication prescribed to you in line with the instructions from your doctor, and blood pressure meds are no different. With high blood pressure being a lifelong condition, it is important to follow your medication regimen.

While it can be tempting to stop taking your meds because you feel fine and your blood pressure is in the normal range, it can be deceptive as taking the medication created that result.

It is also important to stick to the plan as this can help prevent skipping or even overdosing on the medication.

Though some effective lifestyle changes may allow you to reduce or stop taking blood pressure meds, you must only do this under the advice of your doctor.