By Andrea Bartels CNP NNCP RNT
27 Feb 2023
Do you have high blood pressure? Hypertension increases risk of atherosclerosis—a plaquing of the arteries that increases risk of heart attack and stroke. In fact, hypertension can also be a sign indicating the atherosclerotic process is already underway.
While several types of drugs are commonly prescribed by doctors to manage hypertension, each of these come with side effects that can result from nutrient depletion. Let’s look at some of these drugs and the nutrients they deplete.
Thiazides: These are a type of anti-hypertensive medication also known as ‘the water pill’. That’s because they reduce blood pressure by reducing the total volume of fluid within the cardiovascular system, effectively reducing the pressure in the blood vessels. Examples of thiazides include hydrochlorothiazide, chlorthalidone and metolazone.
Since these drugs work by removing excess water from the bloodstream, water-soluble minerals such as magnesium, potassium, sodium and zinc are lost in the urine at the same time. For this reason, individuals taking one of these diuretic drugs would benefit from additional intake of these nutrients. Otherwise, deficiency symptoms such as weakness, muscle cramping or twitching, or dizziness may occur.
Potassium-sparing diuretics: This type of anti-hypertensive drug may sound like a better idea than a water pill, at first. Since sodium increases blood pressure, this sort of drug works by focusing on excreting sodium, while “sparing” potassium.
But potassium-sparing diuretics increase the need for at least 2 nutrients: calcium and folate. This should be of concern to any individual who doesn’t consume milk products because this puts a person at higher risk of dietary calcium deficiency. In the short term, resulting problems could include irritability, muscle twitches or cramps. In the long term, risk of bone fracture increases greatly with calcium deficiency.
Similarly, people who eat processed foods and not enough grains or greens will have difficulty getting enough dietary folate to make up for what this type of drug does to folate status. The resulting deficiencies can show up in a myriad of ways: low energy, digestive problems, mental health instability, and reduced resistance to infection, to name just a few.
An example of a potassium-sparing diuretic is spironolactone.
ACE inhibitors: These drugs belong to another group of blood pressure drugs called ACE inhibitors. They work in 2 ways. For one, they relax and widen blood vessels to allow better blood flow. Secondly, they reduce water retention.
One of the side effects is increased blood potassium levels. High potassium that isn’t balanced with sodium is associated with heart palpitations, nausea, muscle weakness, and numbness or tingling in the hands or feet. It’s important to note here that fresh fruits and vegetables are high sources of potassium, but cutting those out of the diet to reduce risk of these side effects would create some deficiencies: vitamin C, fiber, and possibly, folate.
ACE inhibitors also deplete zinc—which could have detrimental effects on wound healing, sense of smell and taste, reproductive functions and immunity. Meanwhile, even though nuts and seeds are great sources of zinc, dietary intake can be limited by allergies, calorie-counting and conditions like diverticulosis.
Examples of ACE inhibitor drugs include: captopril, fosinopril, enalapril, quinapril, ramipril and tranopril.
Loop diuretics: These work similarly to the thiazides, by stimulating urine production, leading to a reduction in water and sodium retention in the blood. It’s too bad that out with that water goes your water-soluble nutrients.
This group of drugs affects nutrient status in significant ways, depleting calcium, magnesium, potassium and zinc, as well as vitamins B1, B6, C. That’s quite a few nutrient losses, with many of these affecting energy levels and immunity, too. If you’re taking one of these, now you have another reason to bump up your fresh fruits and vegetable intake!
Examples of loop diuretics include: furosemide, torsemide, bumetanide, and etharcrynic acid.
Calcium channel blockers: The calcium channel blockers lower blood pressure in a very different way. They prevent calcium from entering smooth muscle cells of the heart and blood vessels, dilate the blood vessels and reduce heart rate.
Grapefruit lovers take note: no amount of grapefruit or its juice is safe to consume while on calcium channel blockers. That’s because this fruit naturally contains a plant chemical called naringenin, a substance that temporarily slows down the rate at which the liver can detoxify certain substances, including this type of drug.
Examples of calcium channel blockers include: Amlodipine, Diltiazem, Felodipine, Isradipine, Nicardipine, Nifedipine, Nisoldipine and Verapamil.
Beta-blockers: These drugs lower blood pressure by reducing heart rate and the force of the heart’s contractions. Unfortunately, they elevate potassium levels while they’re working, so expect to experience the occasional heart palpitations, and possibly some muscle weakness if you take a beta-blocker.
Examples of beta-blockers include: Acebutolol, Atenolol, Bisoprolol, Metoprolol, Nadolol, Nebivolol and Propanolol.
Time for a Top-Up
To sum up, it’s important to discuss with your doctor or pharmacist any new symptoms you’re experiencing since starting a medication. It’s also equally important to make sure you’re consuming and absorbing enough of the nutrients that your prescription drugs may deplete.
To reiterate, here are the nutrients that you may need to top up if you’re on a drug combination for high blood pressure: calcium, potassium, zinc, magnesium, folate, vitamin B1, vitamin B6 and vitamin C.
No one eats perfectly all the time. Using this information is a step towards helping you determine how to adjust your diet, and what quality nutritional supplements can ensure your vitamin and mineral levels are adequate to keep you healthy.
Are you also using a cholesterol-lowering medication? For information on this topic, please check out this article.
Abell, John B. “Cardiovascular Medication and Associated Drug-Induced Depletion.” Georgia Functional Medicine. Accessed online February 13, 2023.
Chiu HF, Venkatakrishnan K, Golovinskaia O, Wang CK. Impact of Micronutrients on Hypertension: Evidence from Clinical Trials with a Special Focus on Meta-Analysis. Nutrients. 2021;13(2):588.
Mayo Clinic. “Calcium Channel Blockers.” Accessed online February 22, 2023.
Mayo Clinic. “Beta Blockers”. Accessed online February 22, 2023.
Mayo Clinic. “Spironolactone.” Accessed online February 22, 2023.
Micronutrient Information Center, Linus Pauling Institute. “High Blood Pressure.” Accessed online February 13, 2023.
Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics. 2018;10(1):36.
National Kidney Foundation. “Hyperkalemia (high potassium).” Accessed online February 22, 2023.
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