There’s a tendency among physicians to just add blood-pressure medications when one isn’t working adequately, rather than to try substituting them;’ says Dr. Pickering. “Some medications really just don’t work on particular patients. In those people it would make more sense to substitute something that does work, not pile one drug on top of another.”
Part of the problem, he says, is that trying to find out whether a medication is working involves taking lots of blood-pressure measurements. But if you get only three readings at a doctor’s visit and you have only one visit every few weeks, it’s difficult to get enough data to make a good decision on medication. If you’re trying a series of drugs to see which is best, it’s cumbersome and expensive to do it by going to the doctor every week.
One thing a patient can do, Dr. Pickering says, is self-monitor blood pressure. “It’s economical and easy to tell if medication seems to be working by using a home monitor. Then you can phone in or fax in your readings. The doctor can get a feel for whether the stuff is working. It’s a valuable way to assess medication.”

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