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- 1. From the website of Graedon Blood Pressure Drug Combos That Could Be Lethal Blood pressure drugs can save lives by preventing heart attacks and strokes. But combining the wrong BP drugs can lead to life-threatening consequences. The People's Pharmacy April 23, 2015 Drug Side Effects Add a Comment poison pill bottle When doctors prescribe blood pressure medication, their goal is to reduce the likelihood that a patient with hypertension will develop heart attacks, strokes, kidney damage, eye problems or even Alzheimer s disease. But some commonly prescribed blood pressure drugs can interact in dangerous, if not deadly, ways with other anti-hypertensive meds or even with antibiotics. It is not uncommon for health professionals to prescribe two or even three different blood pressure medications to get a patient closer to  normal.  By the way, there is growing evidence that aggressively lowering systolic blood pressure (below 128) with medications in older patients may actually increase the risk for cognitive decline (more about this here). ARBs and ACEIs: A Dangerous Blood Pressure Mix Our greater concern is the discovery that certain blood pressure medications may not play well together. Two of the most popular categories of blood pressure medicines are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). They both belong to what is called RAS (Renin- Angiotensin System) inhibitors. At last count more than 160 million prescriptions are filled annually for ACE inhibitor-type drugs. They include benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril and trandolapril. If there is a  PRIL  in the name, you can pretty much assume you are taking an ACE inhibitor. ARBs include medications such as azilsartan, candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan. If there is a  SARTAN  in the name, you can pretty much assume you are taking an ARB. Over 80 million prescriptions are written annually for ARBs. While most of the ACE inhibitors are now available generically, that is not true for the ARBs. Brand names like Atacand, Avapro, Azor, Benicar, Diovan, Exforge, Micardis and Teveten may be more likely than their generic equivalents. Taken independently, ACE inhibitors or ARBs are reasonably safe and quite effective for controlling high blood pressure. When these categories are combined, however, there can be serious complications. A review of 33 randomized controlled trials in (BMJ, Jan 28, 2013) comparing treatment with one single blood pressure medication to  dual blockade  with both an ARB and an ACE inhibitor together revealed some scary results. The combination therapy led to an increased risk of a potentially life- threatening condition called hyperkalemia (excessive potassium levels). Too much potassium can lead to cardiac arrest. Other adverse reactions associated with dual therapy included hypotension (very low blood pressure) and kidney failure. How Serious Are These Side Effects? When your blood pressure drops too low you can become dizzy and fall. When an older person falls, it can lead to broken bones. A hip fracture is associated not only with disability but also death. Kidney failure is another life-threatening condition associated with the combination of ACE inhibitors and ARBs. The conclusion of the researchers was: