Since hypertension became the most popular disease globally, most adults over the age of 50 have started to take blood pressure medications. These drugs are essential for managing blood pressure and preventing complications associated with hypertension. However, some of them may have side effects that can affect nutrient levels in the body. Because of these medications, the concept of “drug muggers” has been introduced. Our body easily lacks many essential nutrients and cannot absorb those while taking antihypertensives. What kinds of nutrients are affected? First, you need to understand briefly the basic principles of hypertension drugs.

Diuretics 
Diuretics, water pills are commonly prescribed to treat hypertension. The easiest way to reduce hypertension is by increasing urine production and reducing overall blood volume. When the total amount of plasma decreases with water pills, blood pressure goes lower. Diuretics are often used as single or combined drugs. However, it interferes with various enzymes and promotes sodium and water excretion through the kidneys. As a result, water-soluble vitamins flush out with the water. In particular, diuretics cause deficiency of the energy-producing vitamins B1, B6, potassium, and magnesium. 
Thiazide diuretics can lead to the loss of potassium, magnesium, and sodium. This could result in electrolyte imbalances. When magnesium and potassium become deficient, the heart does not beat regularly, and arrhythmia can occur. So, patients on thiazide diuretics may be advised to increase their dietary intake of potassium-rich foods, like beans, lentils, avocados, and bananas. Dried fruits, such as raisins and apricots, may be good choices. And some sort of diuretics could prevent potassium level increase; in this case, taking a potassium supplement can cause hyperkalemia. Calcium is also affected. Through a PTH-dependent mechanism, thiazides may also impact urinary calcium excretion. Daily administration of 200 mg thiazide for four days has been shown to decrease urinary calcium (1).

Beta-blockers
Beta-blockers lower blood pressure by reducing the cardiac output from the heart. Some beta-blockers may affect lipid metabolism and reduce levels of Coenzyme Q10 (CoQ10). CoQ10 may lower blood pressure, but beta-blockers, like propranolol and metoprolol has shown to inhibit CoQ10-dependent enzymes (2). It is an antioxidant with potential benefits for blood vessels and may reduce blood pressure. Some people may choose to supplement with CoQ10, especially if they experience side effects. 

Calcium Channel Blockers
Calcium Channel Blockers dilate blood vessels. Some calcium channel blockers may affect magnesium levels. In particular, magnesium helps to relax blood vessels and helps reduce blood pressure. I don’t think eating this will reduce blood pressure. However, if this is insufficient, blood pressure can rise, so it’s better to take it.
Magnesium has a nerve-stabilizing effect. A deficiency in magnesium can lead to muscle cramps and other symptoms. Some CCB cause folic acid depletion. Meanwhile, patients taking CCBs should be counseled on how to meet their recommended folate intake (3).

Angiotensin-Converting Enzyme (ACE) Inhibitors
These medications generally have a lower impact on nutrient levels compared to diuretics. But, some studies suggest that ACE inhibitors may increase potassium levels, leading to hyperkalemia in some individuals. The retention of potassium in the kidney might be a major concern, indicating ACE inhibitors. Its inhibitory effect is caused by aldosterone secretion. 1-2 percent of ACE inhibitor users reported hyperkalemia with sodium-restricted diet (4). When you take ACE inhibitors, you may think to avoid potassium supplements or potassium-rich foods. 
Long-term treatment with ACE inhibitors, particularly captopril, can cause a reduced sense of taste. Captopril may lower zinc status and increase the risk of zinc deficiency, but only with chronic use at higher doses (2).

Long-term use of antihypertensives can lead to folate deficiency and calcium deficiency. It also affects the rest of the minerals. There is also a high blood pressure drug that raises potassium. People who take high blood pressure medication can be confused.
Can we take blood pressure medication and nutrient supplements together? Then, is it better not to take medication? It’s essential not to make changes to medication or supplementation without consulting a healthcare professional. The prescribed medication must be taken to reduce blood pressure, and it is recommended to make up for possible deficiencies. It is better to take a multivitamin containing minerals such as calcium and magnesium. Omega 3 is good for preventing various complications and cardio-cerebrovascular problems by dilating blood vessels to help reduce blood pressure and suppress blood clots and blood circulation.

References
1) Brickman A.S., Massry S.G., Coburn J.W. changes in serum and urinary calcium during treatment with hydrochlorothiazide: Studies on mechanisms. J. Clin. Investig. 1972;51:945–954. doi: 10.1172/JCI106889
2) Kishi T, Watanabe T, Folkers K. Bioenergetics in clinical medicine XV. Inhibition of coenzyme Q10-enzymes by clinically used adrenergic blockers of beta-receptors. Res Commun Chem Pathol Pharmacol. 1977;17:157–164.
3) Emily S. Mohn,1 Hua J. Kern,2 Edward Saltzman,1 Susan H. Mitmesser,2 and Diane L. McKay1,*. Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics. 2018 Mar; 10(1): 36.
4) Golik A., Modai D., Averbukh Z., Sheffy M., Shamis A., Cohen N., Shaked U., Dolev E. Zinc metabolism in patients treated with captopril versus enalapril. Metabolism. 1990;39:665–667. doi: 10.1016/0026-0495(90)90098-W.
5) Stoltz M.L., Andrews C.E. Severe Hyperkalemia during Very-Low-Calorie Diets and Angiotensin Converting Enzyme Use. JAMA. 1990;264:2737–2738. doi: 10.1001/jama.1990.03450210033017.
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