Treating Tremors

| POLIO TIPS AND TECHNIQUES

by Dr. Richard L. Bruno

Last column, we talked about types of tremor, essential tremor being one, which is often treated with beta-blockers. Beta-blockers have been a first-line drug to treat high blood pressure. The problem for polio survivors is that the side effect of beta-blockers—and of most antihypertension drugs –is fatigue, something polio survivors don’t need more of. So, here are some suggestions to take to your doctor about drugs to lower your blood pressure that, hopefully, will not also put you to sleep:

• The first drug prescribed to treat hypertension used to be a diuretic, a “water pill.” Diuretics, like Diazide and Furosemide, lower blood pressure by decreasing the amount of fluid in your arteries. But diuretics work by making you pee…and pee and pee. Polio survivors with fatigue and weaker arms and legs shouldn’t be running (or rolling) to the bathroom and getting on and off the throne a dozen times throughout the day and night.
• Those beta blockers I mentioned lower blood pressure by stopping adrenaline from stimulating the heart muscle. The problem is that these drugs block adrenaline from stimulating brain activation, too. Of all the antihypertensives, beta blockers are probably the worst offenders when it comes to producing fatigue. The drug companies’ own studies show that fatigue was a side effect in a high percent of patients: Kerlone (3%); Corgard and Tenormin (4%); Trandate, Zebeta, Visken (5%-8%); Sectral, Lopressor, Inderal (11%-17%); and Coreg (24%).
• Another older antihypertensive that causes fatigue is the alpha blocker. This drug stops adrenaline from stimulating blood vessels and thereby allows arteries to open, lowering pressure by increasing the size of the “pipes” blood can flow through. But, as with beta blockers, anything that blocks the stimulating effects of adrenaline can cause brain “deactivation” and fatigue. Fatigue was reported in more than 7% of subjects taking alpha blockers Cardura, Hytrin and Minipress;
• Newer antihypertensives have been developed that don’t block adrenaline and are less likely to cause fatigue. The calcium-channel blockers (CCB) open blood vessels and reduce the force of contraction of the heart. CCB Procardia and Norvasc caused fatigue in from 4% to 6% of subjects. But, fatigue was not reported with CCB Cardene and Verapamil;
• Differences in fatigue reports were also seen among members of another class of newer antihypertensive, the angiotensin receptor blockers (ARB). These drugs block angiotensin, a hormone that causes blood vessels to narrow. ARB Diovan and Avalide caused fatigue in 4% to 5% of subjects. Fatigue was not reported with ARB Atacand, Micardia, and Cozar;
• A varying ability to produce fatigue was also seen among the angiotensin converting enzyme (ACE) inhibitors, which block the production of angiotensin. ACE inhibitors Accupril, Lotensin, Vasotec and Zestril were found to cause fatigue in about 2% to 5% of
  subjects. However, fatigue was not reported with ACE inhibitors Aceon, Altace and Monopril.

Should polio survivors never take certain antihypertensives and always use others? First, some of these “antihypertensive” medications have applications other than lowering blood pressure, like beta blockers, which treat abnormal heart rhythms. Calcium-channel blockers also treat angina and can prevent migraines. And alpha blockers treat enlarged prostates and can help to warm cold hands and feet. Second, since some people have hypertension that is difficult to manage with only one medication, a combination of drugs may be needed that might necessarily include a beta or alpha blocker.

When taking any medication, it is important that polio survivors keep a log of side-effects and discuss these with their doctors. The dose or time of day when you take a drug—taking a fatigue-producing medication before bed or taking a long-acting, slow-release form of a drug—may minimize fatigue. As we’ve discussed before, don’t let doctors tell you that a drug couldn’t cause fatigue because “other patients” haven’t complained. Polio survivors are not like other patients. If your doctor doesn’t listen to you, get another. If you’re not comfortable with the medications your doctor is using to treat your hypertension, or if your blood pressure isn’t coming down in spite taking a combination of drugs, don’t hesitate to consult a cardiologist who’s also a hypertension specialist.

Remember: The stroke you prevent by keeping your blood pressure down will be your own!

Dr. Richard L. Bruno is Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center.