Nocebo responses to antihypertensive medications.

Apatient was seen in consultation for intolerance to multiple antihypertensive medications. She presented a list of her experiences, which is summarized in the Table. Although the cough she experienced while taking angiotensinconverting enzyme inhibitors was a typical side effect of this drug class and consistent on rechallenge, this was not the case with her other reported medication reactions. When the patient received the same medication labeled in the same way (Calan SR), she had diarrhea on both occasions. When she received the same medication labeled differently (Calan SR or Verelan and Cozaar or Hyzaar), her reactions differed. The patient listed valsartan, propranolol, hydralazine, and indapamide as ineffective, but it was not clarified whether they were tolerated. The patient was taking one-fourth 100 mg metoprolol twice a day, but experienced headache and heartburn at higher doses, and clonidine 0.1 mg daily, but experienced a localized rash at higher doses. She had been hospitalized on one occasion for hypertension and on another occasion for hypertension and ‘‘stress.’’ She was currently taking alprazolam. She summarized her view of antihypertensive medications as ‘‘I am scared of them.’’ She added that statins raised her blood pressure, but she was tolerating levothyroxine. After an explanation for the origin of these nonspecific side effects was provided to the patient, she stated that she did not believe this accounted for her reactions.