not exactly sure where to put this
but my friend has been on angiotensin receptor blockers and calcium channel blockers for almost two years now.
they have also been taking party drugs quite frequently during that time.
i'm worried for my friend if they are doing any damage to themselves, but they tell me they are absolutely fine!
later this year they will have a 3 day festival where they will most likely be indulging in mdxx/ketamine/speed/bud/alcohol
they tell me they've tried all these before, even in small combinations and they've been fine during and the next day and so on.
should anything be going wrong? any masked damage?
i know you guys aren't all doctors but i'm sure someone might know someone that is in the same position.
thanks!
(p.s. sorry first post not sure exactly where to put this, but this seemed active, please no hate!)
Calcium channel blocker and ARBs will cause peripheral vasodilation via relaxation of smooth muscle in small arteries and pre-capillary arterioles. The effects of these medications may be offset by MDMA, which is a sympathomimetic, and thus will have peripheral alpha-1 agonist activity, resulting in vasoconstriction of those vessels.
Rather than worrying about MDMA undoing the effects of those medications, I would be more concerned about the underlying cause of your friends hypertension. I'm assuming your friend is young, as most people who take MDMA are. Its not too common for young people to have hypertension from common etiologies such as peripheral vascular disease found in older people. In young people, other, less common causes tend to be the underlying cause for hypertension, such as hyperthyroidism, hyperparathyroidism, hypertrophic cardiomyopathy, renal artery stenosis, pheochromocytoma, etc. Do you know the underlying cause behind your friends hypertension?
In this situation, instead of being worried about causing chronic damage, I would fully assess the risk of cardiovascular collapse after taking MDMA in a person with pre-existing hypertension. The risk may be small depending on the severity and underlying cause of the hypertension, but it should be assessed. If he/she is at moderate risk, he/she may have been lucky up till now.
MDMA releases a significant amount of vasoactive monoamines such as serotonin, dopamine, and norepinephrine, not only in your central nervous system, but also in your peripheral circulation. The effect of this on your cardiovascular system can be somewhat unpredictable as the dosing is not very controlled in a recreational setting, and depends on the relative amounts of these substances being released. For example, dopamine is commonly administered as a vasopressor in the intensive care setting. Dopamine infusion at low rates primarily activates D receptors in the kidneys. However, medium rates tend to preferentially activate beta-1 receptors, and high rates activate alpha-1 receptors. Norepinephrine tends to activate alpha > beta receptors.
In the setting of pre-existing hypertension, the heart is already pumping against an increased afterload (the force the left ventricle must generate to overcome the pressure of the peripheral circulation allowing the aortic valve to open and flow to be generated). If MDMA administration results in an even further increased afterload via peripheral vasoconstriction, the result may be hypertensive crisis or cardiovascular collapse when the left ventricle cannot overcome the peripheral pressure resulting in diminished stroke volume and cardiac output.
Again, the risk of all this may be pretty small, but it is larger in someone with hypertension than someone who is not hypertensive. The risk depends on the severity of hypertension and underlying cause. For example, if the cause is pheochromocytoma, a which is an adrenal gland tumor that is know to secrete vasoactive substances, such as norepinephrine, the results could be pretty bad. The best way for your friend to assess this risk is to see a cardiologist where they can perform tests like echocardiograms to assess left ventricular and valvular function as well as ejection fraction, to see how well the heart pumps against high blood pressures. On the other hand, seeing a doctor to have him/her assess the risk of injury from taking an illegal drug may not be the best idea...
As with everything in life, one has to weight the risk vs. benefits of any decision.
