Life insurance with high blood pressure can be tricky business, especially when you start stacking one pill on top of another.
If you take multiple medications for hypertension, what kind of life insurance rates can you expect? Will you be denied outright?
The good news: There are so many people affected by high blood pressure, insurance underwriters deal with this condition every day and are very familiar with it.
The bad news: Based on your medications and how you are controlling your condition, you might not qualify for the best health classes.
Life Insurance and High Blood Pressure – There’s a History!
Did you know?
If not for your friendly life insurance underwriters in the 1900s, we might not even understand the significance of blood pressure today?
Medical directors of two huge life insurance companies directed applicants to submit blood pressure readings. The life insurance medical examiners did this using a new tool called the sphygmomanometer – which is a version of the arm cuff we still use today.
In 1911, Dr. JW Fisher, Medical Director of Northwestern Mutual said:
The time is not far distant when all progressive life insurance companies will require (blood pressure readings) in all examinations of applicants for life insurance.
… and he was right. By 1916, 90% of their applications had blood pressure readings attached.
This is important because it wasn’t the medical community pushing the relevance of high blood pressure to mortality.
It was the life insurance companies.
Because of the work of those examiners, devices to measure blood pressure became standard equipment in doctor’s offices around the country. The first drugs treating high blood pressure followed in the 1950s.
Types Blood Pressure Medications
Blood pressure medications fall into different broad groupings depending on how they function to lower your blood pressure.
We will profile them here, starting with the most commonly prescribed interventions then moving on to less common prescriptions. Each type of medication will impact your chances of getting coverage as a high risk applicant.
When you take a diuretic, this type of medication helps rid your body of excess water and salt by increasing urine output. When you lose the fluid, your blood pressure goes down.
These medications are the weakest form of blood pressure medications and are often the first medication your doctor will prescribe to lower your pressure. Doctors sometimes give diuretics along with other medications.
Some common diuretics are:
- Hydrocholorthiazide (Esidrix, Hydrodiuril)
- Chlorothiazide (Diuril)
- Bumetanide (Bumex)
- Amiloride hydrochloride (Midamar)
- Furosemide (brand name Lasix). Furosemide/Lasix is a high concern medication for some life insurance companies.
Water loss from a regular diuretic can sometimes create problems in certain patients, so doctors sometimes prescribe specialty diuretics.
For instance, a potassium-sparing diuretic helps you lose water without losing potassium. One common medication is amiloride hydrochloride (Midamar).
Other diuretics are loop diuretics because they act on a specific cell located in a part of the kidney called the loop of Henle. Bumetanide (Bumex) is a common one.
Finally, combination diuretics combine two different types of diuretics or combine a diuretic with another blood pressure medication. One example is the triamterene/hydrochlorothiazide combination known as Dyazide.
Life Insurance and Diuretics
For the most part, diuretics will fly through life insurance underwriting with the greatest of ease. These first level medications indicate that an underwriter needs to spend more time checking on blood pressure numbers and searching for other conditions.
However, if those other conditions are disclosed on the application and your blood pressure numbers are lower than 140/85, diuretics usually aren’t an issue on a life insurance application.
These Diuretics might cause a pause: Furosemide (Lasix) will delay a life insurance application sometimes due to other serious conditions doctors prescribe it for.
If Furosemide was prescribed for high blood pressure alone, it is usually not a problem. However, if it is for the treatment of swelling, excessive fluid retention (Edema), heart failure or liver problems – your application could be rated for those more serious conditions.
An ACE inhibitor helps the body produce less angiotensin, a hormone in the body that makes the arteries constrict.
They also reduce the amount of water your kidneys put back into your blood. When the vessels are more open and the volume of the blood is lower, blood pressure is lower.
ACE inhibitors prescribed with diuretics are usually the first line of treatment for hypertension. Doctors may move on to other treatments if the ACE inhibitors cause unwanted side effects (like uncontrolled coughing)
Doctors prescribe quite a few ACE inhibitors
- Benazepril hydrochloride (Lotensin)
- Captopril (Capoten)
- Fosinopril sodium (Monopril)
- Lisinopril (Prinivel)
- Quinapril hydrochloride (Accupril). Accupril is a High Concern medication for life insurance companies.
ACE inhibitors and Life Insurance
ACE inhibitors are very common to life insurance underwriters and most of them cruise through the application process with no problem.
I believe every application we approved last month had Lisinopril on it. So if you are taking an ACE Inhibitor for high blood pressure, don’t worry about your life insurance approval.
These ACE Inhibitors might cause a second look: Quinapril can delay a life insurance application due to the other serious conditions it treats.
Quinapril is the first choice for heart failure and some kidney diseases. So if those conditions are present, your life insurance application could be re-rated.
A beta blocker actually slows down your heart rate by blocking the adrenaline hormone, thereby lowering the output of blood. Beta blockers also relax the muscle walls inside of the blood vessels expanding them, and this “one-two combo” makes beta blockers effective.
Slower heartbeats through larger veins mean less work for your heart to do.
Less force from your heart means lowered blood pressure.
Usually, beta blockers are not prescribed alone for hypertension. They may be prescribed in the presence of other conditions, such as cardiac arrhythmia or congestive heart failure.
Commonly prescribed Beta Blockers
- Lopressor (Metoprolol tartrate)
- Toprol XL (Metoprolol succinate)
- Sectral (Acebutolol)
- Betapace (Solotol hydrochloride)
Life Insurance and Beta-Blockers
Since beta blockers are usually a secondary medication prescribed after diuretics are not effective, they may raise an eyebrow or two.
They are also prescribed for chest pain, atrial fibrillation or after a heart attack. In the absence of these more serious conditions, they usually do not pose a threat to life insurance underwriting
Calcium Channel Blockers
If you’ve heard of beta blockers, you’ve likely heard of calcium channel blockers. Calcium in muscles is required for the muscles to contract.
These medications block calcium from entering heart cells, and that means the heart contraction is not as strong, and blood pressure goes down.
Commonly prescribed calcium channel blockers
- Amlodipine besylate (Norvasc)
- Bepridil (Vasocor)
- Diltiazem hydrochloride (Cardizem)
Calcium Channel Blockers and Life Insurance
Most calcium channel blockers do not affect life insurance rates unless they were prescribed for chest pain (angina). Usually, clients taking calcium channel blockers, or taking them combined with diuretics will qualify with a great health class, no problem.
These drugs cause blood vessels to relax. When the muscles in the artery walls relax, they dilate and blood pressure drops. Common vasodilators are:
- Apresoline (hydralazine hydrocholoride)
- Loniten (minoxidil)
Vasodilators and Life Insurance
We usually don’t see vasodilators to treat blood pressure alone. They usually signify a more serious condition or higher blood pressure that is not responding to medication. Minoxidil is used for this specifically, not just for regrowing hair.
While most medications for hypertension cause no issues for life insurance, vasodilators will affect a life insurance application negatively.
Angiotensin II receptor blockers (ARBs)
These drugs also make the body produce less angiotensin, but they work in a different way. These drugs block the receptor or “chemical keyhole” needed for angiotensin to work.
With the slot blocked, the blood vessels cannot restrict and blood pressure drops.
Commonly prescribed ARBs
- Alpha methyldopa (Aldomet)
- Clonidine hydrochloride (Catapres)
- Guanabenz acetate (Wytensin)
Life Insurance and ARBs
In the past, ARBs were only prescribed if hypertension patients did not respond to ACE inhibitors, or if those ACE inhibitors caused a dry cough. Not so anymore.
Now ARBs are gaining traction for their multi-symptom treatment. They have been shown to help diabetes and atrial fibrillation while keeping blood pressure in check, though the biomechanical mechanisms are not fully understood.
As long as there are no other major conditions to deal with, ARBs do not pose a problem to life insurance approvals.
Alpha blockers also relax the muscles around the blood vessels, albeit in a different way.
They attach to alpha-adrenergic receptors (thus the name alpha blockers) and block noradrenaline from tiny nerve endings. This increases the circumference of these blood vessels and allows blood to move freely around the body.
If there’s more room in the circulatory pipeline, it’s easier to pump the blood. This makes the heart’s job easier which lowers blood pressure.
There are studies that show diuretics and ACE Inhibitors are more effective at lowering high blood pressure, so an alpha-blocker is only prescribed if those methods are not working.
The exception to this rule is if the client or patient has an enlarged prostate as well as high blood pressure, for alpha blockers also relax the muscles around the prostate and bladder.
Alpha blockers most commonly prescribed
- Doxazosin mesylate (Cardura)
- Prazosin hydrochloride (Minipress)
- Terazosin hydrochloride (Hytrin)
Alpha Blockers and Life Insurance
Alpha blockers have been prescribed for decades without serious side effects. Still, there are more effective medications currently to treat high blood pressure. A life insurance underwriter might question the severity of your HBP if you’re taking alpha blockers.
Alpha blocker prescriptions usually pass through underwriting just fine unless there are more serious underlying conditions (like a prostate problem).
Final word on Life Insurance with High Blood Pressure Medications
Life Insurance has a long history with hypertension medications, and that doesn’t look to change anytime soon. More than 1 in every 3 Americans suffer from hypertension, so most HBP medications are going to pass through underwriting with no issue.
However, whether you get the best rates in the market just depends on who you are working with. High blood pressure is one of those conditions where the details matter.
The difference between one health class and another can be neither
High blood pressure is a special risk condition where the details matter. The difference between one health class and another can be neither black nor white . . . but gray.
Also, since many of the HBP medications on this list treat other more serious conditions, you need an ally on your side to make your case.
No need to go it alone. Let an underwriting expert help you steer your application through the choppy waters to an island of approval.
About the Author:
Jimmy McMillan is the owner of Heart Life Insurance where he specializes in underwriting life insurance with heart problems. He has successfully approved clients with difficult heart issues like heart attacks, atrial fibrillation, cardiomyopathy, angioplasty, multiple stents and mitral valve disorders.
He is a fine fisherman who lives with the catch of his life, Emily, in Palm Coast FL.