Medications for High Blood Pressure
Medications are usually prescribed for people whose high blood pressure cannot be controlled through lifestyle changes, such as following a healthy diet and exercising regularly. In the past, many people with high blood pressure simply stopped taking their medications because of the unpleasant side effects. It used to be said that the treatment for high blood pressure was worse than the disease. This is no longer true. Newer and more effective drugs have been developed that have fewer side effects. Most people who take antihypertensive medications (drugs that lower blood pressure) feel better after they start taking them.
If you experience unpleasant effects from your antihypertensive medication, discuss these effects with your physician, but continue to take the medication until the doctor tells you to stop. He or she probably will prescribe a substitute medication that will not produce the side effects. Because so many drugs are now available, your doctor can work with you to ﬁne-tune your drug regimen so that you can get the best treatment with the fewest side effects. This also applies in terms of drug costs, which can account for 70 to 80 percent of the cost of treating high blood pressure. If you are concerned about the cost of your med- ications, discuss it with your physician or pharmacist to see if less expensive alternatives are available.
Monitor Your Blood Pressure
If you have been diagnosed with high blood pressure and your doctor has prescribed medication, he or she will ask you to measure your blood pressure regularly to see whether the medication is controlling it effectively.You can purchase a home blood pressure monitor at most pharmacies
There are eight categories of antihyperten- sive medications, each having a different method of action. Following is a summary of the types of medications used to treat high blood pressure:
• Diuretics increase excretion of water and sodium by the kidneys, thereby reducing the volume of blood the heart has to pump. Diuretics are helpful to blacks, older adults, and people with heart failure or low renin activity. (Renin is an enzyme involved in maintaining the balance of water and sodium in the
body.) Possible side effects include erectile dysfunction, decreased sexual desire, muscle cramps, and fatigue. Examples include chlorothiazide, furosemide, and amiloride.
• Beta-blockers slow the heart rate and block the output of renin by the kidneys.
These drugs are helpful for people with high renin activity, a high resting heart rate, or coronary artery disease. Possible side effects include slow heart- beat, fatigue, and erectile dysfunction. Examples include atenolol, metopro- lol, and propranolol.
• Alpha-blockers prevent arteries from constricting and block the effects of the stress hormone epinephrine, which increases blood pressure. These drugs are useful for people who have high cholesterol levels, diabetes, or poor circula- tion in the arms and legs (peripheral vascular disease). Possible side effects include headache, dizziness, and mild ﬂuid retention. Examples include dox- azosin, prazosin, and terazosin.
• ACE (angiotensin-converting enzyme) inhibitors block the activity of an enzyme (ACE) that forms a hormone that causes narrowing of blood vessels. These drugs are useful for people with diabetes, congestive heart failure, high renin activity, or certain kidney diseases. The most common side effect is an irritating, dry cough. Examples include benazepril, captopril, enalapril maleate, and lisinopril.
• Angiotensin-receptor blockers prevent the arteries from constricting and pre- vent the kidneys from retaining salt and water. They are useful primarily for people who cannot tolerate ACE inhibitors. Possible side effects are mild and include dizziness, fatigue, and stomach pain. Examples include losartan and valsartan.
• Centrally acting drugs act directly on the brain and the nervous system to lower heart rate and peripheral resistance by keeping the arteries from nar- rowing. These drugs are helpful to people with peripheral vascular disease. Possible side effects include drowsiness, dry mouth, fatigue, and dizziness. Examples include clonidine, guanfacine, and methyldopa.
• Calcium channel blockers prevent narrowing of the artery walls and also may slow or block the development of plaques. They are helpful for blacks, older adults, and people with unsteady heart rhythms, diabetes, angina, or pul- monary hypertension. Possible side effects include constipation, ankle swelling, headache, and dizziness. Examples include diltiazem, amlodipine, and verapamil.
• Vasodilators act directly on the smooth muscle of the arteries to widen artery walls. They are used only in emergencies and for people whose blood pressure cannot be controlled with other drugs. Possible side effects include an abnor- mally strong, rapid heartbeat (usually more than 100 beats per minute), increased ﬂuid retention, and headache. Examples include hydralazine and minoxidil.