What medications are used to treat high blood pressure?
Medication can help to prevent possible long-term health consequences of high blood pressure, such as cardiovascular disease. Because the various medications are equally effective at lowering blood pressure, it's often possible to find one that is well tolerated.
There are different ways to lower your blood pressure. If someone's blood pressure is just a little too high, changing some of their habits can make a big enough difference – for instance, getting more exercise, losing some weight or reducing the salt in their diet. If that isn't effective enough, different kinds of medication may be an option.
Some people may opt for medication right away. Not everyone can or would like to make changes like eating a different diet or exercising more. It is also not easy to permanently lower your blood pressure to normal levels without using medication. And some people who eat a balanced diet, stay slim, and also do sports still have high blood pressure. If this is the case, genes often have something to do with it.
Which medications can lower blood pressure?
There are several classes of drugs designed to reduce blood pressure (also called antihypertensive drugs or simply antihypertensives). The following are the most commonly used antihypertensives:
- ACE inhibitors
- Beta blockers
- Calcium channel blockers (CCBs)
- Sartans (angiotensin receptor blockers, or ARBs)
All of these medications can prevent long-term effects of high blood pressure. The suitability of a medication will depend on various factors. It is best to talk to your doctor about which of the medications is suitable for you. The most important issue is whether you have any other medical conditions.
ACE (angiotensin-converting enzyme) inhibitors
ACE inhibitors affect the production of the body’s hormones that are responsible for regulating blood pressure levels. To do this, they block a particular enzyme that plays a role in making angiotensin, a hormone which increases blood pressure.
The most common side effect of ACE inhibitors is a dry cough. Less common side effects include an impaired sense of taste, swollen mucous membranes and skin rashes.
Pregnant women should not take ACE inhibitors because they can harm the unborn child.
Beta blockers reduce blood pressure by slowing down your pulse and protecting the heart from stress hormones. There are different groups of beta blockers. Which beta blocker is the right one for you will depend on whether you have other health conditions.
If you are already taking beta blockers and would prefer to stop, it's important to decrease the dose gradually over a few days instead of all at once. Stopping abruptly can cause a sudden increase in blood pressure.
The side effects of beta blockers sometimes include constriction of the lower airways, especially the bronchi. This can lead to shortness of breath. For this reason, beta blockers aren't suitable for people who have asthma. Other medications are also more suitable for people active in sports.
Diuretics (also called “water pills”) are drugs that get rid of excess water in the body. They affect how the kidneys work and gradually reduce pressure in the blood vessels. Side effects may include a stronger urge to urinate and urinating more within the first few days of starting treatment. But because the dose taken is generally low at first, they are relatively mild.
If your body loses too much fluid, you may have a dry mouth, weak muscles, or feel confused. To avoid this, it's important to drink enough, especially on hot days or after doing sports. Older people who are taking a diuretic should be especially careful in this respect. Diuretics aren't suitable for people who have gout.
Calcium channel blockers (CCBs)
Calcium channel blockers (CCBs) expand the blood vessels. This gives the blood more room to flow freely, thereby lowering blood pressure. The side effects of calcium channel blockers may include facial flushing, skin rashes, a rapid heart rate, swelling in the ankles or a tight feeling in the lower legs.
Some calcium channel blockers aren't suitable for people who have certain types of irregular heartbeat or constipation.
Sartans (angiotensin receptor blockers, or ARBs)
Sartans block the effects of angiotensin, a hormone that increases blood pressure. Their side effects are similar to those of the ACE inhibitors, but coughing is less common with sartans. Sartans should not be used during pregnancy.
Avoiding side effects
If you do have high blood pressure, your cardiovascular system will have already been working hard for quite some time. If you then start taking antihypertensive (blood-pressure-lowering) drugs, you may often feel weak at first. It could take a while for your circulation to adjust to the drop in blood pressure.
The other side effects also only occur during the first few days of treatment and then go away on their own. To prevent side effects, you can start taking a low dose of medication and then slowly increase it.
It's important not to jump to conclusions about not tolerating a particular medication. For instance, if you get a headache when you take your medicine, it might be a coincidence. Just because two things happen at about the same time, it doesn't automatically mean that there's a link. So it can be worth sticking with the medication for a little longer.
But if you really can't tolerate a medicine, you can try another. Sometimes you need to try out a few different ones so that you can find the right medication, with your doctor's help.
Some dietary supplements and plant-based products may increase or decrease the effectiveness of antihypertensive medication. To avoid these kinds of interactions, it's best to take dietary supplements and plant-based products only if absolutely necessary and after discussing it with your doctor.
Which medication is most suitable?
Different medications will be more suitable for different people, depending on various factors. These include how old you are and whether you have any other medical conditions, such as coronary artery disease, heart failure or atrial fibrillation. Your sex and skin color may also play a role.
Many people only have to take one type of medication to successfully lower their blood pressure. Others may also need a second or third medicine. Using a combination of medicines is more effective because each one works in a different way. If you take several antihypertensive medications, it can be a good idea to take one of them in the evening – especially if your blood pressure doesn't dip at night, either.
The effect of the medication can only be reliably assessed if you take it as prescribed by your doctor. A little patience is needed: It might sometimes seem like medication isn't working if the dose is too low or it hasn't been used for long enough.
If you decide to stop taking medication – for instance due to troubling side effects – or if you sometimes forget to take it, you should be honest with your doctor about it. He or she will then be better able to assess how successful the treatment is and what side effects it has. This is important in order to make sure that you are using the right dose and are only taking as much medication as you really need.
What can help you take long-term medication regularly?
Many people find it difficult to take medication regularly over longer periods of time. But there are a number of things you can do to make it easier. The following have proven especially useful:
- Regular doctor’s appointments to discuss new aspects of treatment
- Keeping your medicine schedule as simple as possible
- Packaging or containers with compartments for each day, so it is obvious if you forget to take your medication
- Patient education courses for people with high blood pressure
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71(19): e127-e248.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36(10): 1953-2041.
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