Hypertension Medications

Hypertension, or high blood pressure, is a chronic condition. It happens when the force of your blood against the walls of your blood vessels is higher than normal. Blood pressure can increase because there is too much volume in your blood vessels, which increases the force against them, or because there is not enough elasticity in your blood vessel walls, which increases the pounding against them and increases blood pressure.

Hypertension is a dangerous condition known as “the silent killer” because it can have no symptoms, but can cause heart attacks, stroke, and kidney disease. Hypertension is related to over 1,000 deaths per day in the U.S., 

Nearly one-third of American adults have hypertension. According to the Centers for Disease Control and Prevention (CDC), diabetes is one of the major causes. [1] Hypertension can also be the result of poor lifestyle behaviors, such as being obese, having a high-sodium diet, getting low amounts of physical activity, and smoking. You are also at increased risk if you are an older adult or of are of African-American descent.

American Heart Association (AHA) and American College of Cardiologists (ACC)[2] have published guidelines on what hypertension is and the best medications for controlling it. These are the classifications for normal, elevated, and high blood pressure.

Category of Blood Pressure Systolic Blood Pressure Diastolic Blood Pressure
Normal
< 120 mm Hg
and
< 80 mm Hg
Elevated (at risk for hypertension)
120-129 mm Hg
and
< 80 mm Hg
Stage 1 hypertension
120-129 mm Hg
or
80-89 mm Hg
Stage 2 hypertension
≥ 90 mm Hg
or
≥ 90 mm Hg

Hypertension can lead to serious health problems if it is not controlled, but you can control it, in most cases, with a combination of lifestyle changes and medications. These are some of the most common types of medications used for hypertension, along with their possible side effects, as well as some strategies for making them work for you as well as possible.

 

Hypertension Medication Overview


You can try different types of treatments for hypertension. The AHA and ACC suggest starting with lifestyle therapies if you have elevated blood pressure or stage 1 hypertension without other serious risk factors. Your doctor may recommend hypertension medication if lifestyle changes do not work within 3 to 6 months, or if you have stage 1 hypertension with other risk factors for heart disease, or if you have stage 2 hypertension.

When you start taking blood pressure-lowering medications, your doctor will probably prescribe a low dose of a single type of drug. You may increase the dose, add another hypertensive medication, or switch medications if your first prescription does not work.

 

Range of drugs used for hypertension


There is a range of drugs used for hypertension. They have different strategies for lowering blood pressure.[3]


Diuretics (“Water Pills”)

Diuretics are often the first type of medication your doctor will prescribe. They increase the elimination of water from your body, which reduces the volume of your blood, which lowers blood pressure. Diuretics are also known as “water pills” because you are likely to notice the excretion of excess water from your body in the form of increased urination. 

Thiazide diuretics include chlorothiazide, hydrochlorothiazide, metolazone, and spironolactone. They can lead to side effects including fatigue and weakness, cramps, and low potassium levels.


Calcium Channel Blockers

Muscle contraction depends on calcium moving through calcium channels. Calcium channel blockers prevent calcium from entering smooth muscle tissue, which is the type of muscle in blood vessels. The result is that calcium channel blockers prevent strong contractions in blood vessels and they may lower heart rates. Examples include diltiazem and amlodipine. Side effects can include weakness, constipation and diarrhea, and headaches. Calcium channel blockers are also famous for interacting with grapefruit juice, which can lead to greater side effects and low blood pressure.


Angiotensin-Converting Enzyme (ACE) Inhibitors

Angiotensin-converting enzyme (ACE) is a natural compound that helps narrow your blood vessels. Angiotensin-Converting Enzyme (ACE) inhibitors are medications that block this chemical’s action so your blood vessels are not narrowed as much. Examples include lisinopril, benazepril, and captopril. Side effects can include a persistent dry cough, fatigue, diarrhea, and a rash.


Angiotensin Receptor Blockers

Angiotensin receptor blockers (ARBs) affect receptors on your cells that respond to the hormone angiotensin II. This hormone constricts your blood vessels and increases blood pressure. Blocking angiotensin with ARBs can lower blood pressure, and ARBs are often used in patients with kidney disease. Examples of ARBs include candesartan and losartan. Side effects can include high potassium levels (hyperkalemia), dizziness, fatigue, and headaches.


Alpha Blockers

Alpha blockers block the normal action on alpha receptors so that they cannot narrow. This allows them to dilate, or relax, which lowers blood pressure. They are among the oldest blood pressure medications, and they can be the medication of choice for hypertension during pregnancy. Examples include prazosin, terazosin, and doxazosin. Side effects can include postural hypertension, which is a sudden drop in blood pressure when you stand up. Other side effects include increased heart rate, weakness, nausea and headache, tremors, a rash, swollen ankles and legs, and trouble with sleep. They can lead to a sudden drop in blood pressure the first time you take them.


Beta Blockers

Your doctor may prescribe beta blockers as a second blood pressure-lowering medication if you need it, but they are not necessarily a great option if you have diabetes. These medications are also used for cardiac patients, especially when trying to prevent a second heart attack. Beta blockers lower your heart rate and open your blood vessels so that your blood pressure decreases and you heart does not need to work as hard. Examples include acebutolol and atenolol. Side effects can include fatigue and weakness, constipation and diarrhea, and headaches.


Central Agonists

Central agonists act on your central nervous system to prevent strong contractions of your blood vessels. Examples include guanfacine, methyldopa, and clonidine. Side effects include drowsiness, dry mouth, sleepiness, constipation, headache, depression, and nightmares.


Vasodilators

Vasodilators prevent your blood vessels from constricting too much so that your blood pressure does not rise too much. Examples include hydralazine and minoxidil, and they are most used with other blood pressure-lowering medications. Side effects can include fluid retention and swelling around the eyes, pain in the joints, heart palpitations, rapid heartbeat, and chest pain, flushing, dizziness, and hair growth on the body.


Peripheral Adrenergic Inhibitors

Peripheral adrenergic inhibitors work in the brain and help block signals that cause constriction of blood vessels. Examples include guanadrel and reserpine. They are not the first choice for most hypertensive patients because of their side effects. You are more likely to be prescribed them if other medications haven’t worked for you. Side effects can include dizziness, diarrhea, erectile dysfunction, stuffy nose, and heartburn. 

 

Can Hypertension Medication Be Taken during Pregnancy?


Uncontrolled hypertension during pregnancy can be linked to a serious condition called pre-eclampsia, which threatens the mother with heart failure and stroke, and threatens the fetus with premature birth and low birthweight. [4]

As important as it is to prevent uncontrolled high blood pressure during pregnancy, though, pregnant women should never take medications without first consulting their doctors. ACE inhibitors and angiotensin II receptor blockers are among the common blood pressure medications that should not be taken during pregnancy or while breastfeeding. Be extra careful if you have diabetes, since blood pressure-lowering medications can also be tricky.

 

Does Everyone Take the Same Kind of Medication for Blood Pressure?


Not everyone ends up taking the same kind of medication for blood pressure. The drug or combination of drugs that works for you can be different than what works for another person. You may start with a single medication, which is often a diuretic. If that does not work, your doctor might increase the dose, add another medication, or switch the type of blood pressure medication that you take.

Lifestyle factors can affect the effectiveness of your medications. For example, you are more likely to get your blood pressure under control with one drug if you eat well, maintain a healthy body weight, exercise, and avoid tobacco and excessive alcohol consumption.

The effectiveness can depend on genetic factors, too. African-Americans and older adults tend to respond better to calcium channel blockers and diuretics than to ACE inhibitors on their own. Furthermore, the National Heart, Lung, and Blood Institute (NHLBI) reports that ACE inhibitors tend to have angioedema, or dangerous water retention. [5] Individuals with chronic kidney disease are likely to use ACE inhibitors and ARBs.

 

Alcohol and Hypertension Medication


Alcohol can cause drowsiness and dizziness. These are some of the same symptoms as those caused by some hypertension medications, so it is especially important to avoid alcohol when you start taking medications or you switch or add medications. 

 

How to Take Hypertension Medication


It is important to take your hypertension medication as prescribed. This includes taking all of your doses, taking the proper dose, and, if your doctor says, taking the medication with food rather than on an empty stomach. A nurse coaching app can help if you have trouble remembering to take your medicines.

Taking your medications at the right time of day can be one of the most important ways you can get the most from them. Taking medications at bedtime appears to lower blood pressure better and reduce your risk for cardiovascular disease and damage to blood vessels and kidneys, according to research published in “Blood Pressure Monitoring.”[6] Research in “Journal of American Society of Nephrology” found that this is also true among patients with chronic kidney disease.[7]

Research published in the journal “Diabetes Care” confirms that bedtime administration of hypertensive medications led to better blood pressure control and lower risk of cardiovascular events among individuals who also had diabetes. [8] Medications examined included ACE inhibitors, diuretics, calcium channel blockers, beta blockers, ARBs, and others.

 

Other Treatments for Hypertension


Non-pharmacological treatments, or lifestyle changes, can improve your health and blood pressure whether or not you are also on medications. You can use the AHA and ACC guidelines for motivation, since they provide estimates of how much your lifestyle changes can lower your blood pressure. [9]

 
Behavior Estimated Decrease in Systolic Blood Pressure
Weight loss if overweight
1 mm Hg per pound lost
Healthy diet (high in fruit, vegetables, whole grains, and reduced-fat dairy products, low in saturated and trans fat)
11 mm Hg
Sodium under 1,500 mg/day
5 mm Hg
Potassium 3,500-5,000 mg/day
4 mm Hg
Aerobic exercise at least 150 minutes per week
5 mm Hg
Resistance (strength) training
5 mm Hg
No more than moderate alcohol consumption
4 mm Hg
 

Weight Loss

Healthy Diet

The DASH (Dietary Approaches to Stop Hypertension) is an example of an overall healthy diet to lower blood pressure. It is a common-sense eating pattern that includes plenty of fruits, vegetables, reduced-fat dairy products, and whole grains such as oatmeal, whole grain bread and pasta, brown rice, and whole grain cereal. DASH is low in saturated and trans fats from fatty red meats and fried food, and low in sugar-sweetened foods. Other healthy approaches are similar, and include a Mediterranean-style diet and a diet based on the US Dietary Guidelines.

Regular Exercise

Aerobic exercise includes brisk walking, cycling, swimming, and anything else that gets your heart rate up for longer periods of time. You can lower your blood pressure by upping your aerobic exercise to 150 minutes per week, as long as your doctor approves. 

Strength training or resistance training further helps with blood pressure. A good goal is to aim to work all of the major muscle groups at least two days per week. You can use weight machines or dumbbells, and body weight exercises, resistance bands, and weighted bars can work just as well.

Stress Management

It is not your imagination that stress can drive up blood pressure. If you cannot reduce the stress in your life, you can still learn to manage it better so that it does not hurt your blood pressure. These tips can help.

  • Let go of what you cannot control.

  • Breathe deeply five times when you feel yourself getting tense or anxious.

  • Find one or more activities that relax you. Possibilities include walking, blogging, meditating, aromatherapy, listening to music, and taking a hot bath.

Excessive alcohol intake can be a factor in the development of high blood pressure. If you choose to drink, be sure to do so responsibly and only as your medication regimen permits. Reducing alcohol consumption to no more than 1 (females) or 2 (males) drinks per day can lower systolic blood pressure by 4 mm Hg. One drink is 12 oz. (1 can) of beer, 5 oz. (1 glass) of wine, or 1.5 oz. of 80-proof liquor.

Uncontrolled hypertension is dangerous, but you have many opportunities to prevent or control high blood pressure. In addition to managing any contributing conditions, such as diabetes if you have it, you can make healthier lifestyle choices. If your doctor does prescribe medications, taking them properly can lower blood pressure and possibly save your life.

 


toru izumida

New York, US