Medicines used to treat high blood pressure.

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A notable number of high blood pressure drug names will be included in any list of the most commonly used treatments for hypertension . This implies at least two things: First, there is no single drug that works the same way for everyone.

Second, with so many high blood pressure medications to choose from, if you and your healthcare provider are patient and persistent, chances are good that you will find an effective and well-tolerated treatment regimen for your hypertension.

If you learn a little more about hypertension medications and look at the steps your healthcare provider will take to choose the right one for you, hopefully you'll take it easy knowing that while there is no "best" universal treatment for hypertension, there is probably the "best" treatment for you.

What are blood pressure medications?

Blood pressure medications are commonly used to treat hypertension or high blood pressure. There are many classes of blood pressure medications, each with a wide variety of different medications. These drugs are generally available by prescription.

Indications

The American College of Cardiology and the American Heart Association define the stage of hypertension as follows. The degree of hypertension, measured by these criteria, helps determine which course of treatment might be best for you. Blood pressure (BP) is measured in millimeters of mercury (mm Hg).

Classification of blood pressure Systolic Diastolic
Normal Less than 120 mmHg Art. Less than 80 mmHg
High 120 to 129 mm Hg Less than 80 mmHg
Hypertension stage 1 * 130 to 139 mm Hg 80 to 89 mm Hg
Stage 2 hypertension * Not less than 140 mm Hg Not less than 90 mm Hg
* Only one of the listed criteria is required for classification.

If there is a difference between the systolic blood pressure (top number) and the diastolic blood pressure (bottom number), the higher value determines the stage.

Decision on the need to take medication

Healthcare providers often take a gradual approach to treating hypertension in their patients. For the vast majority of people, the goal of treatment is to lower blood pressure below 120/80 mm Hg.

Step 1 involves making lifestyle changes that have been shown to lower blood pressure. These include: a heart-healthy diet, weight loss (if necessary), regular exercise, etc.

These changes can be implemented on their own, but they may or may not be sufficient to manage your state. With this in mind, they can also be used in combination with one or more high blood pressure medications.

In adults with stage 1 hypertension and target blood pressure <130/80 mm Hg. Art. It is advisable to prescribe an antihypertensive drug.

However, if you have stage 2 hypertension and your mean blood pressure is greater than 20 mmHg. Above goal, your healthcare provider may recommend drug combination therapy.

Deciding whether to start taking medicine for high blood pressure requires a serious discussion with your healthcare provider. In some cases, the solution is obvious. For example, taking medication is highly recommended if the patient has hypertension and another medical condition, such as type 2 diabetes.

However, other cases are less straightforward. For example, if you are over 75, the potential risks of taking the drug may not outweigh the potential benefits.

Hypertension Discussion Guide for Healthcare Providers

Get our printed guide to your next doctor's appointment to help you ask the right questions.

Types of medications and treatment options.

If you and your healthcare provider decide that taking your hypertension medication is the best approach, the next step is to choose which one (or several) to start with.

There are five main categories of drugs that have been shown to be effective in treating hypertension:

Combination therapy involves taking two antihypertensive medications, each from a different category of medication.

Get Drug Information / JR Bee

Generally speaking, drugs in each of these classes are equally effective in controlling hypertension. However, people can react in completely different ways. Healthcare professionals cannot predict this in advance, so they and patients must agree on a smart trial-and-error approach.

Guessing which is the best starting drug to try, most experts now recommend starting with calcium channel blockers or ARB / ACE inhibitors. While there are no hard and fast rules about which drugs to use for different people, there are certain trends that are helpful when choosing monotherapy.

For example, patients of African American descent tolerate thiazide diuretics or calcium channel blockers better. Additionally, patients with certain medical conditions may benefit from one drug over another.

For example, people with hypertension who also have diabetes or chronic kidney disease with albuminuria (when a person's urine contains high levels of albumin) are usually given an ACE inhibitor or ARB (if the ACE inhibitor is not tolerated) .

Similarly, having a certain medical condition can cause a doctor to stop prescribing certain antihypertensive medications. For example, ACE inhibitors are contraindicated in people with a history of angioedema or in pregnant women.

The most common medications for hypertension.

It is impossible to list all the medications for high blood pressure here, but the following list is quite comprehensive. The brands of each drug are listed first, followed by the generic name.

Diuretics

Diuretics ("water pills") increase the amount of sodium and water that the kidneys excrete in the urine. Diuretics are believed to lower blood pressure primarily by reducing the volume of fluid in the blood vessels.

Examples of diuretics commonly used for hypertension:

  • Thalidone, also marketed as Tenoretic and Chlorpres (chlorthalidone)
  • HydroDiuril, also sold as Microzide and Esidrix (hydrochlorothiazide)
  • Lozol (indapamide)

Less commonly used diuretics for hypertension include:

  • Diamox (acetazolamide)
  • Zaroxoline, also sold as Mykrox (metolazone)
  • Midamor (amiloride hydrochloride)
  • Bumex (bumetanide)
  • Edecrine (ethacrynic acid)
  • Lasix (furosemide)
  • Aldactone (spironolactone)
  • Demadex (torsemide)
  • Direnium (triamteren)

Calcium channel blockers

Calcium channel blockers can lower blood pressure by widening the arteries and, in some cases, decreasing the strength of the heart.

Examples of calcium channel blockers include:

  • Norvasc (amlodipine)
  • Cardizem, also marketed as Dilacor and Tiazak (diltiazem)
  • Plendil (felodipine)
  • DynaCirc (isradipine)
  • Cardin (nicardipine)
  • Procardia XL, also sold as Adalat CC (nifedipine)
  • Sular (nisoldipin)
  • Verelan, also sold as Kalan (verapamil)

ARB

Angiotensin II receptor blockers (called ARBs) also lower blood pressure by dilating the arteries. ARBs are generally considered more effective than ACE inhibitors due to their greater effectiveness and fewer side effects.

The options include:

  • Atacand (candesartan)
  • Avapro (irbesartan)
  • Cozaar (losartan)
  • Mikardis (Telmisartan)
  • Diovan (valsartan)

ACE inhibitors

Angiotensin converting enzyme inhibitors (ACE inhibitors) can lower blood pressure by widening the arteries.

Popular ACE inhibitors include:

  • Lotensin (Benazepril)
  • Capoten (captopril)
  • Vasotec, also sold as a vase (enalapril)
  • Monopril (fosinopril)
  • Adopted, also sold as Zestril (lisinopril)
  • Univask (moexipril)
  • Accupril (quinapril)
  • High (ramipril)
  • Mavic (trandolapril)

Beta blockers

Beta-blockers are no longer considered first-line monotherapy for hypertension, unless the patient has coronary artery disease, heart failure, or arrhythmias. These medications block the effects of adrenaline on the cardiovascular system, slow down the heart rate, and reduce stress on the heart and arteries.

Some beta blockers include:

  • Sectral (acebutolol)
  • Bistolic (nebivolol)
  • Tenormin (atenolol)
  • Curlon (Betaxolol)
  • Zebeta, also sold as Ziak (bisoprolol)
  • Cartrol (cartolol)
  • Coreg (carvedilol)
  • Normodin, also sold as trandat (labetalol)
  • Lopressor, also sold as Toprol (metoprolol)
  • Corgard (nadolol)
  • Levatol (penbutolol)
  • Inderal, Inderal LA (propranolol)
  • Blockadren (timolol)

Less common drugs for hypertension.

These options can be considered in certain circumstances, but are used less frequently:

  • Catapres (clonidine)
  • Cardura (doxazosin)
  • Vitensin (guanabenz)
  • Tenex (guanfacine)
  • Apresolin (hydralazine hydrochloride)
  • Aldomet (methyldopa)
  • Minipress (prazosin)
  • Serpasil (reserpine)
  • Chitrin (terazosin)

Combination drugs for hypertension.

There have been several clinical trials that offer substantial guidance on selecting an appropriate combination therapy for hypertension.

The best scientific evidence (from the ACCOMPLISH study) shows that clinical outcomes (including risk of stroke, heart attack, and cardiovascular death) are further improved with combination therapy when a long-acting calcium channel blocker is used with a ACE inhibitor or ARB. So today most healthcare professionals will try this combination first.

If blood pressure remains elevated with combination therapy with a calcium channel blocker in combination with an ACE inhibitor or ARB, a thiazide drug is usually added as a third drug. And if this combination still doesn't control blood pressure, a fourth drug (usually spironolactone, a non-thiazide diuretic) can be added.

The vast majority of hypertensive patients achieve successful treatment long before a third or fourth drug needs to be considered. The rare individual who does not respond adequately to such combination therapy should be referred to a hypertension specialist.

Numerous combination drugs have been sold for the treatment of hypertension, and it is almost impossible to keep track of newer ones appearing or old ones disappearing.

The following list includes most of the commonly prescribed combination medications used for hypertension:

  • Moduretic (amiloride and hydrochlorothiazide)
  • Lotrel (amlodipine and benazepril)
  • Tenoretic (atenolol and chlorthalidone)
  • Lotensin HCT (benazepril and hydrochlorothiazide)
  • Ziak (bisoprolol and hydrochlorothiazide)
  • Caposide (captopril and hydrochlorothiazide)
  • Vaseretic (enalapril and hydrochlorothiazide)
  • Lexel (felodipine and enalapril)
  • Apresazide (hydralazine and hydrochlorothiazide)
  • Prinzide, also sold as Zestoretic (lisinopril and hydrochlorothiazide)
  • Hizaar (losartan and hydrochlorothiazide)
  • Aldoril (methyldopa and hydrochlorothiazide)
  • Lopressor HCT (metoprolol and hydrochlorothiazide)
  • Korzid (nadolol and bendroflumethiazide)
  • Inderida (propranolol and hydrochlorothiazide)
  • Aldactazide (spironolactone and hydrochlorothiazide)
  • Dyazid, also marketed as Maxid (triamterene and hydrochlorothiazide)
  • Tarka (extended-release verapamil and trandolapril)

Interestingly, studies have shown that combining antihypertensive medications has a significantly greater effect (about five times more) on lowering blood pressure than simply doubling the dose of one agent .

How to avoid side effects

Any of the medicines used to treat high blood pressure can cause problems. And when choosing the best drug regimen for hypertension, it is imperative to find a drug (or drugs) that is not only effective in lowering blood pressure, but is also well tolerated.

In general, lower doses of blood pressure medications are as effective as higher doses and cause fewer side effects .

Although each of the many high blood pressure medications has its own individual side effect profile, most of the potential side effects of these medications are related to their category.

The main side effects that fall into this category are:

  • Thiazide diuretics : hypokalemia (low potassium levels), frequent urination, exacerbation of gout .
  • Calcium channel blockers : constipation, leg swelling, headache.
  • ACE inhibitors: cough, loss of taste, hyperkalemia (increased potassium levels).
  • ARB : allergic reactions, dizziness , hyperkalemia.
  • Beta- blockers : increased shortness of breath in people with chronic obstructive pulmonary disease (COPD) or asthma; sexual dysfunction; fatigue; depression; worsening of symptoms in people with peripheral arterial disease

With so many medications to choose from, it is rare for a healthcare professional to ask a person with hypertension to suffer from serious side effects.

Get the word of drug information

Hypertension is an extremely common medical problem that can have serious consequences if not treated properly. However, with so many treatment options available, you should expect your healthcare provider to find a therapeutic regimen that significantly reduces your risk of adverse hypertension outcomes without disrupting your daily routine. If you experience any unpleasant side effects, be sure to speak with your doctor about choosing a treatment regimen that you can better tolerate.

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