Choosing blood pressure medications

Choosing blood pressure medications

Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you.By Mayo Clinic Staff

http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure-medication/art-20046280

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Dozens of high blood pressure medications (antihypertensives) are available, each with pros and cons. Depending on how high your blood pressure is, your doctor may prescribe one or more high blood pressure medications to treat your condition. For everyone who has high blood pressure or is at risk of developing high blood pressure, lifestyle changes can help keep your numbers under control. Before beginning blood pressure treatment, it's a good idea to understand the options available to you.

Lifestyle changes

Whether you're on the road to developing high blood pressure (prehypertension) or you already have high blood pressure (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. People who have prehypertension have a systolic pressure (top number) ranging from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure (bottom number) ranging from 80 to 89 mm Hg.

Even if your doctor prescribes medications to control your blood pressure, he or she will likely recommend you make lifestyle changes as well. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. To make these changes:

• Don't smoke
• Eat a healthy diet, focusing on fruits, vegetables and low-fat dairy products, and especially, control the salt in your diet
• Maintain a healthy weight
• Exercise by getting 30 minutes of moderate activity — even if you need to break up your activity into three 10-minute sessions — on most days of the week
• Limit the amount of alcohol you drink — For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

You probably won't need to take high blood pressure medications if you have prehypertension and are otherwise healthy. However, if you have prehypertension and diabetes, kidney disease or heart disease, your doctor might prescribe medications to lower your blood pressure to a more desirable level.

Medication options for stage 1 high blood pressure (140/90 to 159/99 mm Hg)

If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range, you also have stage 1 high blood pressure. The first change you can make is to adopt healthy lifestyle changes to help decrease your numbers. Your doctor will likely prescribe medications, as well. Your choices include:

• Diuretics (water pills). Your doctor may first suggest diuretics — also called water pills. Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure, which may be enough along with lifestyle changes to control your blood pressure.
  Although three types of diuretics are available, the first choice is usually a thiazide diuretic. Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure. A diuretic may be the only high blood pressure medication you need. But under some circumstances, your doctor may recommend a different first line medication or may add another medication.
• Angiotensin-converting enzyme (ACE) inhibitors. These allow blood vessels to widen by preventing the formation of a hormone called angiotensin. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
• Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), candesartan (Atacand) and valsartan (Diovan).
• Beta blockers. These work by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and atenolol (Tenormin).
• Calcium channel blockers. These prevent calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat CC, Procardia).
• Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren along with ACE inhibitors or angiotensin II receptor blockers if you have diabetes or kidney disease.

Adding one of these medications may lower your blood pressure more effectively than if you take only a diuretic. This may reduce the risk of developing complications from high blood pressure. Combining two medications of different classes may allow you to take a smaller dose of each, which can reduce side effects and perhaps be less expensive. The choice of medications in combination depends on your individual circumstances.

Medication options for stage 2 high blood pressure (higher than 160/100 mm Hg)

If you have stage 2 high blood pressure, you have a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher or both. In this case, you'll likely need to take at least two high blood pressure medications when you start treatment.

As with stage 1 hypertension, your doctor will likely prescribe a thiazide diuretic. Diuretics work by flushing excess water and sodium from the body, thus lowering your blood pressure. Along with a diuretic, your doctor will generally recommend that you start an additional drug.

For high blood pressure, diuretics, commonly known as "water pills," help your body get rid of unneeded water and salt through the urine. Getting rid of excess salt and fluid helps lower blood pressure and can make it easier for your heart to pump. Diuretics may be used to treat a number of heart-related conditions, including high blood pressure, heart failure, kidney and liver problems, and glaucoma.

Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to lower blood pressure, or to treat edema in heart failure.

Loop diuretics (Lasix, Bumex) are often used when people havecongestive heart failure symptoms and are especially useful in emergencies. However, they do not significantly lower blood pressure.

Potassium-sparing diuretics (like Aldactone, Dyrenium) help your body retain potassium and are used more often in congestive heart failure patients. They are often prescribed in conjunction with the other two types of diuretics, but also do not significantly lower blood pressure.

What Are the Side Effects of Diuretics?

Like any drug, diuretics come with potential side effects. They can include:

• Frequent urination. This may last for several hours after a dose.
• Arrhythmia(abnormal heart rhythm)
• Electrolyte abnormalities -- Blood test monitoring of bloodchemistries or electrolytes, such as potassium, sodium, or kidneyfunction, is important before and during drug use.
• Extreme tiredness or weakness. These effects should decrease as your body adjusts to the medication. Call your doctor if these symptoms persist.
• Muscle cramps or weakness. If you take potassium supplements, be sure that you are taking your potassium supplement correctly, if prescribed. Contact your doctor if these symptoms persist.
• Dizziness, lightheadedness. Try rising more slowly when getting up from a lying or sitting position.
• Blurred vision, confusion, headache, increased perspiration (sweating), and restlessness. If these effects are persistent or severe, contact your doctor.
• Dehydration. Signs include dizziness, extreme thirst, excessive dryness of the mouth, decreased urine output, dark-colored urine, orconstipation. If these symptoms occur, don't assume you need more fluids, call your doctor.
• Fever , sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss. Contact your doctor right away.
• Skin rash. Stop taking the medication and contact your doctor right away.
• Loss of appetite, nausea, vomiting, or muscle cramps. Be sure that you are taking your potassium supplement correctly, if prescribed.

Rarely, potassium-sparing diuretics like Aldactone can cause breast enlargement or tenderness in men and in women it can cause deepening of the voice, decreased hair growth, and irregular menstrual cycles.

In addition, most diuretics are sulfa drugs. If you are allergic to sulfa drugs, tell your doctor.

Uses for calcium channel blockers

Doctors prescribe calcium channel blockers to prevent, treat or improve symptoms in a variety of conditions, such as:

• High blood pressure
• Chest pain (angina)
• Brain aneurysm complications
• Irregular heartbeats (arrhythmia)
• Migraine
• Some circulatory conditions, such as Raynaud's disease
• High blood pressure that affects the arteries in your lungs (pulmonary hypertension)

Calcium channel blockers may not be as effective as diuretics, beta blockers or angiotensin-converting enzyme (ACE) inhibitors at lowering blood pressure. Because of this, calcium channel blockers aren't usually the first medication you'd be prescribed to lower your blood pressure.

However, for blacks, calcium channel blockers may be more effective than other blood pressure medications, such as beta blockers, ACE inhibitors or angiotensin II receptor blockers.

Side effects and cautions

Side effects of calcium channel blockers may include:

• Constipation
• Headache
• Rapid heartbeat (tachycardia)
• Dizziness
• Rash
• Fatigue
• Flushing
• Nausea
• Swelling in the feet and lower legs

Olmesartan medoxomil is a selective angiotensin II type 1 receptor antagonist with proven BP-lowering efficacy. In a number of clinical trials, the agent generally lowered both mean DBP and SBP by at least 10 mmHg after treatment for 8 weeks. Importantly, the majority of patients in clinical trials achieved target DBP of <90 mmHg (Neutel 2001; Puchler et al 2001; Chrysant et al 2003)


Additionally, olmesartan medoxomil has been shown to be at least as effective as the calcium channel blockers amlodipine (Chrysant et al 2003) and felodipine (Stumpe and Ludwig 2002) and the beta-blocker atenolol (Van Mieghem 2001), and significantly more effective than the ACE inhibitor captopril at the doses tested (Williams 2001).