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High blood pressure is the most significant risk factor for mortality across the world. Estimates show that only half of the people who have hypertension are aware of their condition. There are many drugs that can help manage high blood pressure: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, and diuretics. Read on to learn more about blood pressure medications and how blood pressure tablets can help you manage hypertension.
When choosing blood pressure medications, a doctor will take into consideration several factors including your age and sex. The doctor will also look at the severity of the high blood pressure along with other associated conditions (such as diabetes and high cholesterol). Other considerations will include potential adverse side effects to the drug, and the cost of the treatment. In most cases, a person with hypertension will need two or more drugs to manage the condition. These drugs are also used for certain heart diseases.
ACE Inhibitors
ACE inhibitors help reduce blood pressure by preventing the formation of angiotensin II, a chemical that constricts blood vessels called “arterioles.” This, in turn, helps to dilate the blood vessels. These drugs are particularly beneficial for those who have heart diseases (heart failure or coronary artery disease), as well as those with diabetes. They may also help prevent diabetic kidney diseases. Young people, Caucasians, and men who have erectile problems from other antihypertensive drugs are all great fits for this type of drug.
Examples of ACE inhibitors include Benazepril, Captopril, Enalapril, Lisinopril, Perindopril, Ramipril (notice that they all end in “pril”).
Adverse side effects can include dry cough, increased potassium (K+) levels in the blood, fatigue, dizziness, headaches, and loss of taste. Regular use of non-steroidal anti-inflammatory drugs like ibuprofen may reduce effectiveness. Avoid use during pregnancy.
ARBs
This group of antihypertensive drugs is a newer, improved version of ACE inhibitors, and shares a similar mode of action. ARBs can block the action of angiotensin II. ACE inhibitors also achieve this result but in a different way. They do it by blocking an angiotensin-converting enzyme that converts angiotensin I to angiotensin II.
Examples of ARBs include Azilsartan, Candesartan, Irbesartan Losartan, Olmesartan, Telmisartan (notice they all end in “sartan”).
Possible side effects include dizziness, increased K+ levels in the blood, and angioedema. ARBs should not be used during pregnancy. Overall, ARBs seem to have fewer side effects than ACE inhibitors.
CCBs
CCBs (or calcium antagonists) help lower blood pressure by stopping calcium (Ca 2+) from entering the heart and blood vessels. Ca 2+ promotes contraction of the heart and the arteries. By blocking calcium, CCBs help the arteries relax and open. Some CCBs also slow the heart rate, helping manage chest pain and irregular heartbeats.
This class of drugs is useful for elderly individuals, those who have associated coronary artery disease, arrhythmia, or other circulatory conditions. African Americans also respond better to CCBs compared to ACE inhibitors, ARBs, or beta-blockers.
The following drugs belong to Ca 2+ channel blockers: Amlodipine, Diltiazem, Felodipine, Isradipine, Nicardipine, Nifedipine, Nisoldipine, Verapamil.
Potential adverse reactions include gut symptoms like constipation or nausea, fatigue, dizziness, palpitations, headaches, and swelling of the feet. Do not consume grapefruits when taking certain CCBs.
Diuretics
Also known as water pills, diuretics help your kidneys eliminate salt. Salt pulls water from the blood, thus reducing the amount of fluid and raising the blood pressure. When you reduce the amount of salt, you lower your blood pressure. However, diuretics also promote the loss of K+ through urine, causing lower levels. This issue can be fixed by taking K+ supplements or using so-called “potassium-sparing” diuretics.
Diuretics are a great option for the elderly, African Americans, those with heart failure, liver failure, chronic kidney diseases, and obesity.
Example of diuretic drugs include Chlorothiazide, Chlorthalidone, Indapamide, Metolazone (thiazide diuretics); Bumetanide, Furosemide, Torsemide (loop diuretics); Amiloride; Spironolactone; Eplerenone (potassium-sparing diuretics).
Possible adverse reactions include decreased K+ levels (hypokalemia, which can be life-threatening), headaches, dehydration, dizziness, muscle, and joint pain, and erectile dysfunction.
Beta-Blockers
These belong to a class of hypertensive drugs called “adrenergic blockers.” These drugs work by blocking the effects of the sympathetic nervous system that increases blood pressure in response to stress.
Beta-blockers are indicated for young individuals, Caucasians, those who had a heart attack, angina, increased heart rate, and migraines. The drugs are typically not used as a first therapy to manage hypertension, but as add-ons to therapy (to diuretics, for example).
Examples of beta-blockers: Acebutolol, Atenolol, Bisoprolol, Metoprolol, Propranolol (notice that all end in “ol.”)
Possible adverse reactions include fatigue, weight gain, cold feet and hands (more common), difficulty breathing, sleep problems, and depressed mood (less common).
Beta-blockers are not best for people with asthma as they may trigger an acute attack. The risk of side effects is higher for older patients.
To better manage your blood pressure, make sure you optimize your diet, stay active, maintain a healthy weight, and sleep well.
