Overviews Of The Classes Of Blood Pressure Medications
Summaries of some of the major types of commonly prescribed cardiovascular medications are provided here.
- For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
- If your prescription medication isnt on this list, remember that your healthcare provider and pharmacist are your best sources of information.
- It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
- Never stop taking a medication and never change your dose or frequency without first consulting your doctor.
Medicines For High Blood Pressure
Several types of medicine can be used to help control high blood pressure.
Many people need to take a combination of different medicines.
- if you’re under 55 years of age you’ll usually be offered an ACE inhibitor or an angiotensin-2 receptor blocker
- if you’re aged 55 or older, or you’re any age and of African or Caribbean origin you’ll usually be offered a calcium channel blocker
You may need to take blood pressure medicine for the rest of your life. But your doctor might be able to reduce or stop your treatment if your blood pressure stays under control for several years.
It’s really important to take your medicine as directed. If you miss doses, it will not work as well.
The medicine will not necessarily make you feel any different, but this does not mean it’s not working.
Medicines used to treat high blood pressure can have side effects, but most people do not get any.
If you do get side effects, do not stop taking your medicine. Talk to your doctor, who may advise changing your medicine.
Stiffening Of The Arteries
Some physicians consider the most authentic form of pseudo-resistant hypertension to be caused by stiffened brachial arteries that prevent the blood pressure cuff from obtaining a true reading. If your doctor suspects this form of pseudo-resistant hypertension, they might consider other ways to measure your blood pressure.
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How Is Resistant Hypertension Diagnosed
- Full history and physical exam, which includes letting your doctor know about all medications and supplements, whether they are prescription, over-the-counter, herbal or recreational. Its important to mention if you skip doses of daily medicines.
- True measurement of your blood pressure using correct technique and calibrated equipment.
- Home blood pressure measurement during the day and 24-hour ambulatory blood pressure monitoring to record your blood pressure throughout a regular day. It may be used if your physician suspects your blood pressure readings in the office dont tell the whole story.
- Tests for secondary conditions, which may include special blood work and imaging studies. Identifying and treating these conditions may eliminate hypertension or at least make it more treatable.
- Tests for organ damage caused by hypertension, which may include:
- Electrocardiogram to measure your hearts size and rhythm
- Echocardiogram to measure your hearts size and function
- Fundoscopic eye exam to check for damaged blood vessels inside the eye these tiny blood vessels come in from the brain and are a unique opportunity for your doctor to judge the health of similar blood vessels in your brain, heart and kidneys
- Urinalysis to check for kidney damage
- Other blood tests
- Chest X-ray
Side Effects Of Blood Pressure Medications
Occasionally, side effects only happen when you first start taking a new medication or a higher dose. As your body gets used to the medicines the side effects improve or go away.
If you have side effects which dont go awaySometimes side effects dont go away and can affect your day to day life. If this happens, its important that you dont simply stop taking them because your blood pressure will go back up.
Instead, talk to your doctor because they will be able to try a lower dose of your medication, a different medication, or a different combination of medications. Often this will lower your blood pressure with no problems at all.
If you have tried different options and youre still experiencing side effects, your GP can refer you to a . They can often help you get the right balance between controlling your blood pressure and keeping the side effects to a minimum, and might be able to try different treatments.
What are the possible side effects?The side effects vary with . They also vary from person to person. For example, can cause a dry cough in some people, but dizziness or an upset stomach in others. The leaflet that comes with your medication will include a list of possible side effects.
A common side effect is feeling faint or dizzy when you go from sitting or lying down to standing up, especially at night. This is called postural hypotension, and can happen with any blood pressure medication.
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How Is High Blood Pressure Treated
Treatment depends on how high your blood pressure is. For people whose systolic reading falls in the range 120 to 129 and the diastolic reading is equal to or less than 80, lifestyle changes are usually recommended over medications. These may include:
- Losing weight if you are overweight
- Eating a diet rich in fruits and vegetables
- Eating less salt
- More physical activity
- Limiting alcohol.
If treatment is considered necessary, sometimes more than one medication is prescribed. Medications for high blood pressure include:
- Diuretics
High Blood Pressure Medicines
Treating high blood pressure will help prevent problems such as heart disease, stroke, loss of eyesight, chronic kidney disease, and other blood vessel diseases.
You may need to take medicines to lower your blood pressure if lifestyle changes are not enough to bring your blood pressure to the target level.
WHEN ARE MEDICINES FOR HIGH BLOOD PRESSURE USED
Most of the time, your health care provider will try lifestyle changes first and check your BP two or more times.
If your blood pressure is 120/80 to 129/80 mm Hg, you have elevated blood pressure.
- Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range.
- Medicines are rarely used at this stage.
If your blood pressure is equal to or higher than 130/80 but lower than 140/90 mm Hg, you have Stage 1 high blood pressure. When thinking about the best treatment, you and your provider must consider:
- If you have no other diseases or risk factors, your provider may recommend lifestyle changes and repeat the measurements after a few months.
- If your blood pressure remains equal to or higher than 130/80 but lower than 140/90 mm Hg, your provider may recommend medicines to treat high blood pressure.
- If you have other diseases or risk factors, your provider may be more likely to recommend medicines at the same time as lifestyle changes.
MEDICINES FOR HIGH BLOOD PRESSURE
Most of the time, only a single drug will be used at first. Two drugs may be started if you have stage 2 high blood pressure.
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How Is Resistant Hypertension Treated
Treatment options for resistant hypertension or pseudo-resistant hypertension depend on your underlying conditions and how well you tolerate various medications. Treatments include:
- Addressing any conditions that may have caused the hypertension.
- Making lifestyle changes
- Adjusting medications to find your optimal type and dosage
How Blood Pressure Medications Work
Blood pressure tends to vary during the day. It tends to be higher when you wake up in the morning and during the morning hours, and lower in the night and when sleeping. However, there are people whose blood pressure does not drop at night researchers call these “non-dippers.”
Most blood pressure medications have been designed for ease of use, meaning they are meant to be taken once per day. Even so, these medications are not equally effective over the entire 24-hour period during which they are active.
The action of blood pressure drugs peaks anywhere from four to 15 hours later after you take a dose. Ideally, the drug is prescribed so that the peak concentration coincides with the time of day when your blood pressure is at its highest.
There are several different types of blood pressure medications that have different mechanisms of action and are thus best taken at certain times of day.
Medications that are best taken in the morning:
- Diuretics, or water-pills”:These include Diuril and Lozol , and work by helping your kidneys get rid of extra water in your body. Because diuretics can cause you to urinate more , it’s best to take them in the morning. If you need a second dose, take it by mid-afternoon.
Some other common blood pressure medications that are best taken at bedtime include:
- ACE inhibitors , including Lotensin and Vasotec
- ARBs , such as Avapro
- Beta blockers, such as Lopressor
- Calcium Channel blockers, such as Norvasc
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Combination Antihypertensive Drugs: Recommendations For Use
NEIL S. SKOLNIK, M.D., JONATHAN D. BECK, M.D., MATHEW CLARK, M.D., Abington Memorial Hospital, Jenkintown, Pennsylvania
Am Fam Physician. 2000 May 15 61:3049-3056.
The recommendation for first-line therapy for hypertension remains a beta blocker or diuretic given in a low dosage. A target blood pressure of less than 140/90 mm Hg is achieved in about 50 percent of patients treated with monotherapy two or more agents from different pharmacologic classes are often needed to achieve adequate blood pressure control. Single-dose combination antihypertension therapy is an important option that combines efficacy of blood pressure reduction and a low side effect profile with convenient once-daily dosing to enhance compliance. Combination antihypertensives include combined agents from the following pharmacologic classes: diuretics and potassium-sparing diuretics, beta blockers and diuretics, angiotensin-converting enzyme inhibitors and diuretics, angiotensin-II antagonists and diuretics, and calcium channel blockers and ACE inhibitors.
Combination Drugs for the Treatment of Hypertension
ACE = angiotensin-converting enzyme.
*Estimated cost to the pharmacist based on average wholesale prices for 30 days of therapy at lowest given dosage in Red book. Montvale, N.J.: Medical Economics Data, 1999. Cost to the patient will be higher, depending on prescription filling fee.
Adapted from Drugs for hypertension. Med Lett Drugs Ther 1999 41:238.
If You Have High Blood Pressure You Might Need To Take Medications To Help Lower It
Making healthy changes to your lifestyle could be enough to lower your blood pressure to a healthy level, but some people will also need medicines.
If you start taking high blood pressure medicines, its likely you will need to keep taking them for a long time. If your blood pressure stays under control for several years, you might be able to take a lower dose or stop taking them altogether. can help.
- Occasionally medications dont bring blood pressure down low enough, even if youre having more than one type of medication and at the highest possible dose. This is called resistant hypertension. Sometimes the medications bring blood pressure down but the side effects are too much to live with.If you have resistant hypertension or severe side effects, you can ask to be referred to a .
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What Do The Numbers Mean
Blood pressure is the force exerted by blood against the walls of your arteries as it flows through your body. It is measured as two numbers, one over the otherfor example, 120 over 80. The measurement is in millimeters of mercury, expressed as mmHg. The systolic number is the pressure in the arteries when the heart contracts. The diastolic number is the pressure when the heart rests between contractions. An elevation in either or both of those numbers signals high blood pressure. See chart below for more details.
Importantly, even if your blood pressure is not elevated enough to be considered high, the risk of a heart attack or stroke increases as pressure rises above normal.
| 100 or above | Your doctor will prescribe medication in addition to recommending lifestyle changes. |
Source: Adapted from The 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults, a report from the panel members appointed to the eighth Joint National Committee Journal of the American Medical Association Feb. 5, 2014 Vol. 311: 507-520. Clinical Practice Guidelines for the Management of Hypertension in the Community, A Statement by the American Society of Hypertension and the International Society of Hypertension Journal of Clinical Hypertension Dec. 17, 2013.
Other Medications To Consider
Besides the numerous medications an individual may be prescribed based on their blood pressure and current health, there are a few other medications to be considered, alongside a doctor of course. Aldosterone antagonists block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure. Common names for this type of medication is spironolactone and eplerenone.
Vasodilators are another medication that includes hydralazine and minoxidil and treats hypertension by working directly on the muscles in the walls of the arteries by dilating them, preventing the muscles from tightening and the arteries from narrowing. As a result, blood flows much more easily through the vessels, and the heart does not have to pump as hard. Central-acting agents are a class of medications that prevent the brain from signaling the nervous system to increase an individuals heart rate and narrow the blood vessels. Examples of these agents include clonidine, guanfacine, and methyldopa.
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How Will I Know If The Combination Treatment Works
Once your blood pressure is normal, your blood pressure should be measured regularly.
Blood pressure measurements may be performed weekly at first. Over time, they may be taken less frequently — if blood pressure stays within normal range.
It’s a good idea to measure your blood pressure at home. This will let you know how your blood pressure varies throughout the day.
You’ll need to see your doctor for blood pressure checks, too. Blood tests may be needed with some treatments.
What You Need To Know
- Twenty percent of patients with hypertension are resistant.
- Resistant hypertension may have no symptoms at all for months or years, but then can cause heart attack, stroke, and vision and kidney damage.
- Some people have pseudoresistant hypertension, which is caused by other factors, such as conflicting medications or white coat hypertension .
- Pseudoresistant hypertension is important to diagnose and treat.
- Assessment and treatment of resistant hypertension includes addressing any identifiable conditions or causes and adjusting medications in a personalized way.
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Calcium Channel Blockers And Ace Inhibitors
The combination of a calcium channel blocker and an ACE inhibitor is appealing on theoretic grounds. Although calcium antagonists exert much of their antihypertensive effect through a vasodilatory action, they also have diuretic and natriuretic properties.28 ACE inhibitors blunt the stimulation of the reninangiotensin-aldosterone axis that may result from this diuretic effect. These agents also inhibit the central sympathetic stimulation that may result from calcium antagonistassociated vasodilatation, although both classes of drugs are potent vasodilators.29
ACE inhibitors and calcium channel blockers work effectively in combination to lower blood pressure.3032 In one representative study,33 diastolic blood pressures were reduced by 3.6 mm Hg more with a trandolapril-verapamil combination than with monotherapy using either agent. No increase in side effects was observed for treatment with combined trandolapril and verapamil.
Calcium antagonists and ACE inhibitors may also work together to favorably influence target-organ disease independent of their effect on blood pressure. Together they appear to have a renal-protective effect,34 to promote reduction of left ventricular mass35 and to decrease mediators of vascular disease.36 The relatively low dose of ACE inhibitor in some combinations may not confer the same degree of renal or cardiac protection that has been demonstrated for higher doses.
Summary Of Current Bhs Guidelines Re: Thresholds Targets And Drug Classes
summarizes the current advice from the BHS regarding blood pressure thresholds and targets for treatment. Our website and publication contain more detailed diagrams together with the main indications/contraindications for each drug class. The advice is helpful to tailoring therapy to the profile of individual patients with coexistent morbidities. Here we offer an additional, simple algorithm for both initial drug treatment in the asymptomatic patient, and the subsequent additions likely to be required .
Box 2 Cutoffs and targets for antihypertensive treatment
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The Most Commonly Used Hypertension Medications And Drug Combinations
A remarkable number of high blood pressure medication names would be included on 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 for everyone.
Second, with so many high blood pressure medications to choose from, as long as you and your healthcare provider are patient and persistent, it is extremely likely that an effective and well-tolerated treatment regimen will be found for your hypertension.
Choice Of Initial Medication
For mild blood pressure elevation, consensus guidelines call for medically supervised lifestyle changes and observation before recommending initiation of drug therapy. However, according to the American Hypertension Association, evidence of sustained damage to the body may be present even prior to observed elevation of blood pressure. Therefore, the use of hypertensive medications may be started in individuals with apparent normal blood pressures but who show evidence of hypertension-related nephropathy, proteinuria, atherosclerotic vascular disease, as well as other evidence of hypertension-related organ damage.
If lifestyle changes are ineffective, then drug therapy is initiated, often requiring more than one agent to effectively lower hypertension.Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines. Considerations include factors such as age, race, and other medical conditions. In the United States, JNC8 recommends any drug from one of the four following classes to be a good choice as either initial therapy or as an add-on treatment: thiazide-type diuretics, calcium channel blockers, ACE inhibitors, or angiotensin II receptor antagonists.
A subsequent smaller study did not show the slight advantages in thiazide diuretic outcomes observed in the ALLHAT study, and actually showed slightly better outcomes for ACE-inhibitors in older white male patients.
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