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.
Check With Your Doctor
Of course, people can use a pill splitter to divide most of these pills into halves or quarters. But don’t do this on your own, cautions Dr. Gibson. This is especially important for people who have heart disease, because blood pressure medications are the cornerstone therapy for treating many heart conditions, including heart rhythm disorders and heart failure.
But if you don’t have heart disease, it’s worth asking your doctor about the possibility of lowering your blood pressure medication dose. “Ideally, people should be prescribed the lowest effective dose of any medication they take,” says Dr. Gibson. During any routine office visit, be sure to review all your current medications with your physician and discuss any side effects you are experiencing.
But reaching that lower goal leaves people more prone to side effects especially fatigue, dizziness, and fainting, which can occur when blood pressure dips too low, says Dr. Gibson. Also, each class of blood pressure medication has its own side effects. For instance, some diuretics can cause excessive urination, although this usually improves after a few weeks. However, other side effects such as erectile dysfunction from beta blockers, leg swelling from certain calcium-channel blockers, and cough from ACE inhibitors tend to persist. When these occur, doctors often switch the person to a different class of blood pressure drug.
How Can You Prevent Low Blood Pressure
You may be able to prevent hypotension by making changes to your lifestyle and diet, such as:
- Eating fewer carbohydrates and choosing small, healthy meals.
- Staying hydrated and avoiding alcoholic drinks.
- Rising slowly when youve been sitting or lying down.
- Taking a few deep breaths before you change position.
- Wearing compression stockings.
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How To Check Your Blood Pressure
You can check your blood pressure:
- at home yourself using a home blood pressure monitor – talk to your GP about home monitors
Low blood pressure is a measurement of 90/60mmHg or lower.
The first number is the highest pressure when your heart beats and pumps blood around your body. The second number is the lowest pressure when your heart relaxes between beats.
See a GP if you have low blood pressure and keep getting symptoms such as dizziness.
Why You Might Have Low Blood Pressure
Low blood pressure has many possible causes, from lifestyle choices, to medication or an underlying health condition.
In some cases, it may just be the result of being healthy and active or a tendency you’ve inherited from your parents.
Throughout the day, it’s normal for your blood pressure to vary depending on what you’re doing. Stress at work, the temperature outside and your diet could all affect your blood pressure reading.
This is why it’s important your blood pressure is checked under similar conditions each time to make sure results are consistent.
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What Causes Low Blood Pressure
According to the National Heart, Lung, and Blood Institute, some people just have low blood pressure all the time. Because that’s normal for them, it doesn’t cause any symptoms and it is not considered dangerous.
“People who are thin and very physically active tend to have lower blood pressure,” Dr. Lajoie tells LIVESTRONG.com. In general, pre-menopausal women and very thin young people also tend to have lower blood pressure.
In other cases, however, low blood pressure is not normal. Dehydration, for example, is a common cause of low blood pressure, Dr. Lajoie says. And the following conditions could also cause it, according to the AHA:
- Infection, especially if the bacteria enter yourbloodstream
- Anemia
- A decrease in blood volume, such as from a trauma or internal bleeding
- Endocrine disorders, including hypothyroidism and sometimes diabetes
- Neurally mediated hypotension, a disorder caused by miscommunication between the heart and brain that leads your blood pressure to drop after you stand for a long period of time
- Postprandial hypotension, a condition that most commonly occurs in older adults, in which your blood pressure drops after meals
- Orthostatic hypotension, when your blood pressure drops with standing up from a sitting position you can experience this temporarily, such as when you stand up too fast and your legs have been crossed, or chronically, which is a more serious condition
Read more:Causes of Low Diastolic Pressure
Other Medicines For High Blood Pressure
Apart from the five main classes of medicines listed above, sometimes other medicines are used to lower blood pressure. For example:
Methyldopa or alpha-blockers are sometimes used if there are problems with the more commonly used medicines. Doxazosin is an alpha-blocker commonly added when blood pressure is high despite the treated person being on other medicines.
Spironolactone is another stronger water tablet sometimes used as an add-on option for blood pressure which is difficult to control. Spironolactone is not usually given alongside ACE inhibitors or ARBs because the combination can cause potassium levels in the body to become dangerously high. Regular blood tests to check for this are needed if you are on this medication or medicine combination.
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What Are The Dangers Of Low Blood Pressure
Blood pressure is the force that blood exerts on the walls of arteries. There are two numbers associated with blood pressure. The first number is the systolic pressure, which is the pressure as the heart is pumping the blood. The second number is the diastolic pressure, which is the pressure when the heart is between beats. Normal blood pressure is that which has a systolic reading of 120 millimeters of mercury or lower. The normal diastolic reading is 80 mm Hg or lower. The two numbers are typically represented as 120/80 mm Hg. Low blood pressure, also called hypotension, is the condition when blood pressure falls below 90/60 mm Hg. Although some people have low blood pressure all of the time and have no problems, hypotension carries risks and could be an indication of a more serious condition.
Baroreceptor Signals Sent To The Arteries
Baroreceptors communicate directly with arteries when blood pressure is too high or too low to bring it into a more appropriate level. Baroreceptors tell arteries to constrict when blood pressure is too low to help raise blood pressure. Baroreceptors tell arteries to relax when blood pressure is too high to help lower blood pressure.
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Health Risks Of Low Blood Pressure
There are both direct and indirect risks to having low blood pressure:
1. Inadequate Oxygen
As Dr. Lajoie mentioned, the main risk of low blood pressure is that there isn’t enough pressure in your blood vessels to get blood and thus, oxygen where it needs to go in your body, especially to the brain. Think of it like trying to take a shower when the water pressure is too lowyou just can’t get the job done easily or effectively.
2. Heart Problems
Severely low blood pressure can cause damage to your heart by depriving it of oxygen, according to the Mayo Clinic.
Individuals with existing coronary heart disease and very low blood pressure as a result of treatment are at an increased risk for cardiovascular events, such as a heart attack, according to a February 2017 study in the British Medical Journal.
Another study, published September 2018 in the Journal of the American College of Cardiology, found that very low blood pressure is associated with increased angina, or chest pain, in people with chronic coronary artery disease.
3. Injury
If you experience a sudden drop in blood pressure, you are at risk for fainting, which could lead to an injury from falling.
4. Kidney Damage
According to Dr. Lajoie, certain patients with kidney failure can experience worsened kidney function if their blood pressure is too low.
5. Exacerbation of Stroke Symptoms
“Patients with prior strokes can have recurrence of stroke symptoms if their blood pressure drops too low,” Dr. Lajoie says.
What Is Low Diastolic Blood Pressure
Your blood pressure is the force inside your blood vessels when your heart beats and relaxes. This force is measured in millimeters of mercury and is represented as two numbers.
The upper number, called your systolic pressure, is measured when your heart beats. The lower number, called your diastolic pressure, is measured when your heart relaxes between beats.
High blood pressure can increase your risk of heart disease or stroke, but low blood pressure can also be a problem.
The medical term for low blood pressure is hypotension. If you have hypotension, your systolic pressure measurement is under 90 mm Hg and your diastolic number is under 60 mm Hg. Doctors have started to raise concerns specifically about diastolic blood pressure below 60.
Some people can have low diastolic pressure even when their systolic pressure is typical. This condition is called isolated diastolic hypotension. Low diastolic blood pressure may be particularly dangerous for your heart.
Unlike the rest of your body, which receives blood when your heart pumps, the muscles of your heart receive blood when your heart relaxes.
If your diastolic blood pressure is too low, your heart muscles wont get enough oxygenated blood. This can lead to weakening of your heart, a condition called diastolic heart failure.
You may be at higher risk of this type of heart failure if you have coronary heart disease, which is narrowing of your heart arteries.
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How Is Blood Pressure Generated
The left lower chamber of the heart receives oxygenated blood from the lungs and pumps it throughout the body. The heart fills with blood between heartbeats. This phase in the heart cycle is called diastole. When the heart pumps to push blood throughout the arteries, this phase is called systole. You can place your fingers on your neck or the inside of your wrist to detect your heartbeat. The pulse you feel is the contraction of the heart’s left ventricle.
Medications That Can Cause Low Blood Pressure
Medications might also cause your blood pressure to become too low.
Diuretics, tricyclic antidepressants, and erectile dysfunction drugs can also cause hypotension.
If a medication youre taking causes your blood pressure to become too low, your doctor may adjust the dosage or change the medication. This usually improves the hypotension.
Hypotension doesnt always cause symptoms. But sometimes low blood pressure means your vital organs arent receiving as much blood flow as they need. If this happens, you might feel tired or unwell. Symptoms of hypotension may include:
- fatigue, an all-around sense of tiredness or lacking energy
- lightheadedness, or feeling like you might faint
- dizziness, feeling off-balance when you get up from a reclined or seated position, or while youre standing
- nausea, a sense of discomfort in your stomach and feeling like you want to vomit
- clammy skin, when you feel damp or sweaty to the touch
- depression, persistent feelings such as sadness or low mood that interfere with your daily activities
Your treatment plan will depend on whats causing your hypotension. Your doctor will consider factors including:
- the type of hypotension youre experiencing
- the situations that may be causing hypotension for you
For some people, low blood pressure may not cause any symptoms. In cases where treatment is needed, your doctor may recommend lifestyle changes, medical treatment, or a combination of both.
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Younger People With High Blood Pressure :
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Start here. ACE Inhibitors, or angiotensin receptor blockers , are recommended as first line therapy because they lower blood pressure and the risk of stroke and heart disease. ACE inhibitors are cheap, well tolerated medications that end in -il . ARBs are very similar to ACE inhibitors but do not carry the dry cough side-effect that ACE inhibitors have. Common ARBs are losartan, irbesartan and valsartan.
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Another option. Beta blockers are a second option for younger patients who cant take ACE inhibitors or ARBs, as some studies show that they dont provide the same protection against stroke risk. Commonly used beta blockers include atenolol, metoprolol and carvedilol.
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Final notes. Studies show improved blood pressure in patients taking the above options rather than diuretics and calcium channel blockers.
What Blood Pressure Medicine Has The Lowest Side Effects
by Contributing Writer / in Health
Common in nearly every medication, side effects are no stranger to blood pressure medications as every blood pressure medication has some kind of side effects.
Which blood pressure medication that has the lowest side effects depends on how you react to specific medications and what side effects you find most bothersome.
Most commonly prescribed blood pressure medications have an array of similar side effects. Depending on your health status, you may be able to take a diuretic, which does not have many of the side effects associated with beta blockers, ACE inhibitors, alpha blockers and calcium channel blockers.
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If High Blood Pressure Drug Side Effects Bother You
Partner with your doctor. Ask if there are any steps you can take to lessen medication side effects. For example, to lessen the effects of low blood pressure, it may help to avoid standing for a long time in the sun. In some cases, side effects such as fatigue or diarrhea may subside with time. In other cases, your doctor may change the dosage or prescribe another high blood pressure medication. A combination of medications sometimes works better than one medication alone by not only improving high blood pressure control but also by reducing side effects.
Also, when you first start a new high blood pressure medicine, be aware of rare allergic reactions. Call 911 right away if you develop hives, wheezing, vomiting, light-headedness, or swelling in your throat or face.
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Low Blood Pressure Also Known As Hypotension Is When You Have A Blood Pressure Level That Is Below The Normal Range
If your blood pressure is naturally low, this probably wont cause you any problems and wont need treating. In fact, the lower your blood pressure, the lower your risk of heart disease and stroke.
Low blood pressure can sometimes be caused by medications or can be a sign of another health problem. This can sometimes cause problems such as falls, fainting and feeling dizzy, so it might need looking into and treating. Speak to your doctor or nurse if youre worried about low blood pressure.
Plus, take a look at the animation below on how to manage low blood pressure when you stand up.
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When Is Low Blood Pressure Too Low Hypotension And More
Some people naturally have low blood pressure, known as hypotension. However, when high blood pressure suddenly becomes low blood pressure, it could be cause for concern.
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Low blood pressure, or hypotension, may be a sign of good health and of a decreased risk of heart disease. But not always. At times, continually low blood pressure or a sudden drop in blood pressure can lead to worrisome symptoms and even serious health problems.
Heart Tissue Damage And Heart Disease
Researchers have found a link between low diastolic blood pressure and heart damage.A 2016 study that lasted more than 3 decades and involved more than 11,000 people found that a diastolic blood pressure below 60 mm Hg is dangerous.People with this level are 50 percent more likely to have heart damage. This is compared with those who have a low diastolic pressure level between 80 and 89 mm Hg.Heart disease is another concern. The same study found that those with low diastolic blood pressure were 49 percent more likely to develop heart disease.
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When To Contact A Medical Professional
If low blood pressure causes a person to pass out , seek treatment right away. Or call 911 or the local emergency number. If the person is not breathing or has no pulse, begin CPR.
- Black or maroon stools
Hypotension Blood pressure – low Postprandial hypotension Orthostatic hypotension Neurally mediated hypotension NMH
Low Blood Pressure Symptoms
Low blood pressure is pressure so low it causes symptoms or signs due to the low flow of blood through the arteries and veins. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidney, the organs do not function normally and may be temporarily or permanently damaged.
Unlike high blood pressure, low blood pressure is defined primarily by signs and symptoms of low blood flow and not by a specific blood pressure number. Some individuals routinely may have blood pressure numbers of 90/50 with no symptoms and therefore do not have low blood pressure. However, others who normally have higher blood pressures may develop symptoms of low blood pressure if their blood pressure drops to 100/60.
During pregnancy, blood pressure tends to decrease. Normal blood pressure during pregnancy may be lower than 100/60. Your OB/GYN or Midwife should monitor your bood pressure if you are pregnant.
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