Two Types Of Blood Pressure Meds Prevent Heart Events Equally But Side Effects Differ
- In an analysis of almost 3 million patients taking a single high blood pressure medication for the first time, angiotensin receptor blockers were as good as angiotensin-converting enzyme inhibitors at preventing cardiovascular events linked to hypertension, including heart attack, stroke and heart failure.
- 51 possible side effects and safety concerns were examined: The patients taking ARBs were found to be significantly less likely to develop tissue swelling, cough, pancreas inflammation and bleeding in the digestive tract.
- This information may assist clinicians in deciding which type of blood pressure-lowering medication to prescribe for patients diagnosed with hypertension for the first time.
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DALLAS, July 26, 2021 People who are just beginning treatment for high blood pressure can benefit equally from two different classes of medicine angiotensin-converting enzyme inhibitors and angiotensin receptor blockers yet ARBs may be less likely to cause medication side effects, according to an analysis of real-world data published today in Hypertension, an American Heart Association journal.
The findings are based on an analysis of eight electronic health record and insurance claim databases in the United States, Germany and South Korea that include almost 3 million patients taking a high blood pressure medication for the first time with no history of heart disease or stroke.
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 Is High Blood Pressure Diagnosed
It is not uncommon for your blood pressure to go high occasionally however, it is persistently high blood pressure that is a concern. For this reason, if a doctor or nurse takes your blood pressure and it is high but you dont have any risk factors or symptoms, then at least two other separate measurements should be taken before you are diagnosed with high blood pressure.
Before getting your blood pressure taken you should avoid the following for at least an hour before the measurement:
- Strenuous exercise
- Stressful situations.
Sit down for at least five minutes before the reading is taken and dont talk while it is being measured.
Other tests may be ordered if your doctor concludes you have high blood pressure. These may include blood tests, an electrocardiogram, and sometimes a chest x-ray.
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What Are The Safest High Blood Pressure Medications
The most common type of medication given to patients who have primary hypertension is antihypertensive medication. This medicine helps in lowering arterial pressure and consequently, reduces blood volume, heart rate and the chances of stroke.
Different antihypertensive medications produce different effects. Some will stop arteries from constricting by blocking the nerve impulses responsible for it, while others decrease the force of hearts contraction and slowing the heart rate. Beta blockers, calcium channel blockers, ACE inhibitors like valsartan, losartan, are all examples of antihypertensive medicines.
How Do Blood Pressure Medicines Work
Blood pressure medicines can work several different ways. Blood pressure medicines can keep blood pressure at a healthy level by1:
- Causing your body to get rid of water, which decreases the amount of water and salt in your body to a healthy level
- Relaxing your blood vessels
- Making your heart beat with less force
- Blocking nerve activity that can restrict your blood vessels
Talk with your health care team about the best type of treatment for you. You may need to take more than one type of medicine to control your blood pressure. You can also talk to your health care team about how long it should take your blood pressure medicine to work.
It is important to take your blood pressure medicine exactly as your doctor tells you to. Do not stop taking your current medicine without talking to your doctor or pharmacist first. Stopping your blood pressure medicine without first talking to your health care team could lead to serious health consequences.
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Losartan Vs Lisinopril: Differences Similarities And Which Is Better For You
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If you are one of the 103 million Americans with high blood pressure, your doctor may have mentioned starting you on medication to lower your blood pressure. Losartan and lisinopril are both generic prescription drugs that are used to treat high blood pressure . Losartan is an angiotensin II receptor blocker and lisinopril is an angiotensin-converting enzyme inhibitor .
Both drugs work on a part of the body called the renin-angiotensin system but in different ways. In the renin-angiotensin system, ACE inhibitors block a substance called angiotensin II from being made. Angiotensin II narrows the blood vessels and increases blood pressure, so by blocking the production of angiotensin II, blood pressure is lowered. ARBs block angiotensin II from binding to receptors, thereby lowering blood 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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I Quit Drinking Alcohol
I used to drink a lot as I had a good head for alcoholic beverages. However, my doctor friend suggested I quit taking alcoholic beverages or drinks. It was quite a difficult decision for me, but I was able to stay off alcohol for 30 days straight. Since then, I only take a sip or two of red wine occasionally. Red wine is good for the heart.
However, I still had to fall back to those blood pressure medications once in a while due to the nature of my work. I wanted a lasting solution to this common disorder.
What Are Warnings And Precautions For Amlodipine
This medication contains amlodipine. Do not take Norvasc if you are allergic to amlodipine or any ingredients contained in this drug.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
Worsening of angina and acute myocardial infarction can develop after dose is started or increased, particularly with severe obstructive CAD.
Extensively metabolized by liver titrate dose slowly with severe hepatic impairment.
Initiate at lower dose in the elderly.
Titrate dose every 7-14 days on a given dose peak antihypertensive effect is delayed.
Co-administration with CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction monitor for symptoms of hypotension and edema when amlodipine is co-administered with CYP3A inhibitors to determine the need for dose adjustment.
Pregnancy and Lactation
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A Trend Toward Lower Targets
Finding safe, effective ways to manage blood pressure has been a matter of growing interest. “Nowadays, there’s a trend to control blood pressure more aggressively than in the past,” says Dr. C. Michael Gibson, professor of medicine at Harvard Medical School and an interventional cardiologist at Beth Israel Deaconess Medical Center. Although the prior standard was a blood pressure target of less than 140/90 for most people, a goal of 120/80 appears to be even more effective for preventing heart attacks, strokes, and death from heart disease.
New Research Questions Whether A Common Drug Is The Best Approach
by Robin Westen, AARP, December 31, 2019
En español | About six months ago, during my annual checkup, I was surprised to learn that my blood pressure numbers were on the rise and creeping into the danger zone.
I shouldn’t have been. At age 69, I’m a prime candidate for high blood pressure . In fact, by the time we reach 65 years of age, more than three-quarters of U.S. adults have HBP, a condition in which blood pushes too forcefully against arteries, according to the National Center for Health Statistics. If left untreated, it can lead to serious coronary damage or stroke.
As a new member of the hypertension club, I was referred to a cardiologist and, a week later, prescribed an ACE inhibitor, a drug considered the first-line treatment for high blood pressure and taken by millions of Americans.
I took my pill every day and, because it lowered my blood pressure, I never gave it a second thought. That is, until I read about an impressive new study concluding that ACE inhibitors are not the best option to try initially when attempting to bring blood pressure under control. So now what?
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Factors That Can Add Up To Cause Harm
When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.
In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when youre dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys wont filter normally.
If youre dehydrated, NSAIDs can also keep your kidneys from protecting themselves. As a result, taking NSAIDs when youre sick and dehydrated can cause kidney injury.
Choosing The Right Blood Pressure Medicine For You
Your healthcare provider will go through a number of steps with you to find the right blood pressure medicine for you. The choice will depend on your:
- health conditions
- medical history, such as which blood pressure medicines you have tried in the past.
Since everyone is different, some medicines work better for others than they will for you. Often 2 or 3 medicines are needed and it may take time to find the right combination and dosage.
Below are the most common groups of medicines that can be used to lower blood pressure.
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Salt And Sodium Are The Same
Salt and sodium are not exactly the same thing. Salt contains sodium along with another mineral, chloride, and the chemical name for salt is sodium chloride . About 90% of the sodium we consume comes from salt. On food nutrition labels these terms are often used interchangeably even though there is a difference. Sodium is used on the nutrition information panel of labels because it is the sodium portion of the salt that is relevant for health.
People With Diabetes Kidney Disease And Heart Disease Should Use Salt Substitutes
For some people, salt substitutes such as potassium chloride can help manage sodium intake. However, if you have certain medical conditions including diabetes, kidney disease, and heart disease, potassium salt substitutes could be harmful. Talk to your doctor to find out your options for safe salt substitutes.
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Factors To Consider In Managing High Blood Pressure
Not everyone is convinced that diuretics should be the first line of treatment. What’s interesting about the study is the way the researchers looked at the data of such a large number of patients, says Luke Laffin, a preventive cardiologist affiliated with the Cleveland Clinic. But, Laffin says, the study didn’t look at how people of different races respond to different medications. For example, previous data shows that African Americans may respond best to a diuretic when it’s combined with an ACE inhibitor. What really determines your outcome is how well your blood pressure is lowered by a particular medication. The data surveyed didn’t look at how much the blood pressure numbers went down it only reported the patients starting numbers, Laffin says.
What Effect Does Sugar Have On Blood Pressure
Sugar is bad for high blood pressure.
Although sodium is known to prompt hypertension or hypertension, sugar can really play a part as well. Eating a lot of sugar can restrain the creation of nitric oxide in veins. Nitric oxide ordinarily assists with vasodilation . Without NO, vasoconstriction can result, prompting hypertension.
Fructose, a sort of common sugar, raises the degrees of uric acid in the blood, which thus hinders the creation of nitric oxide. Nitric oxide is the thing that helps your veins keep up with adaptability, so when levels of NO are brought down, you can encounter a rise in blood pressure.
Whats more, expanded sugar utilization can prompt weight gain. Obesity is additionally a supporter of high blood pressure.
Sugar in processed food is viewed as a primary driver of hypertension, as well. Specifically, added sugar, for example, table sugar and syrups used to plan and deal with food sources, is believed to be more unsafe than normally happening sugars like those in fruits and vegetables.
Some studies show that sugar can increase salt sensitivity which leads to increasing the negative effects of salt in the body.
Avoiding sugar in the case that you have high blood pressure is highly recommended.
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What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
What Happened To Older Patients Whose Blood Pressure Medications Were Reduced
The OPTIMISE trial provided preliminary evidence that some older adults may be able to reduce the number of blood pressure medications they take, without causing a large increase in blood pressure. For the trial, researchers randomized 569 patients age 80 or older, with systolic blood pressure lower than 150 mm Hg, to either remain on their current blood pressure medications, or to remove at least one blood pressure medication according to a prespecified protocol. The study subjects were followed for 12 weeks to assess blood pressure response.
Researchers found that both the people who remained on their previous blood pressure medications and those who reduced the number of medications had similar control of blood pressure at the end of the study. While the mean increase in systolic blood pressure for the group that reduced medications was 3.4 mm Hg higher than the control group, the number of patients who had systolic blood pressure below the goal of 150 mm Hg at the end of the study was not significantly different between groups. Approximately two-thirds of patients were able to remain off the medication at the end of the study.
It is important to note that OPTIMISE is relatively a small study, and the investigators did not examine long-term outcomes such as heart attack, heart failure, or stroke for this study , so we dont know what the long-term effect of deprescribing would be.
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Finding The Right Blood Pressure Medications For You
How blood pressure medicines work
Your body is constantly working to keep your blood pressure under control. There are receptors in your blood vessel walls which detect when your blood pressure is too high or low. In response, your nerves, hormones and kidneys all play a role in bringing it back to a safe level.
Over time, your blood pressure can creep up for a number of reasons, including an unhealthy lifestyle, and medications can help to bring it back down. They do this by acting on the ways your body controls blood pressure. Some affect the nerves or hormones which send signals to your blood vessel walls, telling them to relax or contract, while some affect the kidneys, causing them to remove excess salt and water from the blood.
Taking more than one medicine
Taking a combination of different medicines can work better than taking one, because they work in different ways. Taking a low dose of two medications rather than a high dose of one, can also help to avoid side effects, as side effects can sometimes be caused by the dose.
Sometimes a medication will work well to begin with, but with time your blood pressure might creep up again. You may then need to take another medicine alongside it which works in a different way.
Choosing a medicine to suit you
Which medications will be suitable for you depends on a number of things, including your:
Finding the right combination of medicines
Simplifying your medicines