If your doctor diagnoses you with high blood pressure, he or she will typically recommend one of two courses of treatment. The first is lifestyle changes. The second is lifestyle changes combined with medications. Blood pressure medications are typically necessary for individuals with more severe cases of high blood pressure or for whom lifestyle changes did not work.
There are several types of medications doctors prescribe to treat high blood pressure. Which is right for you depends on several factors, including how high your blood pressure is, the status of your current health, your age and whether you are on other medications. It is not uncommon for physicians to prescribe two medications to lower blood pressure, as two typically work better than one. Regardless of which medicine or medicines your doctor prescribes, it is important that you follow doctor recommendations.
If you are prehypertension or newly diagnosed with high blood pressure, your doctor may recommend lifestyle changes as the initial course of treatment. Commonly recommended lifestyle changes that have a huge effect on blood pressure numbers are as follows:
Your doctor will only recommend lifestyle changes and not medication if your blood pressure is between 120/80 and 129/80 mmHg. As you try these lifestyle changes, your doctor will want to monitor your blood pressure to determine if they are making any difference. If they are not, or if your blood pressure increases, he or she will recommend medications.
If, at diagnosis, your blood pressure is equal to or higher than 130/80 but lower than 140/90 mmHg, you and your provider must work together to determine the best course of treatment. Some considerations to make when in Stage 1 high blood pressure are as follows:
If, however, your blood pressure is at or equal to 140/99 mmHg at diagnosis, you have Stage 2 high blood pressure. In this case, your doctor will most likely start you off on a medicine regime and recommend lifestyle changes to complement it.
If medication is necessary to control your blood pressure, your doctor may prescribe one or several medicines. Below are the most common medication options for controlling high blood sugar.
Water pills, also known as diuretics, help to rid the body of excess water and sodium. Doctors often recommend waters pills as the first course of action, outside of lifestyle changes, for reducing blood pressure levels. Diuretics are effective in that they reduce the amount of fluid that flows through the veins and arteries and, in the process, minimize the pressure on the walls of the blood vessels.
There are dozens of diuretics on the market, each of which falls into a “class.” Three of the most common classes of diuretics are loop, thiazide and potassium. Your blood pressure numbers and existing health conditions, such as heart failure or kidney disease, will dictate which class for which you receive a prescription. Two of the most common water pills on the market are hydrochlorothiazide (Microzide) and chlorthalidone.
While water pills are typically effective, they do come with a few drawbacks. The first is that it increases urine output dramatically. Not only can frequent urination be inconvenient but also, it can diminish potassium levels. To ensure you maintain a healthy heartbeat, it is important that you keep your potassium levels up. To help you do this, your doctor may also prescribe potassium pills. If your potassium levels are already low, he or she may pair your water pill with a triamterene-containing diuretic, which preserves potassium while flushing fluids and sodium.
ACE inhibitors block the development of a chemical that naturally narrows the blood vessels, thereby relaxing them and reducing pressure. Common types of this medication include benazepril (Lotensin), lisinopril (Prinivil and Zestril) and captopril.
Like ACE inhibitors, these drugs relax the blood vessels. However, unlike the former medication, ARBs inhibit not the formation of the chemical that naturally narrows blood vessels but rather, the action. As a result, the blood vessels have no indication to or desire to narrow. Common ARBs include losartan (Cozaar) and candesartan (Atacand).
Calcium channel blockers such as diltiazem (Cardizem and Tiazac) and amlodipine (Norvasc) are designed to relax the muscles of the blood vessels. Research indicates that they work best for people of African American descent and elderly people than do ACE inhibitors alone. However, they tend to slow heart rate, a side effect that your doctor may try to counteract with additional medications.
If your doctor does prescribe a calcium channel blocker, it is important that you do not consume any products that contain grapefruit when taking it. Grapefruit has been known to boost the blood levels of certain calcium channel blockers, which can prove dangerous for patients.
Renin is a substance that the kidneys produce and that triggers the domino effect that eventually leads to high blood pressure. If you produce too much renin, your doctor may prescribe renin inhibitors to slow the production process.
Sometimes, the cause of high blood pressure is too much epinephrine, otherwise known as adrenaline. Adrenaline can and has been known to increase a person’s blood pressure, as it causes the heart to beat faster and with more force. If your adrenaline levels are constantly up, your doctor may recommend beta blockers.
If you are unable to achieve your blood pressure goals with one of the aforementioned medications or with a combination of medications, your doctor may prescribe a more potent drug. Below are a few medicines that physicians recommend for patients with more stubborn blood pressure problems.
The hormone, norepinephrine — otherwise known as noradrenaline — can and does tighten the muscles in the walls of the veins and smaller arteries. When this happens, blood pressure increases. To prevent this tightening from occurring at all, doctors may prescribe alpha blockers, which cause the blood vessels to open and relax.
Similar to alpha blockers, alpha-beta blockers prevent norepinephrine from tightening the walls of the smaller arteries and veins. A doctor may prescribe this more potent version of the former drug if you are at risk of heart failure.
Vasodilators prevent the muscles in the arteries and veins from narrowing and tightening. In doing so, they help the blood flow more easily to the heart and ensure it does not have to work as hard.
In some people, the brain constantly sends signals to the central nervous system that causes it to speed up the heart rate. When the heart rate speeds up, the blood vessels become narrower, resulting in increased pressure on them. To stop the brain from sending these signals and, therefore, slow heartrate, a doctor may prescribe central-acting agents.
Often paired with diuretics, aldosterone antagonists block aldosterone, a hormone that contributes to fluid and salt retention. Both excess fluid and salt in the system contribute to, if not directly cause, high blood pressure. Your physician may prescribe these meds, along with diuretics, if your blood pressure proves difficult to control via other means, if you are at risk of heart failure of if you live with diabetes.
Resistant high blood pressure occurs when one or more medications, combined with healthy lifestyle changes, fails to lower one’s numbers. If you have resistant high blood pressure, your doctor may recommend as many as three medications. If three does not work, he or she may try four. However, once four medications prove futile, your provider will likely assess you for other undiagnosed and underlying healthy conditions.
If you do have resistant high blood pressure, know that this does not mean you will never be able to achieve normal or healthy blood pressure levels. Rather, it merely means that your doctor must work harder to determine the cause and come up with an effective treatment plan. Some steps your provider may take to help you get control over your numbers are as follows:
It is not uncommon for hypertension to go hand-in-hand with other chronic medical conditions, making treating it all the more difficult. Not only must your doctor find a drug combination that is safe and effective for all conditions but also, he or she must rule out the possibility that one condition is causing the other or vice versa. Some conditions that commonly cooccur are as follows:
It is important that your doctor is aware of or attempts to diagnose other conditions and develop a targeted treatment plan. A tailored approach can help improve these conditions and prevent adverse outcomes.
As an example, if you have diabetes and high blood pressure, your doctor may prescribe an ACE inhibitor and diuretic to decrease your risk of both a heart attack and stroke. If you have diabetes, high blood pressure and kidney disease, on the other hand, the best combination of medications may include an angiotensin 2 receptor blocker and ACE inhibitor, and not a diuretic.
For many people, blood pressure medications help to improve numbers and restore them to a normal range. However, that does not mean they are without side effects. Most side effects are mild and go away with time. Common side effects of blood pressure medications are as follows:
If you do experience any of these side effects, let your doctor know right away. He or she can monitor your health and, if the side effects continue to cause you problems, tweak your regimen or dosages to reduce the adverse effects as much as possible.
That said, even if you do experience side effects, never stop taking a medication on your own. Also, do not tweak the dosage. Always consult with your practitioner for guidance first.
For more severe cases of hypertension, a combination of lifestyle changes and medication is necessary to treat it. If you go through several medications and combinations of medications before finding a regimen that works for you, do not discourage, as this is not uncommon. Given that you work with your doctor and do your part, you should, eventually, find an effective treatment plan.