Tuesday, 25 October 2016

Choosing High Blood Pressure Medicine

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Choosing High Blood Pressure Medicine:

Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you.

Dozens of high blood pressure medications (anti-hypertensives) are available, each with pros and cons. Your doctor might prescribe more than one high blood pressure medication to treat your condition.

If you have high blood pressure or are at risk of developing it, lifestyle changes can help keep your numbers under control. But you might need medication, as well. Having an effective medication regimen, taking drugs as prescribed, monitoring your blood pressure and making lifestyle changes can help you keep your blood pressure under control.

Lifestyle changes

Whether you're beginning to develop high blood pressure (prehypertension) or you already have it (hypertension), you can benefit from lifestyle changes that can lower your blood pressure.

Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure.

Eat a healthy diet, focusing on fruits and vegetables and, especially, reduce the sodium in your diet.
Maintain a healthy weight.
Exercise. Get 30 minutes of moderate activity on most days of the week. It's OK to break up your activity into three 10-minute sessions a day.
Limit the amount of alcohol you drink. For healthy adults, that means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men 65 and younger.
Don't smoke.
Manage stress.
Medication options

If a trial of making lifestyle changes isn't enough to control your blood pressure, you'll likely receive a prescription for one or more of these medications in addition to maintaining your lifestyle measures.

Diuretics (water pills). Your doctor might first suggest diuretics, which remove excess water and sodium from your body. That decreases the amount of fluid flowing through your blood vessels, which reduces pressure on your vessel walls.

There are three types of diuretics: thiazide, loop and potassium-sparing. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that most people try thiazide diuretics first to treat high blood pressure and heart problems related to high blood pressure.

If diuretics aren't enough to lower your blood pressure, your doctor might recommend adding other blood pressure medications to your treatment.

Angiotensin-converting enzyme (ACE) inhibitors. These help relax blood vessels by preventing the formation of a hormone called angiotensin, a substance in your body that narrows blood vessels. Frequently prescribed ACE inhibitors include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and ramipril (Altace).
Angiotensin II receptor blockers (ARBs). These help relax blood vessels by blocking the action, not the formation, of angiotensin, a chemical in your body that narrows blood vessels. ARBs include valsartan (Diovan), losartan (Cozaar) and others.
Calcium channel blockers. These medications prevent calcium from entering heart and blood vessel muscle cells, thus causing the cells to relax. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and nifedipine (Adalat CC, Afeditab CR, Procardia).
Beta blockers. Also known as beta-adrenergic blocking agents, these work by blocking the effects of the hormone epinephrine, also known as adrenaline. They cause your heart to beat slower and with less force.

Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and atenolol (Tenormin).


Renin inhibitors. Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows the production of renin, reducing its ability to begin this process.

Alpha blockers. Alpha blockers relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, which causes the vessels to remain open and relaxed.

Frequently prescribed alpha blockers include doxazosin (Cardura), prazosin (Minipress) and terazosin.

Alpha-beta blockers. Alpha-beta blockers work similarly to beta blockers. They might be prescribed for people with high blood pressure who are at risk of heart failure. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
Central-acting agents. These prevent your brain from sending signals to your nervous system to speed up your heart rate and narrow your blood vessels. As a result, your heart doesn't pump as hard and your blood flows more easily through your blood vessels.

Clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa are examples of central-acting agents.

Vasodilators. These medications open (dilate) blood vessels. They affect the muscles in blood vessel walls, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily through your vessels and your heart doesn't have to pump as hard.

Other blood pressure medications, such as calcium channel blockers, also dilate blood vessels. But the vasodilators that work directly on the vessel walls are hydralazine and minoxidil.

Aldosterone antagonists. These are often used with other drugs, such as a diuretic, for black people, older people, people with heart failure, people with diabetes and people whose hypertension is difficult to treat. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
Each of the blood pressure drugs has been shown to lower blood pressure. However, different people respond better to certain drugs than other people do, which often depends on age, sex, race, how high your blood pressure is and your other health conditions.

A two-drug combination generally is more effective than is a single drug to get your blood pressure under control. Sometimes a third medication, or more, is needed to achieve your blood pressure goal.



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