High Blood Pressure Treatment and Medication

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Blood pressure control is a lifelong challenge. Hypertension can progress through the years, and treatments that worked earlier in life may need to be adjusted over time. Blood pressure control may involve a stepwise approach beginning with diet, weight loss, and lifestyle changes and eventually adding medications as required. In some situations, medications may be recommended immediately. As with many diseases, the health care practitioner and patient work together as a team to find the treatment plan that will work for that specific individual.

In about half of people with high blood pressure, limiting sodium intake by eliminating table salt, cooking salt, and salty and processed foods can reduce blood pressure by 5 mm Hg. Losing weight and participating in regular physical activity can reduce blood pressure further.
If these lifestyle changes and choices don't work, medications should be added. The medications have been proven to reduce the risk of stroke, heart disease, and kidney problems. Do not stop taking your medications without talking to your health care practitioner.

Medication

It may take trial and error to find the proper medication or combination of medications that will help control hypertension in each case. It is important to take the medications as prescribed and only discontinue them on the advice of your health care practitioner.

Water Pills (diuretics)
  • Diuretics are used very widely to control mildly high blood pressure, and are often used in combination with other medications.

  • They increase sodium excretion and urine output and decrease blood volume. The sensitivity to the effect of other hormones in your body is decreased.

  • One example of a diuretic is hydrochlorothiazide (HydroDIURIL)

  • The most commonly used diuretics to treat hypertension include:

    • hydrochlorothiazide (HydroDIURIL),

    • the loop diuretics furosemide (Lasix) and torsemide (Demadex),

    • the combination of triamterene and hydrochlorothiazide (Dyazide), and

    • metolazone (Zaroxolyn).
Beta-Blockers
  • Beta-blockers reduce heart rate and decrease the force of heart contraction by blocking the action of adrenaline receptors. Beta blockers are widely prescribed and effective but can cause increased fatigue and decreased exercise tolerance because they prevent an increased heart rate as a normal response to physical activity.

  • They are also prescribed for people who have associated heart disease, angina, or history of a heart attack.

  • Examples of beta blockers include, carvedilol (Coreg), metoprolol (Lopressor), atenolol (Tenormin)
Calcium Channel Blockers (CCBs)
  • Calcium channel blocking agents work by relaxing the muscle in artery walls and by therefore reducing the force of contraction of heart muscle.

  • Example of calcium channel blockers include, nifedipine (Procardia), diltiazem (Cardizem), verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc), and felodipine (Plendil)
Angiotensin-Converting Enzyme (ACE) Inhibitors
  • ACE inhibitors stop the production in the body of a chemical called angiotensin II, which causes blood vessels to contract. Narrower blood vessels are associated with increased blood pressure. Relaxing artery walls leads to lower blood pressure.

  • Examples of ACE inhibitors include Captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), quinapril (Accupril), and fosinopril (Monopril)
Angiotensin Receptor Blockers (ARBs)
  • ARBs work block angiotensin II receptors and prevent vasoconstriction, or narrowing of blood vessels.

  • Examples of ARBs include losartan (Cozaar), valsartan (Diovan), candesartan (Atacand), and irbesartan (Avapro)
Blockers of Central Sympathetic (autonomic nervous) System
  • These agents block messages from the brain's autonomic nervous system that contract blood vessels. The autonomic nervous system is the part of the unconscious nervous system of the body that controls heart rate, breathing rate, and other basic functions.

  • These medications relax blood vessels, thus lowering blood pressure.

  • An example is clonidine (Catapres)
Direct Vasodilators
  • Direct vasodilators relax (dilate) the blood vessels to allow blood to flow under lower pressure.

  • These medications are most often used in times of hypertensive crisis and are injected intravenously to quickly lower blood pressure readings.

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