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How to Choose Hypertension Medication

Updated on September 19, 2012
There are many factors to consider when choosing medications for hypertension.
There are many factors to consider when choosing medications for hypertension. | Source

Hypertension Medications

As we all know, there are more medications than well...Carter has pills. It seems like in my line of work (medical transcription), a new drug hits the market every few months.

If you happen to suffer from hypertension, there usually is a period where you can try and get your blood pressure down before going on medication. Goal blood pressures that don't require treatment are in the 120/80 range.

You can gain a little leeway usually but once you get up near 90 for your bottom number (diastolic), or 130-140 for your top number (systolic), your doctor is probably going to be thinking about prescribing a medication to get it down to lower levels.

But with all the medications out there, how do you know which one is right for you? Choosing the right one depends on many factors.

Differences in Blood Pressure Medications

There are many kinds of blood pressure medications.

Categories for Antihypertensives:

  • ACE inhibitors--blocks angiotensin which causes vessels to relax
  • Alpha blockers--relax your blood vessels so blood flows more easily
  • ARBs--prevent blood vessels from tightening
  • Beta blockers--make the heart beat slower, lessening the pumping force
  • Calcium channel blockers--prevents calcium in vessels or slows heart rate
  • Central agonists--target your brain to lower blood pressure
  • Direct vasodilators--relax muscles in blood vessel walls
  • Diuretics--remove salt and water from your body
  • DRIs--block enzyme renin and allow blood vessels to relax
  • Peripheral-acting adrenergic blockers--work on nerves to prevent vessel constriction

Coexisting conditions to consider when taking these medications:

  • Type 2 diabetes
  • Congestive heart failure
  • Kidney disease

People with the above conditions usually can be treated with most all of these drugs but the right combination sometimes needs to be found.

Most Prescribed Antihypertensive Drugs

These classifications of drugs seem to be on the rise in treating different types of hypertension:

  • ARBs
  • ACE inhibitors
  • DRIs

Comparison of Effects of ARBs, ACE inhibitors and DRIs:

  • ARBs and ACE inhibitors work about equally effectively to lower blood pressure and by about the same amount
  • ACE inhibitors and ARBs have no effect whatsoever on blood sugar levels
  • ARBs and ACE inhibitors do not affect cholesterol levels at all
  • DRIs are relatively new so there is no data accumulated to note so far
  • ACE inhibitors and ARBs are said to both protect kidney function equally

Did you know?

  • 9 out of 100 people on an ACE inhibitor will get a dry cough
  • 2 out of 100 people on an ARB will get a dry cough

These drugs are usually used to treat in more specific instances and where other factors may be involved--for example needing to treat a heart rate:

  • Beta blockers though due to many side effects such as erectile dysfunction, fatigue, higher risks in asthmatics and diabetics, and nightmares, they are not as preferred
  • Calcium channel blockers though they tend to cause fatigue, shortness of breath, nausea, drowsiness and slow or irregular heartbeat so again are used with caution
  • Diuretics--these are used quite often and in fact are sometimes a first line of treatment but do have side effects such as weakness and may quickly cause electrolyte disturbances which can be debilitating and require hospitalization

What To Do To Lower Your Blood Pressure Naturally

There are several lifestyle modifications anyone with high blood pressure can adopt--whether or not you're on medication.

Changes in lifestyle may or may not have the necessary effect on lowering the numbers, but in many cases, it's worth a try.

Even if it doesn't completely work and medications are prescribed, the followiong lifestyle changes can only help someone who has hypertension.

  • Quit smoking--immediately if not sooner
  • Lose weight
  • Start doing aerobic exercise 5-7 times per week for 30-60 minutes--60 preferred
  • Drink less alcohol
  • Limit salt in your diet
  • Add more fiber to your diet
  • Include fruits and vegetables in your diet several times per day
  • Eat less meat and substitute at least 1 vegetarian meal per week
  • Switch to a heart healthy diet using more grains and avoiding processed foods
  • Avoid stressful situations
  • Have routine checkups and have your kidney function monitored

Side Effects of Hypertension Medicines

This author has had low blood pressure lifelong. However, a few years ago, out of the blue, I developed malignant hypertension which if untreated can result in stroke, heart attack or any number of other health problems.

What alerted me to the fact that my blood pressure was high was a severe and unrelenting headache. It was unlike any headache I'd ever had. I also developed sudden and severe irritability, dizziness and fatigue.

By the time I found out that my blood pressure was sky high, I was put on several medications to try and get it down. Unfortunately in my case, I don't tolerate many medications. I experienced every side effect possible and still my blood pressure would not come down.

When I decided to change physicians after trying to cope with my condition for over a week, he scheduled me for an emergency MRI and MR angiogram of my kidneys. It turns out I had both renal arteries that were more than 50% blocked. After an outpatient angioplasty to open up the arteries, my blood pressure dropped immediately.

In the meantime, I was put on an older generation antihypertensive, lisinopril. I could not take any of the other medications that they had prescribed for me without severe headaches, nausea and dizziness.

The moral of the story is twofold--if you are diagnosed with hypertension, make sure that it can be explained. For instance, simple kidney lab work will determine if you might have renal artery hypertension. It is most commonly bilateral in women and one-sided in men. Either way, if left undetected, it can cause permanent damage and you can end up with other health problems.

Secondly, always monitor your body for side effects from medications. You are your own best diagnostician. If the medication makes you feel bad in any way--talk to your provider and try a different one. The reason I ended up switching providers (and probably saving my own life) was because she would not listen to me when I told her the medications were making me feel worse and could something else be wrong other than "regular" high blood pressure.

Last but not least, always self-monitor your own blood pressure. If you're over 40, this should be a routine part of your health maintenance.

Make sure that you keep a diary and that you try to stay at or near your goal numbers. Think about lifestyle modifications if your numbers aren't where you'd like them to be.

Check every medication for side effects and determine which are more tolerable than others. In my case, I have the cough that 9% of people get--not all the time--but it is very annoying. However, considering it's the only side effect I've had, I've stuck on that medication by choice.

If you're pregnant or nursing, or thinking of getting pregnant, make sure you consult with a pharmacist or physician before taking any antihypertensive medication as they have been linked to potential for birth defects and can be transmitted through breast milk.

Factors to Consider About Hypertension Medications

Not all hypertension is treated alike.

Not all people tolerate medications the same way.

When it comes to choosing a hypertension medication, consider the following factors:

  • what kind of hypertension do you have or what's causing it?
  • what are the numbers? how high are they? different levels require different drugs
  • what other health conditions do you have?
  • if prescribed medication, is it working and how do you feel?
  • how many medications are being used to treat your blood pressure?
  • how many other medicines are you on? (they do interact sometimes badly)
  • what is the cost of the medication?
  • are there cheaper alternatives/generics?
  • are you on combination drugs?
  • what are the side effects?
  • can you live with them?
  • do you need monitoring labs for potassium and sodium levels, kidney functions?
  • if you do, are you doing them faithfully?

Medicating Hypertension

When considering which medication is best for you, always go with what makes you feel the best and also brings your blood pressure into reasonable control.

Remember that hypertension untreated can have devastating results such as stroke, heart attack or even death.

If you happen to be of certain ethnic origins, you can be more prone to severe complications from even mild hypertension and should be monitored regularly.

If you have any of these conditions, you'll need to talk to your medical provider about which drugs are the best adjunct to other medications and treatments:

  • Chronic kidney disease
  • Congestive heart failure
  • Diabetes mellitus
  • Previous stroke or mini-strokes
  • Left ventricular hypertrophy (enlargement of left heart chamber)
  • Previous heart attack
  • Coronary artery disease

In some cases, blood pressures can be resistant to medications and it's not unusual for some people to require 2, 3 or even 4 medications to control their hypertension.

Investigate each drug's interaction with other medications though and don't hesitate to ask your pharmacist for guidance as to what medications are best for you--and which are more affordable.

FACTOID: As of 2012, 68 million Americans have high blood pressure in some form or another and the numbers keep climbing---literally.


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