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Wednesday, November 25, 2020

High Blood Pressure (Hypertension) Treatments


High Blood Pressure (Hypertension) Treatments


Hypertension means that the heart has to work harder than normal to force blood out of the heart into the arteries. This additional work can make the muscle walls of the ventricles thick and stiff. Over time, tension on the heart weakens the heart muscles and does not work as well.This can lead to :

• Stroke 

 Heart failure

 Heart attack

 Kidney disease/ Kidney failure

 Vision loss

 Sexual dysfunction 


Blood pressure lowering medicines:


Why bother to treat it? 

Hypertension increases the workload of the heart and can damage the lining of the blood vessels. So, the blood supply to the heart, brain, kidneys, eyes, etc. It will be put at risk. The risk of heart attack, stroke, kidney disease and eye damage will be greater in someone with hypertension than someone with normal blood pressure


Angiotensin converting enzyme (ACE) inhibitors

ACE inhibitors work by relaxing and dilating blood vessels. This lowers bP and makes it easier for your heart to pump blood around your body. You will need regular blood tests to monitor kidney function and potassium levels. ACE inhibitors can increase the level of potassium in the blood, so you should avoid having salt substitutes because they also contain potassium. For example,  lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) and others

Up to 15 in 100 people taking an ACE inhibitor develop a cough. If you develop a cough and become problematic, talk to your doctor


Angiotensin receptors blockers (ARBs)

ARBs work similarly to ACE inhibitors. However, they are less likely to cause persistent dry cough than some people have when taking an ACE inhibitor. You may receive an ARB instead of an ACE inhibitor if you cannot take an ACE inhibitor. For example, candesartan (Atacand), losartan (Cozaar) and others

As with an ACE inhibitor, you'll need to have regular blood tests if you are taking an ARB


Calcium channel blockers

These drugs limit the movement of calcium to heart cells and blood vessels. This relaxes and widens the blood vessels, which lowers bP  and reduces the amount of work your heart has to do. For example, amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others

You should avoid grapefruit juice with calcium channel blockers, except for diltiazem


Thiazide-type diuretic

Thiazide diuretics cause the body to remove excess fluid that has accumulated in the tissues and blood vessels. They do this by increasing the amount of salts (like sodium and potassium) and the water that urinates (like urine). Diuretics are sometimes also called water tablets, as they can make you urinate more often. For example, bendrofumethiazide, indapamide, chlortalidone

This means that it has less fluids in the tissues, which helps eliminate swelling and fluid build-up in the body. You will also have less fluid in the blood vessels, which helps lower blood pressure

Like calcium channel blockers, they can also cause relaxation of the lining of the vessel wall which lowers blood pressure, as enlarged vessels facilitate the passage of blood


Beta Blocker

Beta blockers work by blocking the effect of the adrenaline and noradrenaline hormones. This results in a decrease in heart rate and a decrease in blood pressure, making it easier for your heart to pump blood around your body. For example, acebutolol (Sectral), atenolol (Tenormin) and others

Beta blockers are generally not recommended for people with asthma, as they can make the situation worse. They can be used for people with certain lung conditions and diseases, such as chronic obstructive pulmonary disease (COPD), but you may need to check them more carefully than usual

Other side effects include tiredness , cold hands and feet, erectile dysfunction (impotence), dizziness and disturbed sleep or even nightmares. These will generally improve over time. It is important not to suddenly stop beta blockers. If you experience side effects, talk to your doctor, pharmacist or nurse, as they may reduce your dose or try another beta blocker


Alpha-blockers

Alpha blockers act on the nervous system. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that constrict blood vessels, allowing arteries to dilate and reducing the strength of heart contractions. For example, doxazosin (Cardura), prazosin (Minipress) and others


Alpha-beta blockers

Alpha-beta blockers combine the actions of alpha and beta blockers, which serve to reduce nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that has to be pumped through the vessels. For example, carvedilol (Coreg) and labetalol (Trandate)


Vasodilators

Vasodilators relax the muscles in the walls of blood vessels, so that blood can move more easily through them, especially the small arteries (arterioles). They lower blood pressure rapidly and are injected in hypertensive emergencies when patients have dangerously high blood pressure, resulting in a drop in blood pressure. For example, Hydralazine hydrochloride (Apresoline) and minoxidil (Loniten)


Peripheral adrenergic inhibitors

Peripheral adrenergic inhibitors serve on the nervous system to relax arteries and slow the heart rate. They are usually used with other antihypertensive medicines. Peripheral acting adrenergic antagonists can cause lethargy and decreased mental function


Direct Renin Inhibitor

Aliskiren (Tekturna) blocks the renin-angiotensin-aldosterone system at its trigger point, an enzyme produced by the kidneys that initiates a chain of chemical steps that increase blood pressure, resulting in decreased plasma and BP renin activity. Due to the risk of serious complications, including stroke, you should not take aliskiren with ACE inhibitors or ARBs



Hypertension is not the end of life. Visit your doctor and listen to the treatment modalities provided. Poor management of high blood pressure, such as no treatment at all. In this case, appropriate lifestyle changes are indispensable: exercise regularly, reduce salt intake, avoid a lot of stress, the consumption of tobacco and alcohol should be a no, or at least reduced to non-lethal quantities. You may also want to abandon these two habits, consult your doctor. Eat well and sleep well. The DASH diet (dietary approach to stop hypertension) is recommended here. Your meals should generally contain low-fat dairy products, enough vegetables and whole grains, fruit is essential even with limited sugary foods and drinks

Usually the treatment is for life :

Remember that by controlling high blood pressure, the risk of heart disease and stroke is significantly reduced


• You probably need to continue taking blood pressure tablets for the rest of your life

• It may be necessary to take more than one type of tablet to control your blood pressure

• Take BP medications as directed by your doctor

• Don't stop taking blood pressure tablets without consulting your doctor first


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