HIGH BLOOD PRESSURE (HYPERTENSION) MEDICATIONS
- What Is High Blood Pressure (HBP)?
- HBP Medication List
- Most Common HBP Medications
- Best HBP Medication
- Side Effects
- Safe to Take During Pregnancy
- Safe to Take With Alcohol
- Weight Gain
WHAT IS HIGH BLOOD PRESSURE (HYPERTENSION)?
High blood pressure, also known as hypertension, affects nearly a third of all
Americans. With hypertension, too much force is exerted on the arteries
as blood is pumped through. This results not
only in damage to the blood vessels
themselves, but to other organs forced to bear the stress.
Blood pressure is assessed using two
parameters -- the systolic and diastolic pressures
-- which measure, respectively, the maximum pressure exerted in the arteries as
the heart contracts, and the minimum pressure
in those vessels between cardiac contractions.
In adults, blood pressure is considered normal if the top number (systolic
pressure) is between 90 and 120 and the bottom number (diastolic) is between 60
and 80.
HIGH BLOOD PRESSURE MEDICATION LIST
There are several classes of blood pressure medications. Each class lowers blood pressure in a different way.
DIURETICS
Diuretics increase
urination which reduces sodium and
fluid in the body. That can help lower blood pressure because it lowers blood
volume. Mild hypertension can sometimes be treated using diuretics alone,
although they are more commonly used in combination with other high blood
pressure medications. Examples of diuretics include:
Ø Bumetanide (Bumex)
Ø Chlorthalidone (Hygroton)
Ø Chlorothiazide (Diuril)
Ø Ethacrynate (Edecrin)
Ø Furosemide (Lasix)
Ø Hydrochlorothiazide
HCTZ (Esidrix, Hydrodiuril, Microzide)
Ø Indapamide (Lozol)
Ø Methyclothiazide (Enduron)
Ø Metolazone (Mykroz, Zaroxolyn)
One side effect of
diuretics is a loss of potassium, which is
carried out of the body in urine along with the
sodium. Potassium is needed for proper muscular movement and
a deficiency of this mineral can result in fatigue, weakness, leg cramps, and even
problems with the heart. So often, patients on traditional diuretics will be
advised to take their medication with
a potassium-rich food,
such as orange juice or a banana, or they'll be prescribed a potassium
supplement.
Some diuretics were
subsequently developed to address the issue of potassium loss. These blood
pressure medications are known as "potassium-sparing" diuretics. They
include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium).
Finally, there are
the combination diuretics, which include a potassium-sparing agent and a
traditional diuretic.
These include amiloride
hydrochloride and hydrochlorothiazide HCTZ (Moduretic), spironolactone
and HCTZ (Aldactazide),
and triamterene and HCTZ (Dyazide,
Maxzide).
BETA BLOCKERS
Beta-blockers lower blood pressure by acting directly on the heart. These high blood pressure medications reduce heart rate and force of pumping, as well as reduce blood volume. Beta-blockers include:
·
Acebutolol
(Sectral)
·
Bisoprolol fumarate (Zebeta)
·
Carvedilol (Coreg)
-- Combined alpha/beta-blocker
·
Esmolol
(Brevibloc)
·
Labetalol
(Trandate,
Normodyne) -- Combined alpha/beta-blocker
·
Metoprolol
tartrate (Lopressor) and metoprolol succinate
(Toprol-XL)
·
Nebivolol
(Bystolic)
·
Penbutolol
sulfate (Levatol)
·
Propranolol (Inderal)
·
HCTZ
and bisoprolol (Ziac) is a beta blocker plus diuretic
ACE INHIBITORS
Angiotensin is a hormone in
the body that causes blood vessels to narrow. The angiotensin-converting enzyme (ACE)
inhibitors decrease the production of angiotensin and, in turn, that helps
lower blood pressure. Examples of ACE inhibitors include:
·
Benazepril hydrochloride (Lotensin)
·
Fosinopril
sodium (Monopril)
·
Lisinopril (Prinivil, Zestril)
·
Moexipril
(Univasc)
·
Perindopril
(Aceon)
·
Quinapril hydrochloride (Accupril)
·
Trandolapril
(Mavik)
ANGIOTENSIN II RECEPTOR BLOCKERS
The hormone
angiotensin narrows blood vessels, but to do its job it needs a place to bind.
That's where angiotensin II receptor blockers
come in. They prevent angiotensin from binding to receptors on the blood
vessels and that helps lower blood pressure. Angiotensin II receptor blockers
include:
·
Azilsartan
(Edarbi)
·
Candesartan
(Atacand)
·
Eprosartan
mesylate (Teveten)
·
Irbesartan (Avapro)
·
Olmesartan
(Benicar)
·
Telmisartan
(Micardis)
CALCIUM CHANNEL BLOCKERS
Calcium increases
the strength and force of contractions in the heart and blood vessels. Blocking
its entry into smooth muscle tissue reduces
this effect. Calcium channel blockers lower blood pressure by relaxing blood
vessels and reducing heart rate. Examples of calcium channel blockers include:
·
Amlodipine besylate (Norvasc, Lotrel)
·
Clevidipine
(Cleviprex)
·
Diltiazem
hydrochloride (Cardizem CD, Cardizem SR, Dilacor
XR, Tiazac)
·
Felodipine (Plendil)
·
Isradipine
(DynaCirc, DynaCirc
CR)
·
Nicardipine
(Cardene SR)
·
Nifedipine (Adalat CC, Procardia
XL)
·
Nimodipine
(Nimotop, Nymalize)
·
Nisoldipine
(Sular)
·
Verapamil hydrochloride (Calan
SR, Isoptin SR, Verelan,
Covera HS)
ALPHA BLOCKERS
Alpha-blockers cause
blood vessels to dilate, thereby lowering blood pressure. These
medications are also used to treat prostate enlargement in men.
Alpha-blockers include
·
doxazosin mesylate
(Cardura),
·
prazosin hydrochloride
(Minipress), and
·
terazosin hydrochloride
(Hytrin).
ALPHA-2 RECEPTOR AGONIST
Methyldopa,
formerly known under the brand name Aldomet,
is one of the oldest blood pressure medications still in use.
·
It was first introduced more than 50 years ago.
·
Methyldopa works in the central nervous system to lower blood
pressure.
·
While its general use has declined over the years, methyldopa is
considered the first-line of treatment for high blood pressure that develops
during pregnancy.
CENTRAL AGONISTS
Some hypertension
medications work in the central nervous
system rather than directly on the cardiovascular system. Central agonists thus
have a tendency to cause drowsiness. Drugs in this class include
·
clonidine hydrochloride (Catapres)
and
·
guanfacine hydrochloride (Tenex).
PERIPHERAL ADRENERGIC INHIBITORS
There was a time
when the high blood pressure medication list was very short indeed. In the
1950s, reserpine was one of the few products on
the market to treat hypertension. It is rarely used due to its numerous side
effects and drug interactions. The peripheral adrenergic inhibitors work in the brain to
block signals that tell blood vessels to constrict. They are mostly used when
other high blood pressure medications fail to solve the problem.
The peripheral adrenergic inhibitors include
·
Guanadrel (Hylorel),
·
guanethidine monosulfate (Ismelin),
and
·
reserpine (Serpasil).
WHAT ARE THE MOST COMMON BLOOD PRESSURE
MEDICATIONS?
In terms of dollar sales, recent statistics put the angiotensin II receptor blocker valsartan (Diovan) in the lead for high blood pressure medications, followed by the beta blocker metoprolol, the generic combination of valsartan and HCTZ, olmesartan (Benicar), and olmesartan and HCTZ (Benicar HCT).
In terms of prescriptions written, the ACE inhibitor lisinopril (Prinivil, Zestril) tops the list, followed by amlodipine besylate (Norvasc), a calcium channel blocker, and generic hydrochlorothiazide (HCTZ).
WHAT IS THE BEST HIGH BLOOD PRESSURE MEDICATION?
Selecting the
"best" high blood pressure medication depends on several things,
including the general health of
the patient, his or
her age, ethnicity, and whether or not they have any co-existing medical issues
or drug sensitivities.
For example, in
a hypertensive patient with asthma,
it may be inadvisable to prescribe a beta-blocker, as these drugs can aggravate
that respiratory condition.
Similarly, in patients prone to constipation (the elderly, for example) use
of certain calcium channel blockers might best be avoided -- along with
diuretics -- as both these classes of drugs can inhibit proper bowel function.
African-American patients respond to
some antihypertensive medications better than
others.
Certain groups of
patients require the use of a specific class of high blood pressure medication.
These include:
Pregnant
Women
The drug of choice
for hypertensive, pregnant women is one of the oldest high
blood pressure medications on the market. Methyldopa, which works to lower
blood pressure through the central nervous system, has the lowest risk of
harming the mother and developing fetus.
Other possible safe options include labetalol, beta-blockers, and diuretics.
Two classes of drugs that should never be used during pregnancy include ACE
inhibitors and angiotensin II receptor blockers.
African-Americans
Hypertension in
African-Americans tends to occur earlier in life and tends to be more severe.
Plus, some medications that work to lower blood pressure in other ethnicities
may have limited effect on African-Americans. Thiazide diuretics (such as HCTZ)
or a calcium channel blocker are recommended first choices along with the
possible add-on of a second drug from either the ACE inhibitor class or the
angiotensin II receptor blocker group.
Elderly
Patients
With age, comes an
increased risk for systolic hypertension which can be aggravated by severe atherosclerosis. According to one study, the
diuretic chlorthalidone (Hygroton) had significant benefits in elderly patients
with systolic hypertension. Along with a diuretic, some calcium channel
blockers, ACE inhibitors, and angiotensin II receptor blockers may also be good
choices. However, beta-blockers may not be as effective for hypertension in
those over 60; though they may be good choices if co-existing heart disease is present. It also may be
preferable in elderly patients to give two high blood pressure medications at a
low dose versus one at a higher dose.
WHAT ARE COMMON HIGH BLOOD PRESSURE SIDE
EFFECTS?
Different classes of blood pressure medications have different side effects.
Diuretics
Diuretics can lead
to an increase in potassium loss, known as hypokalemia, which, in turn, can affect muscular
function -- including the muscles of the heart. There is also an increased risk
for gout with diuretics -- as well as the
possibility of weakness, thirst, dehydration, and increased urination. Changes
in blood sugar levels are also
possible. Skin reactions, some severe, are possible
with thiazide diuretics (such as hydrochlorothiazide). Potassium-sparing
diuretics, such as spironolactone (Aldactone) may cause breast enlargement
in males.
Beta-blockers
Beta-blockers cause
the heart to slow down and so some of their side effects can be traced to that
mechanism of action. Dizziness,
weakness, fatigue, and fainting are possible. Beta-blockers also
affect the respiratory system, so other side effects
include shortness of breath, difficulty breathing,
and chest pain. Beta-blockers should not be
withdrawn suddenly, as that could result in a heart attack or sudden death.
ACE inhibitors
The most common side
effect from ACE Inhibitors is also an unusual one -- a dry cough.
Usually, it goes away with continued use of the drug, but that could take
weeks. ACE Inhibitors could reduce blood pressure too much, resulting in hypotension which could, in turn, lead
to headache, dizziness, fainting, and
reduced kidney function.
Angiotensin II receptor blockers
The most common side
effect from the angiotensin receptor blockers (ARBs) is
an increased potassium level in the blood, known as hyperkalemia. Dizziness is also common, along
with fatigue. Upper respiratory tract infections have also been reported --
along with gastrointestinal issues such as
upset stomach and diarrhea.
Calcium channel blockers
Up to a third of
patients may experience the following side effects with calcium channel
blockers: Swelling of the ankles and other extremities, flushing, and
dizziness. Other common side effects include heartburn and nausea.
Alpha-blockers
A common, transient,
but distressing initial side effect of the alpha-blockers is postural hypotension. This is a sudden drop in
blood pressure when standing up. It can be severe enough to cause dizziness or
even fainting. Also, alpha-blockers can result in increased heart rate,
headache, nausea, and weakness.
Methyldopa
Methyldopa is mostly
well-tolerated, but some patients may experience dizziness, drowsiness,
weakness, headache, and dry
mouth.
Central agonists
Up to 40% of
patients taking clonidine (Catapres) will experience dry mouth and
about a third will have drowsiness, headache, and sleepiness. Other common side
effects include constipation, dizziness, and local skin reactions with the use
of the Catapres-TTS skin patch. Reserpine use is
linked with possible side effects including nightmares, stuffy nose, depression, and an inability to fall asleep. Diarrhea and
heartburn are also possible. Guanadrel and guanethidine can cause diarrhea and
other gastrointestinal issues – as well as dizziness and drowsiness.
Vasodilators
Taking minoxidil
might result in excessive body hair growth, as well as weight gain and
dizziness. Hydralazine is linked to headaches, heart palpitations, swelling around the eyes, and
aches and pains in the joints.
IS IT SAFE TO TAKE HIGH BLOOD
PRESSURE MEDICATION DURING PREGNANCY?
Some high blood
pressure medications should absolutely NOT be used during pregnancy as they may
harm the mother and developing fetus. These medications include
·
ACE inhibitors and
·
angiotensin II receptor blockers.
·
Reserpine may also be harmful during pregnancy and should only
be used when no other alternatives exist.
Safe medications to
use include methyldopa and potentially some diuretics and beta-blockers,
including labetalol.
DOES HIGH BLOOD PRESSURE LEAD TO WEIGHT
GAIN?
Some high blood
pressure medications can, in fact, lead to weight gain. Common offenders
include older beta-blockers such as propranolol (Inderal) and atenolol
(Tenormin). There could be several reasons for this -- including the fact that
the medications can make patients feel tired and
thus less likely to exercise.
·
Minoxidil tablets (Loniten) -- used only when other
antihypertensive medications have failed -- can also cause weight gain.
·
Weight gain is also listed as a common side effect of doxazosin
(Cardura). Diuretics are more likely to cause weight loss.
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