High Blood Pressure Treatment

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If lifestyle changes such as losing excess weight and restricting your salt intake do not bring your blood pressure down to 160/100 or below, your doctor will probably prescribe medication to lower the pressure. There is a long list of antihypertensive medications, but there is no single ideal drug for this job. You should work closely with your health-care practitioner to find the regimen that is appropriate for you. Your doctor may suggest that you purchase a blood-pressure monitor so that you can take periodic readings and report back to him or her.

A diuretic is often the first drug prescribed for high blood pressure. Diuretics promote the excretion of fluids through the kidneys, thus lowering the amount of fluid circulating in the bloodstream. This reduces the pressure. The so-called thiazide diuretics are the type most commonly prescribed. Examples of these include chlorothiazide (Diuril) and hydrochlorothiazide (HydroDiuril). These drugs can cause side effects including abnormally low potassium levels, low blood pressure (enough to cause lightheadedness) on standing, high blood sugar, high blood uric acid, nausea, and unfavorable changes in the levels of fats in the blood. There are other classes of diuretics and some medications that combine different types, but these are less commonly used.

Beta-blockers are drugs that inhibit the transmission of certain nerve impulses, causing the heart to slow its rate and lower its output of blood. This in turn lowers blood pressure. The generic names of these drugs usually end in the syllables olol; examples include atenolol (Tenormin), metoprolol (Lopressor), and propranolol (Inderal). These drugs can cause a wide variety of side effects, including an abnormally slow heart rate, asthmatic attacks, dizziness, depression, fatigue, nausea, and heart failure. They also lower the level of high-density lipoproteins (HDL, the so called "good" cholesterol) in the blood. Beta-blockers should not be taken by anyone who has asthma.

Angiotensin-converting enzyme (ACE) inhibitors are a more recent entrant in the field of blood-pressure medication. These drugs inhibit the production of an enzyme that causes the formation of angiotensin, a hormone that is a potent blood-vessel constrictor, thus relaxing the vessels and lowering blood pressure. They also have other mechanisms of action that are not understood. Examples include captopril (Capoten), enalapril (Vasotec), and ramipril (Altace). Possible side effects include headaches, dizziness, nausea, fatigue, a nagging cough, low blood pressure on standing, and low potassium levels. However, side effects tend to be less of a problem with ACE inhibitors than with other types of drugs used for high blood pressure.

Calcium-channel blockers block the transfer of calcium ions into smooth-muscle cells. This has effect of relaxing blood vessels and lowering blood pressure. Members of this class of drug include diltiazem (Cardizem), nifedipine (Adalat, Procardia), and verapamil (Calan). They can cause a range of side effects including fatigue, nausea, swelling, and shortness of breath, heart failure, and liver damage. They are not generally suitable for use by people with heart-rhythm problems, and should be used with great caution by people with heart failure or liver or kidney disease.

Alpha-blockers lower blood pressure by dilating blood vessels. They may also lower total blood cholesterol and triglyceride levels. Doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytin) are examples of this kind of drug. Possible side effects include dizziness, fatigue, headache, fainting, and nasal congestion. Pregnant women and nursing mothers should use these drugs with caution.

Central alpha agonists such as clonidine (Catapres), methyldopa (Aldomet), and guanfacine (Tenex) lower blood pressure by reducing constriction of blood vessels. These drugs can cause drowsiness, rashes, constipation, and joint pain, and should be used with caution in the presence of liver disease.

If an individual drug proves to be inadequate, two or more different medications may be combined for greater effect. Unfortunately, this can result in a combination of side effects as well.

People with high blood pressure usually have high triglyceride and/or cholesterol levels. Unfortunately, many (if not all) of the drugs used to lower blood pressure tend to raise triglycerides and/or cholesterol. If you must take medication for high blood pressure, it is important to maintain regular, close communication with your healthcare provider and undergo periodic testing to monitor the situation.

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