If individuals suffer from hypertension, more commonly known as high blood pressure, it can be challenging to choose the right medication. As patients make essential lifestyle changes, such as dietary changes, reducing salt in their diet, regularly exercising, and quitting smoking, they may require medications to better control their blood pressure and reduce their risk of complications. The most successful medication for a single patient will depend on several factors, including their current blood pressure reading and their overall health.
When angiotensin is produced in the body, this hormone causes blood vessels to narrow. When taking angiotensin-converting enzymes (ACE) inhibitors, production decreases. Essentially, ACE inhibitors help relax the blood vessels by blocking the formation of angiotensin, which causes them to narrow. In turn, patients experience lower blood pressure. Some common examples include lisinopril, benazepril, captopril, fosinopril, perindopril, enalapril, and ramipril. Individuals with chronic kidney disease may also greatly benefit from taking an ACE inhibitor as well.
Calcium Channel Blockers
Increases in calcium strengthen the force of contractions in both the heart and blood vessels. Calcium channel blockers, which relax the muscles of the blood vessels, also reduce a patient's heart rate, and as a result, the patient's blood pressure decreases. Some of the most common options include amlodipine, diltiazem, clevidipine, isradipine, nisoldipine, and verapamil hydrochloride.
Calcium channel blockers may also work better for seniors and those of African heritage than using ACE inhibitors alone. It should be noted that grapefruit juice interacts with some forms of calcium channel blockers, increasing blood levels of the medication and putting the patient at a higher risk of complications. Thus patients should be wary of consuming grapefruit juice when taking this medication
Diuretics, also known as water pills, are medications that act on the kidneys to increase the urge for urination, thus reducing the amount of sodium and fluid circulating throughout the body and blood volume, resulting in lower blood pressure. When suffering from mild hypertension, diuretics alone are often effective. Diuretics also help the blood vessel walls relax, improving blood circulation. There are three types of diuretics: thiazide, loop, and potassium-sparing, and The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure also recommend individuals try thiazide diuretics first. Some of the most commonly prescribed diuretics include thiazide, bumetanide, chlorthalidone, metolazone, and torsemide. Since these drugs can reduce potassium levels, it's recommended for patients to consume these medications with a potassium-rich food, such as a banana.
Beta-blockers target hormones, specifically epinephrine, also known as adrenaline. Also known as beta-adrenergic blocking agents, beta-blockers work by blocking the effects of adrenaline, causing the heart to beat slower and with less force. These medications essentially influence an individual's heart rate, helping reduce their overall blood pressure. They also help reduce the workload on the heart and open up the blood vessels as well, promoting healthier blood circulation. Beta-blockers include acebutolol, bisoprolol, esmolol, nadolol, atenolol, metoprolol, and propranolol.
Similar to beta-blockers, alpha-blockers help the blood vessels dilate, or open up, as well as block the hormone adrenaline, which naturally narrows the blood vessels. Specifically, alpha-blockers reduce nerve impulses to the blood vessels, reducing the effects of adrenaline and other bodily chemicals that cause the narrowing of blood vessels, as well as slowing down a patient’s heartbeat. As the blood vessels begin to relax due to alpha-blockers, blood flow increases and blood pressure decreases. The most commonly available alpha-blockers include doxazosin, carvedilol, labetalol, prazosin, indoramin, and terazosin.
Angiotensin II Receptor Blockers
Another common medication often used to help treat hypertension is angiotensin II receptor blockers (ARBs). These medications help relax the blood vessels by blocking the action, and not the formation, of a natural chemical called angiotensin that narrows the blood vessels. Angiotensin II receptor blockers include numerous types of prescription drugs including candesartan, valsartan, and losartan. Some individuals dealing with chronic kidney disease may also benefit from using angiotensin II receptor blockers as well.
Renin inhibitors work by slowing down the production of renin, an enzyme produced by the kidneys that starts a chain reaction of chemicals within the body that increases blood pressure. Aliskiren is a commonly prescribed type of renin inhibitor that works by decreasing the body’s ability to produce renin that creates this chemical reaction. Due to a severe risk of complications, such as stroke, patients should not take aliskiren along with ACE inhibitors or angiotensin II receptor blockers.
Other Medications To Consider
Besides the numerous medications an individual may be prescribed based on their blood pressure and current health, there are a few other medications to be considered, alongside a doctor of course. Aldosterone antagonists block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure. Common names for this type of medication is spironolactone and eplerenone.
Vasodilators are another medication that includes hydralazine and minoxidil and treats hypertension by working directly on the muscles in the walls of the arteries by dilating them, preventing the muscles from tightening and the arteries from narrowing. As a result, blood flows much more easily through the vessels, and the heart does not have to pump as hard. Central-acting agents are a class of medications that prevent the brain from signaling the nervous system to increase an individual’s heart rate and narrow the blood vessels. Examples of these agents include clonidine, guanfacine, and methyldopa.