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Which blood pressure drug is right for you?

Controlling high blood pressure involves trial and error. It may take more than one medication to do the job, and the dosages may need to be adjusted over time.
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The medications your doctor prescribes may depend on your underlying health issues.

Controlling high blood pressure often involves taking at least one daily medication. But with more than 200 drugs avail-able to treat the condition, how does your doctor decide which one will work for you? “Each person is unique, so what works for one may not work for another. In many cases, more than one drug is needed to control high blood pressure, and the dosages may need to be adjusted over time,” says Dr. Randall Zusman, a cardiologist with the Corrigan-Minehan Heart Center at Harvard-affiliated Massachusetts General Hospital.

Tailoring a regimen

The most common drugs used to control blood pressure include diuretics, angiotensin–converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), beta blockers, and calcium-channel blockers. Each medication works differently in the body, and there are many varieties of those drug types (see “Common blood pressure medications” below).

The safety and effectiveness of a particular drug can be affected by other health problems. In many cases, it’s a balancing act. For example:

  • Taking a diuretic can help if you have heart failure. This is because diuretics reduce fluid levels in the body, and people with heart failure often experience fluid buildup because their hearts aren’t pumping blood effectively. However, if you have high cholesterol or high triglycerides, diuretics may increase those levels.

  • If you have gout, diuretics may trigger an attack. In those cases, Dr. Zusman says that an ACE inhibitor or an ARB may be a better choice.

  • For active people, ACE inhibitors or ARBs may also be better options, as opposed to diuretics or beta blockers, because the latter can impair physical activity. However, beta blockers are a good choice if you have palpitations or abnormal heart rhythms (arrhythmias).

Trial and error

Dr. Zusman says it’s important not to change new drugs or dosages for a least a month, unless blood pressure is dangerously high. “If the first drug or the first dosage doesn’t work, you can go to a higher dose for another few weeks. When you reach the maximum recommended or tolerated dose of that first drug, you might add another, but only if the first drug isn’t helping you reach the target blood pressure.” If side effects emerge immediately, it might be time to try a completely different drug. If a side effect develops only at a higher dose, Dr. Zusman says he may lower the dose and add a new drug.

And remember that regardless of which medication you take, lifestyle will also influence your treatment. “You need to recognize the importance of diet, weight control, exercise, and a reduced salt intake,” Dr. Zusman says. “And if you don’t adhere to lifestyle modification, you may negate some of the benefits of the drugs and need more medications as a result.”

Common blood pressure medications

Drug type

Examples

How they work

Best used in people with

ACE inhibitors

captopril (Capoten)

lisinopril (Prinivil)

ramipril (Altace)

Help the body produce less angiotensin, a hormone that narrows blood vessels

Diabetes or heart failure

ARBs

irbesartan (Avapro)

losartan (Cozaar)

valsartan (Diovan)

Block the effect of angiotensin, a hormone that narrows blood vessels

Diabetes or heart failure

Beta blockers

atenolol (Tenormin)

metoprolol (Lopressor)

nebivolol (Bystolic)

Help reduce heart rate

Heart palpitations, angina (chest pain), irregular heartbeat

Calcium-channel blockers

amlodipine (Norvasc)

diltiazem (Cardizem)

felodipine (Plendil)

nifedipine (Procardia)

verapamil (Calan)

Help prevent calcium from entering the heart and blood vessel walls and causing harder heart contractions

Angina (chest pain), irregular heartbeat

Diuretics

chlorthalidone (Hygroton)

furosemide (Lasix)

hydrochlorothiazide (Esidrix, HydroDiuril, Microzide)

spironolactone (Aldactone)

Help reduce or prevent
salt retention and reduce fluid volume in the body

Heart failure, peripheral edema (fluid accumulation that causes swelling, usually in the lower limbs)

Posted by: Dr.Health

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