Choosing blood pressure medications
Choosing blood pressure medications
Dozens of high blood pressure medications (antihypertensives) are available, each with pros and cons. Depending on how high your blood pressure is, your doctor may prescribe one or more high blood pressure medications to treat your condition. For everyone who has high blood pressure or is at risk of developing high blood pressure, lifestyle changes can help keep your numbers under control. Before beginning blood pressure treatment, it's a good idea to understand the options available to you.
Whether you're on the road to developing high blood pressure (prehypertension) or you already have high blood pressure (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. People who have prehypertension have a systolic pressure (top number) ranging from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure (bottom number) ranging from 80 to 89 mm Hg.
Even if your doctor prescribes medications to control your blood pressure, he or she will likely recommend you make lifestyle changes as well. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. To make these changes:
You probably won't need to take high blood pressure medications if you have prehypertension and are otherwise healthy. However, if you have prehypertension and diabetes, kidney disease or heart disease, your doctor might prescribe medications to lower your blood pressure to a more desirable level.
Medication options for stage 1 high blood pressure (140/90 to 159/99)
If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range, you also have stage 1 high blood pressure. The first change you can make is to adopt healthy lifestyle changes to help decrease your numbers. Your doctor will likely prescribe medications, as well.
Diuretics (water pills)
Although three types of diuretics are available, the first choice is usually a thiazide diuretic. Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure.
Adding one of these medications can lower your blood pressure more quickly than can taking only a diuretic. This may reduce the risk of developing complications from high blood pressure. Combining two medications of different classes may allow you to take a smaller dose of each, which can reduce side effects and perhaps be less expensive. The choice of medications in combination depends on your individual circumstances.
Medication options for stage 2 high blood pressure (higher than 160/100)
If you have stage 2 high blood pressure, you have a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher or both. In this case, you'll likely need to take at least two high blood pressure medications when you start treatment.
As with stage 1 hypertension, your doctor will likely prescribe a thiazide diuretic. Diuretics work by flushing excess water and sodium from the body, thus lowering your blood pressure. Along with a diuretic, your doctor may recommend that you also take:
If none of these medications is effective in lowering your blood pressure, your doctor may recommend another medication, such as an alpha blocker, central-acting agent or vasodilator. These medications are strong and may cause more side effects than may other blood pressure medications.
When your blood pressure is very high, it's important to reduce it quickly to prevent or delay complications, such as damage to your arteries, heart failure or kidney damage. A two-drug combination generally works faster than does a single drug to get your blood pressure under control. Sometimes a third medication, or more, may be needed to achieve your blood pressure goal.
High blood pressure and other health problems
High blood pressure often goes hand in hand with other health problems. If you have a serious health condition in addition to high blood pressure, it's likely you'll need aggressive treatment. Those conditions include:
High blood pressure itself puts you at higher risk of having one of these conditions. If you already have one or more of these conditions plus high blood pressure, your chance of developing a life-threatening complication increases. A more aggressive treatment approach may reduce your risk of these complications.
Your doctor may recommend specific high blood pressure medications to treat these conditions, as well as additional medications for your high blood pressure. For example, if you have chest pain (angina), your doctor may recommend a beta blocker, which can lower your blood pressure and also prevent your chest pain, reduce your heart rate and decrease your risk of death. If you have diabetes and high blood pressure, taking a diuretic plus an ACE inhibitor can decrease your risk of heart attack and stroke. If you have diabetes, high blood pressure and kidney disease, you may need to add additional medications to the mix, such as an angiotensin II receptor blocker.
Keep trying to reach your blood pressure goal
Sometimes high blood pressure can be difficult to treat. If your high blood pressure doesn't decrease despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure and are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
It's not unusual to try several different medications or doses before finding what works best for you. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective. Home monitoring of your blood pressure can help your doctor decide if your blood pressure treatment is working, or if a different dose or medication is necessary.
In most cases, a combination of lifestyle changes and medication can help you successfully control your blood pressure. Once that's done, your doctor may recommend a gradual decrease in medications while monitoring the effect on your blood pressure; however, don't attempt to do this on your own.
Keeping your blood pressure under control may take some time, but in the long run it may mean a longer life, with fewer health problems.
Last Updated: 2010-12-16
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