Most with hypertension will need lifelong treatment. Sticking to the treatment plan is important, this can prevent the hypertension complications and help to live & stay active.
When do you need hypertension drugs?
If you have borderline or stage I hypertension, hypertension lifestyle change might help you to lower your blood pressure to achieve "normal" range.
Suggest a hypertension drug if:
- Your blood pressure remains at 160/100 mmHg or more after following lifestyle guidelines for hypertension.
- Your blood pressure remains at 140/90 mmHg or more additionally having diabetes or cholesterol or having a cardiovascular disease after following lifestyle guidelines for hypertension.
- People whose blood pressure remains at 130/80 mmHg or more additionally have certain diseases - have had a recent heart attack, stroke, TIA (transient ischemic attack) or chronic kidney diseases. Follow lifestyle guidelines for hypertension along with the medication to avoid further risks.
Different classes of hypertension medication
Blood pressure medications also known as antihypertensive are to lower your blood pressure available on prescription. The classes of blood pressure medications include:
- Diuretics - Diuretics get rid of excess sodium and water from your body and help control blood pressure. Mostly used in combination with other medication.
- ACE inhibitors - Angiotensin is a chemical in your kidney and throughout the body causes the arteries to narrow. Angiotensin-converting enzyme (ACE) inhibitors allow the body produce less angiotensin, which helps the blood vessels to relax, which lowers blood pressure.
- ARBs - Angiotensin II receptor blockers blocks angiotensin, a chemical causes the arteries to narrow. Angiotensin needs a receptor to bind with to constrict the blood vessel. Angiotensin receptor blocker (ARBs) block the receptors so fails to constrict the blood vessel. Blood vessels stay relaxed and thus blood pressure reduced.
- Beta-blockers - Beta-blockers reduces your heart rate, heart's workload and heart's output, which lowers your blood pressure.
- Calcium channel blockers - It prevents calcium from entering the smooth muscle cells of the heart and arteries, which lowered normal heart’s contraction. Calcium channel blockers relax blood vessels, reduce heart rate and lower blood pressure.
- Renin inhibitors - Renin is an enzyme produced by your kidneys that start a chain of chemical steps that construct blood vessels thus increases blood pressure. Renin inhibitors reduce the production of renin and lowering its ability to begin this process. Thus relaxes the blood vessels and lower the blood pressure.
- Alpha blockers - It reduce the arteries resistance, relax muscle tone of the vascular walls.
- Alpha-beta blockers – It is used as an IV drip for patients under hypertensive crisis and prescribed for hypertensive outpatient at risk for heart failure. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
- Central agonists - It works in the central nervous system rather than work directly on the cardiovascular system, thus may cause drowsiness.
- Peripheral adrenergic inhibitors - It blocks brain signal that messages blood vessels to constrict. This medication is rarely used when others failed to help.
- Blood vessel dilator or vasodilators - It causes the blood vessel muscles to relax, allowing it to dilate (widen).
- Antihypertensive combination medicine - It is a combination of 2 different type of hypertension medicine to get the benefit of both for effective blood pressure control.
On many occasions, the most effective antihypertensive medication or its combination is a matter of trial and error. It is the fact that two or more drugs combination is often more effective than one.
What should be your blood pressure treatment goals?
- For healthy adults aged 60 or older, the BP goal less than 150/90 mmHg.
- For healthy adults aged younger than 60, the BP goal less than 140/90 mmHg.
- For people with chronic kidney disease, diabetes, coronary artery disease, or high risk towards coronary artery disease, the BP goal less than 140/90 mmHg
However 120/80 mmHg or lower is the ideal blood pressure you should aim. Additionally, you should better achieve with healthy lifestyle changes.
Antihypertensive questions you want to ask
My blood pressure is now normal, can I stop my hypertension medications!
People with their blood pressure is sky high frequently reach emergency department just because of stopped taking their hypertension medicine thinking that blood pressure is normalized.
Your blood pressure is in normal range BECAUSE you are taking your medication. If you stop taking it, then your BP will become sky high.
However, if you are ready to take drastic changes such as healthy diet, physically more active, exercise regularly, weight loss, etc. then it possible to lower your antihypertensive medicine in steps and it is possible to reach normal BP without medication.
These drastic lifestyle changes make your blood pressure LOW (less than 110/70) with symptoms such as lightheadedness, dizziness, or fainting if your blood pressure drops. This symptom indicates you need to reduce your blood pressure medication dosage or even stop it.
What if I forget to take my hypertension medication?
If it is just 6 hours to the next dose, then you just skip and continue with the next dose. Otherwise, you can take the medication immediately.
You can download a smartphone app to remind you! Search Google play store for meds and pills reminder. “Medisafe” is a meds and pills reminder that help prepares your schedule and add alarms or reminders. There are also reminder services to remind you through a phone call at the time of your medication.
Is it true, once I start taking hypertension medication you need to take it lifelong?
No, it is not true. But it is tough to stop, and almost everyone who starts taking antihypertensive drugs keeps taking it for the rest of their life. Antihypertensive drugs lower your blood pressure and not cure hypertension cause. Hence you need lifelong treatment.
You know, diabetes, cholesterol, hypertension, etc. are all not diseases but disorders. Except in very few exceptions, your body require this medication support for lifelong.
It does not mean you cannot stop though, what it means you need to reduce it gradually in steps allowing your body to readjust itself. For example, if you are taking one tablet once daily, then along with stringent lifestyle changes you can cut down your dose to half tablet once daily for few weeks. Monitor your blood pressure more frequently to avoid accidental spiking of your BP due to reduced medication dosage. If your blood pressure is within the normal range, then along with lifestyle changes you cut down dose further for few weeks gradually until you totally withdraw your medication.
If your hypertension is due to obesity, stress or smoking, then by changing these factors it is possible to withdraw your antihypertensive medication.
Even after taking the antihypertensive drugs my BP is not normalizes, why?
If your blood pressure stays stubborn about the target in spite of the treatment with three drugs one among them is a diuretic known as resistant hypertension. High blood pressure cannot be classified as “Resistant” until treatment failure with three-drug combination one among them should be a diuretic.
Having resistant hypertension does not mean you never reach your target. If you are your doctor can identify the exact reason behind failure to achieve the target, then there is good chance to achieve your goal effectively.
How long should it take for the antihypertensive drug to start producing a result?
One medicine work very quickly, another one may take time, so generally speaking, if you do all the things right as well as taking a right antihypertensive medicine, three weeks is a pretty good maximum time to see some results. Otherwise, you may require changing the drug or drug combination.
What is the best first line of drug for the hypertension treatment?
Some individuals respond well to one drug but not for another. Usually, it takes the time to determine the right drug or drugs and proper dose to lower your blood pressure with minimum side effects.
- For prehypertension treatment - No antihypertensive drug is indicated and advised to follow healthy hypertension lifestyle changes.
- For stage 1 hypertension - For hypertensive patients aged 55 and over, first-line antihypertensive drug choice should be either a calcium channel blocker or a low dose thiazide-type diuretic. For hypertensive patients younger than 55, first-line antihypertensive drug choice should be an ACE inhibitor or ARB (if an ACE inhibitor not tolerated).
- For stage 2 hypertension - If the first-line drug was a calcium channel blocker or thiazide-type diuretic and if you require a second-line drug, then add an ACE inhibitor or ARB (if an ACE inhibitor not tolerated). If the first-line drug was an ACE inhibitor or ARB, then add a calcium channel blocker or a thiazide-type diuretic if the second-line drug is required.
What antihypertensive drug is suitable for hypertension along with other health condition?
- For people with heart failure – Choose one or combination of drugs from diuretic, BB, ACEI, ARB & Aldo ANT.
- For people with post myocardial infarction – Choose one or combination of drugs from BB, ACEI & Aldo ANT.
- For people with high coronary disease risk – Choose one or combination of drugs from diuretic, BB, ACEI & CCB.
- For people with diabetes – Choose one or combination of drugs from diuretic, BB, ACEI, ARB & CCB.
- For people with chronic kidney disease – Choose one or both of drugs from ACEI & ARB.
- For people with recurrent stroke prevention – Choose one or both of drugs from diuretic & ACEI.
ACEI angiotensin-converting enzyme inhibitor; Aldo ANT aldosterone antagonist; ARB angiotensin receptor blocker; BB beta blocker; CCB calcium channel blocker.