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Medicating Pressure

PART 1 Medications for Hypertension

If lifestyle changes don’t reduce blood pressure to an acceptable level, doctors will generally prescribe antihypertensive medications. There are a number of different types of antihypertensives available. The most commonly prescribed include:

Thiazide diuretics. Often the first drug prescribed, diuretics dilate blood vessels and also decrease fluid volume in the body by helping the kidneys to eliminate salt and water.

Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors reduce hypertension by dilating arterioles (the smallest divisions of the arteries, linking the arteries and the capillaries). They do this by blocking the production of ACE, a naturally occurring substance that constricts blood vessels.

Angiotensin II receptor blockers (ARBs). Like ACE inhibitors, ARBs dilate arterioles, but they accomplish this by preventing ACE from having any effect on the heart and blood vessels. ARBs are often prescribed for people who experience adverse side effects from ACE inhibitors.

Beta-blockers. These are the most commonly used type of adrenergic blocker, a group that also includes alpha-blockers, alpha-beta blockers, and peripherally acting adrenergic blockers. Adrenergic blockers block the effects of the sympathetic division of the nervous system. They slow heart rate, decrease cardiac output, lessen the force with which the heart muscle contracts, and dilate blood vessels.

Calcium channel blockers. These also dilate arterioles, but by a different method than ACE inhibitors and ARBS. Calcium channel blockers obstruct the movement of calcium into the heart. By doing this, they decrease the pumping strength of the heart, slow the heart rate, and relax blood vessels and muscles.

Renin inhibitors. A newer class of high blood pressure medication, renin inhibitors act on renin, an enzyme produced by the kidneys. Renin inhibitors prevent renin from triggering a blood pressure-regulating process. This causes blood vessels to dilate, lowering blood pressure.

If the blood-pressure goal isn’t reached using combinations of the above drugs, the doctor may prescribe:

Alpha blockers or alpha-beta blockers. These adrenergic blockers help to dilate blood vessels. Alpha-beta blockers also help to slow the heartbeat.

Vasodilators. Vasodilators work directly on arteries to dilate them.

Central-acting agents. These agents impede the brain from signaling the autonomic nervous system to narrow the blood vessels and increase the heart rate.

LESS

PART 2 Resistant Hypertension

People who are taking at least three different types of antihypertensives (of which one is a diuretic) and who still can’t reach their blood-pressure goal are considered to have resistant hypertension. If this is the case, it may be necessary to see a hypertension specialist. There may be underlying problems, such as kidney disease or sleep apnea, that are causing the high blood pressure.