High blood pressure is typically treated with a combination of lifestyle changes and medication. For many people, lifestyle changes are tried first, but depending on your circumstances, your doctor may suggest medication when your high blood pressure is diagnosed. If you start with lifestyle measures and your blood pressure does not decrease enough, medication may be added to help. Some people may be prescribed 2 medications at the started of treatment. And if you're using medication and your blood pressure is still too high, the dose of a medication may be increased or another medication may be added until the target blood pressure level is achieved.
Doctors often prescribe medication because it is a very effective way of lowering high blood pressure and reduces a person's risk of developing complications (other problems caused by the high blood pressure). However, medication is only effective when it is taken as prescribed by a doctor.
In some cases, it may also be necessary to use medication and lifestyle changes to treat other conditions such as diabetes or high cholesterol in order to decrease your risk of heart attack and stroke.
Medications for long-term use
Research has proven that many antihypertensive (blood-pressure-lowering) medications provide effective long-term treatment for people with hypertension. The blood-pressure-lowering effects of these medications help to decrease the risk of death and disability from the complications associated with hypertension. Although taking medications for a long period of time may seem like a chore, there are many other things you do every day - such as brushing your teeth - that take more time and effort and aren't a burden.
Many different medications have been developed to treat hypertension. Because they work to decrease blood pressure, they are called antihypertensives. This group of medications is divided into other groups or classes by how they work in the body.
The main classes of prescribed medications include:
- angiotensin-converting enzyme (ACE) inhibitors
- calcium channel blockers
- angiotensin II receptor blockers
- direct renin inhibitors
To determine what kind of medication you have been prescribed, go to the related medications page for a listing of medications by class.
Diuretics: This class of medications increases the amount of salt removed by the kidneys. In turn, the body gets rid of more water (in the form of urine) and the volume of water in the blood is lowered, which helps lower the blood pressure. You can think of your blood vessels as balloons filled with water. If the balloons are not filled as full, there is less pressure on the sides of the balloon.
Diuretics are often the first type of medication prescribed. Combination products are available containing two diuretics; these are intended to increase the likelihood of staying with the therapy, to lower blood pressure even more, and to decrease some side effects. Diuretics are also combined with other antihypertensive medications called ACE inhibitors, beta blockers, and angiotensin II receptor blockers (see below). Side effects of diuretics may include dizziness, increased blood sugar, and decreased potassium levels.
Others may have told you their pharmacist said to eat a banana or drink orange juice to maintain their potassium levels while taking a diuretic. While this is good advice for them to heed, it doesn't apply to all diuretics, so check with a health care professional before changing your diet.
ACE inhibitors: These medications reduce the amount of a chemical in the blood that is responsible for causing blood vessels to narrow or tighten. As a result, the blood vessels relax and the blood pressure decreases - and the heart uses less effort to circulate the blood.
In many situations, ACE inhibitors are an option for first-line therapy, especially for people with diabetes and certain types of kidney disease, but they should not be taken by women who are pregnant or may become pregnant. Common side effects associated with ACE inhibitors include dizziness, swelling, headache, and dry cough. The dry cough causes many people to stop using ACE inhibitors. The cough is usually nothing more than an inconvenience and goes away when the ACE inhibitor is stopped. Talk to your doctor before stopping any medication.
Beta-blockers: This type of medication works to lower high blood pressure by slowing down the rate of the heart and decreasing the strength of each beat. This means blood is pumped through the vessels with less force, which lowers blood pressure. If you have diabetes and use beta-blockers, you should monitor your blood glucose levels more frequently, since beta-blockers can hide the symptoms of low blood sugar. Side effects of this type of medication may include dizziness when getting up from a lying or seated position, exercise intolerance (inability to do as much physical exercise as you normally could), sexual dysfunction, and drowsiness. Caution is recommended when beta-blockers are combined with certain other medications that can directly affect the heart rate. Also, they are not recommended as first-line treatment for people 60 years and older.
Angiotensin II receptor blockers: These medications work by blocking the action of a chemical in the blood that normally tightens blood vessels. Although they can be used as first-line therapy, they are also commonly used in some cases when other choices have intolerable side effects. The side effects of angiotensin II receptor blockers can include dizziness, rash, headache, and swelling.
Calcium channel blockers: These medications lower blood pressure by relaxing blood vessels. Some calcium channel blockers also decrease heart rate and the force of contraction of the heart, and it is necessary to be careful when combining these with beta blockers. Some of these medications interact with grapefruit, so it is best to avoid grapefruit and its juice when taking calcium channel blockers. Some of the side effects associated with calcium channel blocker use are constipation, headache, flushing, and swelling (especially in the ankles and feet).
Alpha-blockers: This class of medication works to lower blood pressure by causing dilation or widening of the blood vessels. Alpha-blockers are not recommended as the first therapy for treating hypertension - they are generally only used to add to another therapy when the other therapy has not lowered blood pressure levels enough. There tend to be more side effects associated with alpha blockers than with other choices. Common side effects include lightheadedness when getting up from a seated or lying position, dizziness, drowsiness, headache, and swelling. Sometimes a diuretic is added to keep the body from retaining fluids. This type of medication can also be used to help treat a condition known as benign prostatic hypertrophy in men.
Direct renin inhibitor: This is a new class of medication that reduces the amount of a chemical in the blood that is responsible for causing blood vessels to narrow or tighten. Currently only one medication (aliskiren) is available in Canada. This medication can be used alone or in combination with diuretics, ACE inhibitors, or calcium channel blockers to treat mild-to-moderate hypertension. Some common side effects include diarrhea, dizziness, swelling, rash, and cough.
There are many combination products that contain more than one medication in a single pill. Once the right dosage of each medication is found, then a tablet that contains both medications can be prescribed. There are a number of benefits associated with this single-tablet format, including:
- convenience: not having to remember to take two separate pills
- potentially reduced costs: only one prescription needs to be dispensed
The possibilities and different combinations are extensive, considering the number of possible medications available to treat hypertension. Not all antihypertensive medications are available in a single-tablet format, however. If you are taking more than one blood pressure medication, check with your doctor to see whether a combination medication could be an option for you.
Staying with your medication
After taking medications for a while, many people question the need to continue to take medication every day. This is sometimes referred to as "treatment fatigue." But if you stop your medication, your blood pressure will start to rise and you will again be at risk of health problems.
Remember, the benefits of lowering your high blood pressure through medication include:
- improved cardiovascular (heart) health
- reduced risk of death
- reduced risk of disability due to stroke or heart attack
- reduced risk of kidney disease
If taking your medication is difficult, here are some options that might help:
- using a combination medication so you are taking fewer tablets daily
- taking a long-acting medication so you can take it fewer times a day
- blister packs
Ask your doctor or pharmacist about ways to make staying on medication less complicated for you.