Treating Hypertension with Medications

Simple lifestyle changes can help reduce high blood pressure, although some people may need to take medicine as well. Your doctor can advise you about changes you can make to your lifestyle and discuss whether they think you'd benefit from medicine.

Here are some changes you could make to your lifestyle to reduce high blood pressure. Some of these will lower your blood pressure in a matter of weeks, while others may take longer.

Try to:

• Cut your salt intake to less than 6g (0.2oz) a day, which is about a teaspoonful – find out how you can reduce the amount of salt in your diet
• Eat a low-fat, balanced diet – including plenty of fresh fruit and vegetables
• Be active – get more exercise
• Cut down on alcohol 
• lose weight t
• drink less caffeine 
• stop smoking 

You can take these steps today, regardless of whether or not you're taking blood pressure medicines. In fact, by making these changes early on you may be able to avoid needing medicines.

Sometimes lifestyle changes aren't enough to treat high blood pressure. If they don't help, your provider may recommend medicine to lower your blood pressure.

Medications

The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is. Two or more blood pressure drugs often work better than one. It can take some time to find the medicine or combination of medicines that works best for you.

When taking blood pressure medicine, it's important to know your goal blood pressure level. You should aim for a blood pressure treatment goal of less than 130/80 mm Hg if:

• You're a healthy adult age 65 or older
• You're a healthy adult younger than age 65 with a 10% or higher risk of developing cardiovascular disease in the next 10 years
• You have chronic kidney disease, diabetes or coronary artery disease

The ideal blood pressure goal can vary with age and health conditions, particularly if you're older than age 65.

Medicines used to treat high blood pressure include:

Water pills (diuretics). These drugs help remove sodium and water from the body. They are often the first medicines used to treat high blood pressure.

There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your provider recommends depends on your blood pressure measurements and other health conditions, such as kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.

A common side effect of diuretics is increased urination. Urinating a lot can reduce potassium levels. A good balance of potassium is necessary to help the heart beat correctly. If you have low potassium (hypokalemia), your provider may recommend a potassium-sparing diuretic that contains triamterene.

Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others.

Angiotensin II receptor blockers (ARBs). These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.

Calcium channel blockers. These drugs help relax the muscles of the blood vessels. Some slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may work better for older people and for Black people than do ACE inhibitors alone.

Don't eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your provider or pharmacist if you're concerned about interactions.

Other medicines sometimes used to treat high blood pressure
If you're having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe:

Alpha blockers. These medicines reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.

Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).

Beta blockers. These medicines reduce the workload on the heart and widen the blood vessels. This helps the heart beat slower and with less force. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle) bisoprolol and others.

Beta blockers aren't usually recommended as the only medicine prescribed. They may work best when combined with other blood pressure drugs.

Aldosterone antagonists. These drugs may be used to treat resistant hypertension. They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).

Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure.

Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

Vasodilators. These medicines stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing. Examples include hydralazine and minoxidil.

Central-acting agents. These medicines prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

Always take blood pressure medicines as prescribed. Never skip a dose or abruptly stop taking blood pressure medicines. Suddenly stopping certain ones, such as beta blockers, can cause a sharp increase in blood pressure called rebound hypertension.

If you skip doses because of cost, side effects or forgetfulness, talk to your care provider about solutions. Don't change your treatment without your provider's guidance.

High blood pressure can often be prevented or reduced by eating healthily, maintaining a healthy weight, taking regular exercise, drinking alcohol in moderation and not smoking. 

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