High blood pressure is one of the health problems that most affects people of all ages, either by a diet high in fat and sodium, or by a very fast pace of life. It is very closely related to cardiovascular diseases and is the leading cause of mortality in developed countries as has been demonstrated in multiple observational studies.
Normally hypertension is usually treated with changes in diet, physical exercise or home remedies, after several months in case that none of these works to lower your blood pressure or that your case of hypertension has a high risk, that is to say that you have organ damage or that your pressure is at a level 3 (more than 180/110 mmHg), you would start a medication treatment, so it is necessary to visit your doctor and he would prescribe you the drugs that he deems most convenient according to your case.
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The doctor and the nurse, with the commitment of the patient, must set targets for blood pressure figures to be achieved. Trying to use the least possible number of drugs, using if necessary, combinations of drugs. They should also consider factors such as the patient’s age, the existence of other diseases, the cardiovascular risk and the side effects of each medication, and according to that, choose which one suits your case best. Also, some time after taking the drug should check the blood pressure to check its effect.
The most common antihypertensive medications that may prescribe for you to lower your blood pressure are:
Generally, they are usually the first option to lower the tension thanks to its easy handling and low cost. They act by helping the kidneys to eliminate sodium (salt) and water, increasing the expulsion of urine, which makes the pressure go down, as well as helping to reduce water (fluid) retention.
The use of diuretics is safe, but it can cause imbalance in the metabolic state, so it is advisable to check them periodically. It can also cause potassium lowering in the body, this usually appears in both thiazide and loop diuretics, but this potassium can be supplemented by increasing the consumption of foods rich in potassium, such as bananas or oranges.
Some examples of diuretics are: Chlorthalidone, Metolazone, Furosemide and Amiloride.
They reduce blood pressure in hypertensive patients, but not in normotensive people; they act by blocking the stimulating effect of adrenaline on the heart, which causes it to slow down so that the blood passes through the blood vessels with less force.
These have certain side effects that limit their use. Among the most important are: excessive decrease in heart rate, bronchospasm in asthmatic patients or with chronic obstructive pulmonary disease (COPD), they can also produce a sensation of fatigue and alterations at the sexual level such as impotence.
Some of the examples of beta blockers are: timolol, atenolol, bisoprolol and betaxolol.
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Calcium channel blockers:
They act by inhibiting the entry of calcium into the muscle cells of the heart and into the blood vessels, causing the cells to dilate, decrease the vascular resistance and consequently lower the pressure figures.
Due to their neutral metabolic effect, they are useful in the treatment of patients with hyperglycemia, metabolic syndrome or insulin resistance, and dyslipidemia. They are also very useful in combination with any other antihypertensive, even with diuretics.
As side effects have been described malignant edema, orthostatic hypotension (dizziness on standing up due to decreased blood pressure), facial flushing, headache, constipation and bradycardia.
Some of the examples of calcium channel blockers are: Amlodipine, Isradipine, Diltiazem and Felodipine.
Angiotensin-converting enzyme inhibitors (ACEIs):
They act by preventing the formation of a substance in the body called angiotensin, without which renin can’t be produced (which raises blood pressure and contracts the arteries). The antihypertensive effect increases significantly when combined with diuretics.
ACEIs have been shown to be effective in the prevention of cardiovascular events in patients with uncomplicated high blood pressure. In addition, they can be administered safely in most situations in which hypertension is associated with other diseases.
ACE inhibitors are contraindicated in pregnancy and lactation, and should be used with great caution in renovascular hypertension.
The most common side effects are the appearance in some patients of non-productive cough, isolated cases of angioedema (which appears with the first doses of the drug), hypotension, skin rashes and elevation of urea (in patients with renal insufficiency).
Some examples of ACE inhibitors are: captopril, enalapril, lisinopril and ramipril.
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Angiotensin II receptor blockers (ARBs):
This type of drugs produces a blockade of the renin-angiotensin system, but at a different level than the ACEIs. They are the best tolerated antihypertensive group. The almost total absence of side effects associated with its use is the greatest advantage of this group of medicines. They present antihypertensive efficacy similar to other medications and provide protection for the onset of cerebrovascular disease.
Its antihypertensive efficacy increases when combined with diuretics, although it can also be combined with calcium channel blockers to obtain good results.
Some examples of angiotensin II receptor blockers are: Valsartan, Telmisartan and Losartan.
They are effective antihypertensive agents, more useful in combination with other medications when you cannot reach the goal.
In addition, they cause a decrease in LDL-cholesterol (“bad” cholesterol), and improve the symptomatology of benign prostatic hyperplasia.
Some examples of alpha blockers are: Prazosin, Terazosin and Doxazosin.
Adrenergic receptor antagonists:
They’re also known as central-acting agents. They diminish the nervous impulses that cause that the blood vessels are tensed or they are reduced.
They can be used alone, but it is advisable to combine them with diuretics.
Some examples of the adrenergic receptor antagonists are: methyldopa, clonidine and guanfacine.
They act directly on the muscular walls of the blood vessels, dilating them and, therefore, decreasing the peripheral vascular resistance.
This dilation causes reflex tachycardia (promotes the appearance of angina in coronary patients) and saline retention, so they cannot be used without association with other drugs. Due to this, they are usually complemented with a diuretic or a beta-blocker that counteracts these effects.
Vasodilator drugs are potent antihypertensive agents, whose usefulness is limited by the frequent side effects and their use is restricted almost exclusively to patients with severe hypertension or refractory to combined treatment.
Some examples of vasodilators are: hydralazine and minoxidil, the latter is the most used medication for chronic treatment and is particularly useful in hypertensive patients with renal failure.