High blood pressure medication

There are various forms of medication available to control high blood pressure. You may be prescribed a single or combination of medications depending upon how bad your blood pressure is.

You might have to continue with high blood pressure for the rest of your life; but, if your blood pressure stabilises and remains so for a period of years then you may be able to stop taking it.

Your age, ethnic background and lifestyle will be taken into account when prescribing a blood pressure medication.

So, what medications are used to treat high blood pressure?

These include:

• ACE inhibitors
• Angiotensin receptor blockers (ARBs)
• Calcium channel blockers
• Diuretics
• Alpha blockers
• Beta blockers
• Vasodilators
• Central alpha antagonists

ACE inhibitors

ACE stands for ‘angiotensin-converting enzyme’ and is a form of medication which prevents certain hormones from acting upon your blood pressure. In other words, it stops them from raising your blood pressure.

It also relaxes and widens your arteries which enable blood to flow through as per normal. This also helps to lower your blood pressure.

Brand names of these include ‘Rampril’, ‘Enaliapril’and ‘Quinapril’.

However, these do have side effects and are not advisable for people with kidney problems, women who are pregnant or breastfeeding and people with heart disease.

Side effects include:

• Dizziness
• Persistent dry cough
• Headaches
• Fatigue

Many of these effects pass after a few days apart from the dry cough which often lingers. Be careful if you intend taking these along with any current over the counter medicines as they can cause unpredictable side effects. Check with your GP first.

You will have to undergo annual blood and urine tests if you use ACE inhibitors to see if they are affecting the function of your kidneys.

Angiotensin receptor blockers (ARBs)

These are very similar to the ACE inhibitors in that they also prevent certain hormones from stimulating your blood pressure (and causing it to rise).

They are often prescribed instead of ACE inhibitors if the side effects are particularly severe.

An example of this is ‘Candesartan’.

Calcium channel blockers

These work in a very similar way to ACE inhibitors in that they relax and widen your arteries which then lowers your blood pressure. They are particularly effective in people who have heart disease or kidney failure as well as high blood pressure.

An example of this is ‘Amlodipine’.

But, these are not advisable for people with a history of heart or liver disease or circulatory problems.

Side effects of these include:

• Fatigue
• Dizziness
• Skin rashes
• Flushed facial appearance
• Swollen ankles
• Headaches
• Very slow, uneven or fast heart rate

Some types of calcium channel block cause constipation.

But these side effects usually pass after a few days, once your body has become accustomed to the medication.

Do not drink grapefruit juice if you are prescribed calcium channel blockers as they can dramatically lower your blood pressure.

Diuretics

Thiazide diuretics help widen your arteries and also reduce the amount of water and salt in your bloodstream. Basically, they help your kidneys with this vital function which then reduces the volume of blood in your arteries and so lowers your blood pressure.

One example of this is ‘bendroflumethiazide’.

However, diuretics are not recommended for people with gout or pregnant women.

They can have the effect of lowering the amount of potassium in your body which then affects the functions of your heart and kidneys. Plus they can also raise blood sugar levels which increases the risk of diabetes.

Side effects include:

• Nausea
• Cramps (muscles)
• Dizziness

Some men have reported a failure to have an erection as a result of this medication although this resolves itself once the medication is stopped.

Alpha blockers

These work by preventing the muscles in the walls of your arteries (known as ‘alpha receptors’) from tightening and narrowing these. This medication opens these arteries which enables blood to flow through as normal. This has the effect of lowering your high blood pressure.

An example of this is ‘Doxazosin’.

However they are not considered suitable for women who are pregnant or breast feeding as they can cause stress incontinence. They are also not recommended for people with Parkinson’s disease or a history of heart or liver disease.

Side effects of these include:

• Headache
• Dizziness
• Fainting (only in the early stages)
• Swollen ankles or legs
• Rashes
• Tremors
• Extreme tiredness

These are less commonly prescribed than other blood pressure medications and only if you continue to have high blood pressure -in spite of taking these other medications.

Alpha blockers are seen as a third or fourth choice medication.

Beta blockers

These too are less commonly prescribed. They are effective at lowering high blood pressure but are only prescribed when other forms of treatment are unsuccessful, e.g. ACE inhibitors.

The main reason for this is that they have more side effects than any of the other types of medication.

Beta blockers slow down your heart rate which also reduces the rate of blood flow around your body. This has the effect of lowering your blood pressure.

Brand names include ‘Propranalol’, ‘Atenolol’and ‘Esmolol’

Side effects of beta blockers include:

• Cold hands and feet
• Diarrhoea
• Nausea
• Fatigue
• Slow heartrate

Less common side effects include sleep problems and impotence (men).

Be aware that beta blockers can interfere with other medications which may cause unpleasant side effects. Check with your GP if you are taking an over the counter or prescribed medicine before taking beta blockers.

Vasodilators

These are known as ‘direct acting vasodilators’which work by widening and relaxing the muscles within the walls of your arteries. This enables blood to flow through normally and also lowers your blood pressure.

Examples of this include ’Loniten’ and ‘Apresoline’. These are not recommended for women who are planning to start a family, are already pregnant or breastfeeding. They are not advisable for people with heart disease, angina or diabetes. If they are permitted then the patient will be very closely monitored. This equally applies to people who have suffered a heart attack, stroke or kidney disease.

Side effects of these include:

• Nausea
• Upset stomach
• Headaches
• Flushed face
• Skin rashes
• Weight gain
• Swollen ankles/lower legs
• Irregular heart rate

Some people experience chest pain or shortness of breath from taking a vasodilator.

Central alpha antagonists

These types of medication work by stopping your brain from signalling to your nervous system to increase heart rate and narrow your arteries.

In other words, they block these signals.

This keeps the arteries relaxed and open which enables blood to flow through. This has the effect of lowering your blood pressure.

Brand names include ‘Clonidine’, ‘Moxonidine’ and ‘Methyldopa’.

They are not suitable for people with a history of angina, heart disease or kidney failure. This also applies to people with Parkinson’s disease or who suffer with depression.

There are side effects as with any form of medication which include:

• Headache
• Nausea
• Upset stomach
• Fatigue
• Dizziness
• Drowsiness
• Dry mouth
• Swollen feet or legs
• Sleep problems

There are a few less common side effects which include anxiety, depression and impotence (men).

Your GP will discuss these effects with you beforehand.

If you experience side effects from these or any of the medications discussed in this section then DO NOT stop taking these but speak to your GP first.

Maximise the effect of your blood pressure medication/s

You will have to continue taking medication to lower your high blood pressure on a permanent basis. Unless there is any change to this then continue to do so.

Your blood pressure will rise again if you stop taking your medication.

This means accepting and devising a routine for taking your blood pressure medication. This can include:

• Maintaining a healthy lifestyle
• Home blood pressure monitoring
• Thinking positively about your medication
• Devising a routine which is based around your medication
• Learning as much as you can about your medication

No-one likes taking medication but the alternatives are far worse. You can take blood pressure medication but still lead a normal, healthy life.

As well as these types of medication there are a few natural remedies which are discussed in the next section.