Treatment of High Blood Pressure

Treating high blood pressure is both one of the easiest and most difficult things we do in the primary care setting.  A wide variety of blood pressure medication categories and options exist, but for some patients it comes down to finding the right pill in order to maximize efficacy and minimize side effects.  I tell my patients that medicines for hypertension and mood disorders are the ones that we “play around with” the most with patients.  Sometimes it takes a trial of 1 to 3 medicines to find the right fit for patients.

Here I will briefly mention the major classes of hypertensive medicines and talk about the ones that will likely be discussed with you in the event that your blood pressure is high.  This is an overview; this list is not comprehensive or detailed and is not intended to be so.  It does however provide a good foundation for patient education.  Classes are in bold; popular examples are italicized.  For more information, please contact your healthcare provider.

Diuretics, hydrochlorothiazide/HCTZ

Mechanism of action – decreases water volume through the kidneys; Blood Pressure Medicine 101

The good – cheap, easy, effective, and safe

The bad – can worsen gout for those with a predisposition; can cause an allergic reaction if you are allergic to sulfa drugs

Beta blockers, metoprolol/Toprol/Lopressor, carvedilol/Coreg, -lol suffix drugs

Mechanism of action – decreases the strength and speed of heart contractions; loosens up arteries

The good – effective and safe; favorable effect on patients with a history of heart-failure, heart attacks, and stroke

The bad – can affect the breathing of patients with asthma or COPD; can lower pulse rates

ACE inhibitors, lisinopril, -pril suffix drugs

Mechanism of action – works at the level of the kidneys to dilate blood vessels

The good – great upside; decreases mortality in diabetics and those with a history of heart failure and heart attacks; protective effect on the kidneys

The bad – can cause an annoying cough; can cause an allergic reaction that includes lip swelling; can elevate potassium; in rare circumstances can paradoxically worsen kidney function; a strict no-no in pregnancy

ARBs, losartan/Cozaar, -artan suffix drugs

Mechanism of action – similar to ACE inhibitors but works downstream in the cascade; can be thought of as ACE-inhibitors minus the possibility of cough

Calcium channel blockers, amlodipine/Norvasc

Mechanism of action – loosens up the arteries; some medicines in this class can also effect the strength and speed of muscle contractions

The good – easy, effective, and safe; good for blood pressure symptoms

The bad – limited use for those on certain cholesterol medicines; can cause leg swelling

Alpha blockers, tamsulosin/Flomax, most have -osin suffix

Mechanism of action – loosens up the arteries

The good – effective; can be used to treat enlarged prostate in men

The bad – can lower blood pressure too low, causing side-effects such as dizziness