Blood pressure medicines
The regulation of blood pressure is a complex system with various feedback loops and "control points" that medications can target. For that reason, there are many different ways drugs can lower blood pressure. Recommended lifestyle changes are always the foundation of treatment. They can be enough to prevent or at least delay the need for medication in patients with mild hypertension (grade 1). Also, if blood-pressure-lowering medications are still needed, lifestyle changes can boost their effect so that less medication is required.
The following measures are recommended:
- Stop smoking
- Reduce alcohol consumption to less than 14 units per week for men and 8 units per week for women (1 unit = 125 ml wine or 250 ml beer).
- Lose weight if you are overweight
- Regular physical activity - at least 30 minutes on 5-7 days per week.
- Reduce table salt intake to under five grams per day
- Increase consumption of vegetables, fruit, fish, nuts and unsaturated fats (olive oil). Also choose low-fat dairy products and eat little red meat.
- Avoid binge drinking completely
An adequate but not excessive potassium intake from food (e.g., fruit, vegetables, legumes) can have a positive effect on blood pressure. However, before you reach for over-the-counter potassium effervescent tablets or similar products, please talk to your doctor to avoid side effects. This is especially important with kidney disease, when too much potassium should not be taken. So a discussion with your doctor is urgently needed.
Quit smoking
Reduce alcohol consumption
Lose weight
Sport and exercise
Reduce salt intake
Healthy eating
If blood pressure is high enough (hypertension grade II or III) or if additional risk factors are present (for example diabetes), drug therapy is started early.
Antihypertensives – blood pressure-lowering medications
- Diuretics - water pills
- Beta blockers
- Calcium channel blockers (three groups can be distinguished here)
- ACE inhibitors
- Angiotensin receptor blockers (ARBs)
In most patients the treatment is started right away with a combination of two drug classes, preferably combined in a single tablet.
Monotherapy, i.e. treatment with only one drug class, should only be used for grade 1 hypertension or in selected patients (e.g. those of very advanced age). As long as the target blood pressure has not been reached, drug therapy should be intensified. Triple combination therapy may also be considered for this purpose.
Diuretics
For combination therapy, a thiazide diuretic is often used: hydrochlorothiazide (HCT). HCT is commonly used in multiple combination therapies and is available in many preparations.
In 2018 a warning was issued that HCT therapy may be associated with an increased risk of skin cancer. However, HCT should not be stopped without consulting and weighing the risks with your treating physician.
Mechanism of action: HCT initially increases sodium excretion, which reduces blood volume; resistance in the smaller vessels also decreases. Although sodium excretion and blood volume normalize over time, the blood-pressure-lowering effect remains. The best-known drug in this group is hydrochlorothiazide.
Betablockers
Beta-blockers partly reduce the effects of adrenaline and noradrenaline in the body. When adrenaline or noradrenaline is released, certain beta receptors normally cause an increase in heart rate and blood pressure. By blocking these receptors, beta-blockers reduce heart rate and blood pressure, among other effects on the heart. The best-known active ingredients in this group are bisoprolol, carvedilol, metoprolol, nebivolol and propranolol.
Calcium channel blockers
Calcium channel blockers block the calcium channel on the cell and thus reduce the influx of calcium into the cell interior.
In the smooth muscle of our blood vessels, calcium causes the vessels to constrict and raises blood pressure to ensure sufficient blood flow. Calcium channel blockers therefore relax the smooth muscle in the vessels and cause them to widen, which reduces blood pressure. The best-known drugs in this group are diltiazem, nifedipine and verapamil.
ACE inhibitors
ACE inhibitors block a specific enzyme (the angiotensin-converting enzyme) and thus intervene in a chain of protein conversions. By inhibiting this enzyme, less angiotensin II is formed, which normally causes contraction (tightening) of the vascular muscle. Because the vessels then dilate, blood pressure falls. However, the breakdown of a hormone is also inhibited, leading to increased bradykinin in the body. Since bradykinin acts similarly to histamine, this can cause a range of side effects, such as edema (particularly the feared angioedema, which causes swelling of the skin and mucous membranes of the face) and a persistent dry cough. This dry cough is completely harmless but can be very bothersome and often leads to stopping the medication. The best-known active ingredients in this group are captopril, enalapril, fosinopril, lisinopril and ramipril.
Angiotensin receptor blockers
Angiotensin receptor blockers are also called AT1 blockers or sartans. Unlike ACE inhibitors, they do not inhibit the formation of angiotensin II; instead, they selectively block angiotensin II receptor subtype 1 at the site of action (hence AT1 blockers). Because bradykinin can be broken down unhindered, a dry, irritating cough occurs much less often than with ACE inhibitors. Angiotensin receptor blockers also cause the smallest arteries to widen, thus lowering blood pressure. The best-known active substances in this group are candesartan, losartan, olmesartan, telmisartan and valsartan.
The preferred two-drug combinations consist of:
The preferred two-drug combinations consist of:
- ACE inhibitor or ARB combined with a calcium channel blocker or a diuretic.
- Beta blocker with a diuretic or a drug from another major drug class, when there is a specific indication for a beta blocker (e.g., angina pectoris, after a heart attack, heart failure, heart rate control). However, note that beta blockers MUST NOT be combined with calcium channel blockers of the verapamil and diltiazem type.
The preferred three-drug combinations are:
- ACE inhibitor or ARB + calcium channel blocker + diuretic
If blood pressure still cannot be normalized with triple therapy, spironolactone or another diuretic, an alpha blocker, or a beta blocker should be added.
Therapy options for high blood pressure are considerably limited in pregnancy (preexisting hypertension, gestational hypertension). In persistent or severe cases of high blood pressure during pregnancy, drug therapy may be necessary.
Methyldopa, labetalol and calcium channel blockers are the drugs of first choice in pregnancy.
The final treatment decision lies with your treating physician.
Further information can be found in our article on Blood pressure medications.
Sources:
This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 11/2024).
