Blood pressure medications can be broadly grouped in different categories. Some categories inhibit the kidneys' ability to regulate blood pressure, while others reduce the pressure that the blood exerts in the interior of blood vessels by removing fluids from the body. Other drugs lower blood pressure by acting directly on the brain or on cardiac tissue. Some hypertension medications have a greater risk of side effects than others.
ACE Inhibitors
Angiotensin converting enzyme inhibitors are commonly referred to as ACE inhibitors. This is one of the first drugs that doctors prescribe when trying to get a patient's blood pressure down because they are generally well tolerated in most people. ACE inhibitors are frequently prescribed to kidney patients because they also lower urine protein, a common symptom of kidney disease.
ACE inhibitors work by inhibiting the kidneys' ability to regulate blood pressure. This approach seems to cause fewer issues than hypertension medications that act on the heart and brain.
Diuretics
Some patients refer to diuretics as "water pills." These drugs work so well together with ACE inhibitors that a common diuretic called hydrochlorothiazide is often combined in the same pill as an ACE inhibitor.
A few patients complain that diuretics make them urinate a lot. Working with your doctor on timing and dose helps prevent problems like waking up in the middle of the night having to urinate. This side effect does not occur with other hypertension medications.
ARBs
Angiotensin receptor blockers, or ARBs, are similar to ACE inhibitors. They both lower blood pressure by acting upon enzymes made by the kidney, and both are well tolerated. Frequently they are prescribed together. Unlike water pills, neither ACE inhbitors nor ARBs make patients urinate a lot.
CCBs
According to the Mayo Clinic, calcium channel blockers, or CCBs, act by preventing calcium from entering heart and blood vessel muscle cells, which causes the cells to relax. Since these drugs act more centrally, they tend to have more side effects than ACE inhibitors, diuretics and ARBs.
For a long time, CCBs were dogged by controversy. A 2001 study published in the journal Circulation showed that the incidence of cancer is 0.08 percent higher in patients who take a common CCB called amlodipine, when compared to a control group. The PBS show Frontline fanned the flames when it reported that amlodipine increases the incidence of heart disease when compared to other hypertension medications.
CCBs continue to be commonly prescribed. Despite the controversy, they are an effective treatment. Often they are combined with ACE inhibitors, diuretics and ARBs, either in a single medication or as an additional medication.
Beta Blockers
Beta blockers are very different from the drugs discussed so far. Beta blockers minimize nerve signals from the brain to the heart and other blood vessels, effectively telling the heart not to beat as fast. Beta blockers tend to have more side effects than CCBs, ACE inhibitors, ARBs or diuretics, and for that reason they are not the first drugs that doctors usually prescribe to treat hypertension. Many patients complain about feeling in a fog when they take drugs in this category. Alone among other hypertension medications, beta blockers also increase the risk of diabetes.
References
- Frontline: Producer's Notebook
- National Heart Blood and Lung Institute: Types of Blood Pressure Medications
- Mayo Clinic:Choosing blood pressure medications
- Circulation: Does Amlodipine Increase Cancer Incidence?
- InSciences Organization: FDA approves Twynsta® (telmisartan plus amlodipine) a new single pill combination
