High blood pressure, as known as hypertension, is a common disease in which the blood pressure is persistently above normal. A normal value is a measure of 120/80 mm Hg; any reading over 140/90 mm Hg will require drug therapy. Because the only symptom is often an elevated blood pressure, it is important have regular physical exams and follow your physician's instructions. There are many classes of medications used for the treatment of high blood pressure. Diuretics, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and calcium channel blockers are the primary drugs chosen.
Diuretics
Thiazide-type diuretics are used as standard therapy for most patients. These drugs include chlorthalidone (Thalitone), hydrochlorothiazide (HydroDiuril or Microzide), indapamide (Lozol) and metolazone (Mykrox or Zaroxolyn). The thiazide-type diuretics act by preventing sodium from being absorbed back into the body. Sodium and water will be released from the body leading to a drop in blood pressure. Loop diuretics and potassium-sparing diuretics are two subclasses used in people who have other health issues. Loop diuretics also prevent the reabsorption of sodium and work in the loop of henle in the kidney. These drugs are bumetanide (Bumex), furosemide (Lasix), and torsemide (Demadex). The potassium-sparing diuretics prevent potassium from being released and can be used when a risk of low potassium levels is a concern. The potassium-sparing diuretics are amiloride (Midamor) and triamterene (Dyrenium).
ACE Inhibitors
The ACE inhibitors are another class that can be used to treat high blood pressure. They work by preventing a chemical called angiotensin I from being converted in the body to angiotensin II. The "Drug Information Handbook" explains that angiotensin II, a chemical produced in the body, causes the narrowing of blood vessels and the release of another chemical called aldosterone. Aldosterone will retain sodium and water in the body. The combination of this and the narrowing of blood vessels will cause the blood pressure to elevate. By blocking the formation of angiotensin II, aldosterone production is decreased and sodium and water are released from the body. This results in a lower blood pressure. ACE inhibitors include benazepril (Lotentsin), captopril (Capoten), enalpril (Vasotec), fosinopril (Monopril), quinapril (Accupril), ramipril (Altace), moexipril (Univasc), trandopril (Mavik) and perindopril (Aceon).
Beta-Blockers
Beta-blockers are another option in the treatment of hypertension. These medications work by blocking the beta receptors found in the cells of the heart. Beta receptors respond to chemicals that make the heart beat faster. Beta-blockers inhibit this response leading to a decrease in the rate and force of the heart. The medications in this class are atenolol (Tenormin), Betaxolol (Kerlone), bisoprolol (Zebeta), metoprolol (Lopressor or Toprol XL), nadolol (Corgard), propanolol (Inderal), acebutolol (Sectral), pindolol (Visken), penbutolol (Levatol), timolol (Blocarden), carvedilol (Coreg), and labetolol (Normodune).
ARBs
Candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan) are the ARBs available as treatments. The "Drug Information Handbook" explains that angiotensin II binds to molecules called receptors to exert their action in the body. ARBs prevent angiotensin II from binding in the body and block these actions leading to a drop in the blood pressure.
Calcium Channels Blockers
Calcium channel blockers (CCBs) are used for treatment when other medications can not control blood pressure effectively. According to "Pharmacotherapy: A Pathophysiologic Approach," CCBs are usually given to individuals who have another disease called chronic angina (chest pain). CCBs work by preventing calcium from exerting its action on the body leading to muscle relaxation. This allows oxygen to flow more readily through the body lowering the blood pressure. CCBs include amlodipine (Norvasc), felodipine (Plendil), isradipine (Dynacirc) and isradipine SR (Dynacirc SR), nicardipine (Cardene SR), nisoldipine (Sular), diltiazem (Cardizem SR or Cardizem LA), verapamil (Isoptin SR or Covera HS).
References
- "Drug Information Handbook 15th Edition"; Charles F. Lacy, RPh, PharmD, FCSHP, Lora L. Armstrong, RPh, PharmD, BCPS. et al; 2007
- "Pharmacotherapy: A Pathophysiologic Approach"; Joseph T. Dipiro, Robert L. Talbert, et al; 2008
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