High Blood Pressure Treatment (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
- What is high blood pressure (hypertension)?
- Which lifestyle modifications are beneficial in treating high blood pressure?
- Coffee and caffeinated beverages
- Other dietary considerations
- Exercise and stress reduction
- How is high blood pressure treated?
- Starting treatment for high blood pressure
- Treatment with combinations of drugs for high blood pressure
- Emergency treatment for high blood pressure
- Treatment during pregnancy
- Which medications are used to treat high blood pressure?
- Beta blockers
- Calcium channel blockers (CCBs)
- Alpha blockers
- Renin inhibitors
- Aldosterone blockers
- Combining agents
- What about the patient's compliance with medication regimens?
- Is alternative medicine used to treat high blood pressure?
- What are the complications of high blood pressure?
- Can high blood pressure be prevented?
- What's new in high blood pressure?
- Find a local Internist in your town
Which medications are used to treat high blood pressure?
Angiotensin converting enzyme inhibitors (ACE Inhibitors) and angiotensin receptor blockers
The angiotensin converting enzyme (ACE) inhibitors and the angiotensin receptor blocker (ARB) drugs both affect the renin-angiotensin hormonal system which helps regulate blood pressure. ACE inhibitors act by blocking (inhibiting) an enzyme that converts the inactive form of angiotensin in the blood to its active form. The active form of angiotensin constricts or narrows the arteries, but the inactive form cannot. With an ACE inhibitor as a single drug treatment (monotherapy), 50 to 60 percent of Caucasians usually achieve good blood pressure control. African American patients also may respond, but they may require higher doses and frequently do best when an ACE inhibitor is combined with a diuretic. (See the discussion of diurectics that follows.)
As an added benefit, ACE inhibitors may reduce an enlarged heart (left ventricular hypertrophy) in patients with hypertension. These drugs also appear to slow the deterioration of kidney function in patients with hypertension and protein in the urine (proteinuria). They have been particularly useful in slowing the progression of kidney dysfunction in hypertensive patients with kidney disease resulting from type 1 diabetes (insulin-dependent). ACE inhibitors usually are the first-line drugs to treat high blood pressure in patients who also have congestive heart failure, chronic kidney failure, and heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction). ARB drugs currently are recommended for first-line kidney protection in diabetic nephropathy (kidney disease).
Patients treated with ACE inhibitors who also have kidney disease should be monitored for further deterioration in kidney function and high serum potassium. These drugs may be used to reduce the loss of potassium in people who are being treated with diuretics that cause patients to lose potassium. ACE inhibitors have few side effects, but the most common is a chronic cough. Occasionally, there may be fluid retention (edema). The ACE inhibitors include:
- enalapril (Vasotec),
- captopril (Capoten),
- lisinopril (Zestril and Prinivil),
- benazepril (Lotensin),
- quinapril (Accupril),
- perindopril (Aceon),
- ramipril (Altace),
- trandolapril (Mavik),
- fosinopril (Monopril), and
- moexipril (Univasc).
For patients who develop a chronic cough on an ACE inhibitor, an ARB drug is a good substitute. ARB drugs work by blocking the angiotensin receptor (binder) on the arteries to which activated angiotensin must bind to have its effects. As a result, the angiotensin is not able to work on the artery. (Angiotensin is a hormone that constricts the arteries.) ARB drugs appear to have many of the same advantages as the ACE inhibitors but without the associated cough; however, edema still may occur. They are also suitable as first-line agents to treat hypertension.
ARB drugs include:
- losartan (Cozaar),
- irbesartan (Avapro),
- valsartan (Diovan),
- candesartan (Atacand),
- olmesartan (Benicar),
- telmisartan (Micardis), and
- eprosartan (Teveten).
In patients who have hypertension in addition to certain second diseases, a combination of an ACE inhibitor and an ARB drug may be effective in controlling the hypertension and also benefiting the second disease. This combination of drugs can treat hypertension and reduce the loss of protein in the urine (proteinuria) in certain kidney diseases and perhaps help strengthen the heart muscle in certain diseases of the heart muscle (cardiomyopathies). Both the ACE inhibitors and the ARB drugs are not to be used (contraindicated) in pregnant women. (See the section above on pregnancy.)
Next: Beta blockers
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