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.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- What is high blood pressure (hypertension)?
- Which lifestyle modifications are beneficial in treating high blood pressure?
- Alcohol
- Smoking
- Coffee and caffeinated beverages
- Salt
- Other dietary considerations
- Obesity
- 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
- Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers
- Beta blockers
- Diuretics
- Calcium channel blockers (CCBs)
- Alpha blockers
- Clonidine
- Minoxidil
- 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
Minoxidil
Minoxidil is the most potent of the drugs that lower blood pressure by dilating the peripheral arteries. This drug does not work through the peripheral sympathetic nervous system as do the alpha and beta blocker drugs, or through the control center in the brain, as does clonidine. Rather, it is a muscle relaxant that works directly on the smooth muscle of the peripheral arteries throughout the body. Minoxidil is used for patients who have not responded to other medications. It must be combined with a beta blocker or clonidine to prevent an increase in the heart rate and with a diuretic to prevent retention of fluid (swelling). Minoxidil may also increase hair growth.
Renin inhibitors
Aliskiren (Tekturna) is in a class of antihypertensive drugs called renin inhibitors. Renin is an enzyme in the chain of blood pressure regulating hormones referred to as the renin-angiotensin-aldosterone (RAA) hormonal system.
The first step in the chain is the production of renin in the kidneys when the kidneys detect lower blood pressure. The renin stimulates the formation of a protein called angiotensin I, which is then converted to angiotensin II by angiotensin-converting enzyme (ACE) in the lungs, the same ACE targeted by ACE inhibitors. Angiotensin II is the most powerful constrictor of blood vessels known. This effect of constricting blood vessels tends to elevate the blood pressure. Angiotensin II also causes the secretion of an additional blood pressure elevating hormone in the adrenal glands called aldosterone, which helps the body retain sodium.
Aliskiren inhibits the effects of renin and angiotensin so that blood pressure does not go up.
Aliskiren should not be combined with ARB or ACE drugs in patients with diabetes because of the risk of renal impairment, hypotension, and hyperkalemia.
Next: Aldosterone blockers
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