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
Treatment with combinations of drugs for high blood pressure
The use of combination drug therapy for hypertension is common. At times, using smaller amounts of one or more drugs in combination can minimize side effects while maximizing the anti-hypertensive effect. For example, diuretics, which also can be used alone, are more often used in a low dose in combination with another class of antihypertensive medications. This way, the diuretic has fewer side effects while improving the blood pressure-lowering effect of the other drug. Diuretics also are added to other antihypertensive medications when a patient with hypertension has fluid retention and swelling (edema).
ACE inhibitors or ARBs may be useful in combination with most other antihypertensive medications. The effects of these drugs are additive, meaning that a combination of drugs from each category is more effective than either drug alone in treating patients with cardiomyopathies and proteinuria. Another useful combination is that of a beta blocker with an alpha blocker in patients with high blood pressure and enlargement of the prostate gland in order to treat both conditions simultaneously. Caution is necessary when combining two drugs that both lower the heart rate. For example, patients receiving a combination of a beta blocker to a non-dihydropyridine calcium channel blocker (for example, diltiazem [Cardizem, Dilacor, Tiazac] or verapamil [Calan, Verelan, Isoptin, Covera-HS]) need to be monitored carefully to avoid an excessively slow heart rate (bradycardia). Combining alpha and beta blockers such as carvedilol (Coreg) and labetalol (Normodyne, Trandate) is useful for cardiomyopathies and for hypertension patients.
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