Medications for Hypertension

Hypertensive people have several drug treatment options. Let's get to know all the available groups and some specific drugs that are part of them.

Medications for hypertension, also known as antihypertensives, are key in treating high blood pressure.

They don’t cure the disease, but they help keep it under control and reduce the occurrence of complications related to them. There are many types and it is even possible to make combinations between them in order to achieve better results.

It is important for hypertensive individuals to become familiar with all drug options, partly as a means of raising awareness. The choice of one or the other varies according to the context, age, previous conditions, the intake of other medications, and other additional criteria.

Today we want to show you the groups that they’re cataloged under, and some of the most used drugs for hypertension.

How do medications for hypertension work?

Not all medications for hypertension work in the same way. Although the end goal is the same – to reduce stress levels – they achieve it in different ways. The Centers for Disease Control and Prevention of the United States (CDC) remind us of its most common ways of acting:

• Relaxing your blood vessels
• Blocking nerve activity that can restrict arteries
• Causing your heart to beat with less intensity
• Helping your body get rid of extra water.

This is the way most hypertension drugs work. Because of this, blood pressure levels drop to values close to, equal to, or lower than 120/80 mmHg, the range suggested by the World Health Organization (WHO).

In turn, the development of complications related to high blood pressure is prevented. Namely, myocardial infarction, kidney failure, strokes, and many more. With this in mind, let’s get to know how the drugs are grouped and which are the most used depending on the case.

Types of medications for hypertension

There are many classes of drugs for high blood pressure. Each one with different ways of acting, side effects, and recommendations. The groups that we present to you have been selected based on those suggested by the American Heart Association (AHA) and approved by the Food And Drug Administration (FDA) to treat hypertension:

Diuretics

Also known as water pills, they are the ones most used medicine for hypertension. There are three types: loop, thiazide, and potassium-sparing. In general, they all work by helping the kidney to remove excess water and sodium. As a consequence, blood pressure drops.

Evidence certifies the use of this group with other types of antihypertensive drugs, age groups, and some underlying conditions. Among the most common we find the following:

• Indapamide (Lozol)
• Metolazone (Mykroz and Zaroxolyn)
• Chlorthalidone (Higroton)
• Chlorothiazide (Diuril)
• Hydrochlorothiazide (Esidrix, Hydrodiuril, and Microzide)
• Amiloride hydrochloride (Midamar)
• Triamterene (Dyrenium)
• Furosemide (Lasix)
• Bumetanide (Bumex)

There is also the category of combined diuretics. These group several of them together in one place: for example, amiloride hydrochloride + hydrochlorothiazide (Moduretic). Among its adverse effects we can highlight the following:

• Increased urination (and, because of this, it’s far better to take it first thing in the morning)
• Dizziness
• Increase in blood sugar levels
• Gout episodes

Its use should be avoided during lactation, as the drug can pass to the baby through breast milk. In the event of underlying kidney or liver problems, a continuous assessment should be made or alternatives in other groups should be looked for.

Beta-blockers

Also known as beta-adrenergic blockers, they work by blocking the effects of adrenaline in the body. Because of this, the heart rate slows down and the heart doesn’t work as hard. This results in a reduction in blood pressure.

Although they’re no longer considered a first-line drug, studies don’t stop showing their usefulness in counteracting the side effects of hypertension. They’re also used for angina pectoris, heart failure, and myocardial infarction. The most used can be found below:

• Atenolol (Tenormin)
• Propranolol (Inderal)
• Betaxolol (Kerlone)
• Acebutolol (Sectra)
• Timolol (Blocadren)
• Bisoprolol (Zebeta)
• Cartelol (Cartrol)

Some of the side effects it can cause include the following:

• Fatigue
• Sexual dysfunction
• Insomnia
• Dyspnoea
• Stomach ache

It should not be given to people with slow heart rates, shock, heart blockages, pregnant women, or those with asthma, thyroid, liver or kidney problems.

Angiotensin-converting enzyme inhibitors

These are also known as ACE inhibitors and are characterized by inhibiting the production of the enzyme angiotensin. This is a hormone with vasoconstrictor qualities, so that its absence causes the blood vessels to dilate and thus reduce the pressure.

In general, the evidence indicates that they are drugs that are very well tolerated by people in general, regardless of whether the treatment is long-term. Here are a selection of the most popular in the following list:

• Captopril (Capoten)
• Enalapril (Vasotec)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Benazepril (Lotensin)
• Lisinopril (Zestril and Prinivel)
• Ramipril (Altace)
• Fosonipril (Monopril)

Some of the adverse effects after ingestion are dizziness, headache, loss of taste, coughs, and elevated potassium levels. It is not recommended for use in pregnant women.

Angiotensin II receptor blockers

Known as ARBs , they operate by blocking the effects of angiotensin. They act directly on the receptors, species of chemical grooves that angiotensin needs to fit and manifest its effects. As a result, vasoconstriction isn’t produced and the arteries remain dilated.

We know that this group of drugs shouldn’t be used during pregnancy, lactation, and in children (in the absence of evidence). It’s possible that in older adults an adjustment of the dose will be required, so doctors will start with a small one that will be increased accordingly. The most commonly used drugs in this group are the following:

• Losartan potassium (Cozaar)
• Valsartan (Diovan)
• Candesartan (Atacand)
• Irbesartan (Avapro)
• Olmesartan (Benicar)
• Telmisartan (Micardis)

Their side effects are rare. The most common are dizziness and hyperkalemia. Like all groups, allergic reactions can occur.

Calcium channel blockers

They prevent calcium from penetrating the smooth muscular walls of the heart and arteries. Under normal conditions, when this happens, both cardiac contraction and vasoconstriction occur, phenomena that increase blood pressure. Given its reduction, the contraction is milder, and therefore a relaxing effect is produced.

Studies indicate that use with other drugs can lead to adverse effects. For example, with some antifungals such as fluconazole or itraconazole, calcium channel blockers interact unfavorably. Among the most used we mention the following:

• Amlodipine (Norvasc)
• Felodipine (Plendil)
• Nifedipine (Procardia and Adalat)
• Bepridil (Vasocor)
• Diltiazem (Cardizem, Dilacor, and Tiazac)
• Clevidipine (Cleviprex)

Some of the sequelae of its treatment are dizziness, constipation, headache, ankle swelling, and drowsiness. It shouldn’t be used in heart conditions, or in pregnant or lactating women.

Alpha-blockers

They act directly on the hormone norepinephrine, which prevents the walls of the blood vessels from contracting. Some are short or long-acting and may also be useful to improve urine flow in some patients.

It’s usually used together with other drugs for blood pressure, since its monotherapy in some cases is insufficient. Those currently marketed are the following:

• Doxazosin (Cardura)
• Prazosina (Minipress)
• Terazosin (Hytrin)
• Phenoxybenzamine (Dibenziline)

As adverse effects, they can increase the heart rate, promote drops in blood pressure (hypotension) and cause dizziness. Because of all these effects, its administration in elderly people must be very carefully controlled.

Alpha 2 receptor agonists

These are also known as alpha-2 adrenergic agonists. Evidence supports its use to prevent hypertension and altered heart rate during surgery, as well as the subsequent protection of the heart muscle.

They work by decreasing the sympathetic portion of the involuntary nervous system, which causes a decrease in blood pressure. The most widely used drug is methyldopa. It’s considered a first-line drug during pregnancy, as long as its intake is controlled. It may cause drowsiness and dizziness.

Combined alpha and beta blockers

These are used intravenously to treat a hypertensive crisis. They can sometimes be prescribed outside of these settings, especially if the patient is likely to have heart failure.

Its most common adverse effect is orthostatic hypotension, so it should be administered with caution in adults. The most common are carvedilol (Coreg) and labetalol (Trandate).

Central agonists

These are also known as centrally-acting alpha-adrenergic agents. They work by blocking the signals from the brain to the nervous system that encourage the narrowing of blood vessels and increased heart rate. The most used are the following:

• Clonidine (Catapres)
• Guanfacina (Tenex)
• Methyldopa (Aldomet)
• Guanabenz (Wytensin)

Its side effects are dry mouth, constipation, drowsiness, and hypotension. Its intake shouldn’t be stopped abruptly, as blood pressure can rise to dangerous levels. It is not recommended to accompany your treatment with alcohol, as adverse reactions may worsen.

Peripheral adrenergic inhibitors

These block neurotransmitters that send contraction signals to smooth muscles. They aren’t part of the first line of blood pressure medications. In fact, its use is rare, unless the patient’s body hasn’t tolerated the above options.

Its most common side effects are diarrhea, nasal congestion, stomach problems, insomnia, and orthostatic hypotension. An example of them are guanadrel (Hylorel), guanethidine (Ismelin), and reserpine (Serpasil).

Vasodilators

These act directly on the blood vessels, specifically on the arterioles. Their vasodilator effect relaxes the walls of the arteries causing blood to flow with less resistance. They can cause headaches, swelling, and joint discomfort.

The most commonly used blood vessel dilators are minoxidil (Loniten) and hydralazine hydrochloride (Apresolin). These drugs must be administered with caution due to their negative interaction with other medications or due to underlying conditions.

Frequently asked questions about hypertension medications

The choice of drugs for hypertension usually depends on the tolerance level of the body. When they don’t work after a couple of weeks, the specialist will try other different groups. It isn’t uncommon for several to be used at the same time to improve results.

The FDA recommends that patients purchase a blood pressure monitor to keep track of values after the start of intake. It’s an affordable, safe, and fast method of checking pressure levels from home. That said, here are some questions about hypertension medications:

What is the recommended dosage?

The dose is regulated by the specialist based on age, previous conditions, weight, interaction with other drugs, and severity of blood pressure levels. If the patient doesn’t develop improvements or the side effects are very persistent, a dose adjustment can be made.

You should never make an adjustment on your own. If through a digital blood pressure monitor you realize that the values are high, consult with your trusted specialist without abandoning the treatment you are currently maintaining.

What should I do if I forget to take the drug?

It’s recommended that you take the medicine as soon as possible, unless the next dose is very close (less than 12 hours away). In these cases, you shouldn’t take it, as you could cause an overdose of the drug in your body. This can lead to worsening side effects or dangerous reactions in the heart or kidneys.

What should I do in the case of an overdose?

You should go to a medical center as soon as possible, as, depending on the group of antihypertensive drugs, the prognosis can be even fatal. Beta-blocker overdose, for example, is one of the most dangerous. In the medical center they will carry out a series of tests destined to corroborate the severity of the episode and its consequences in the body.

How to store or dispose of hypertension medications?

Always keep the medicine in a dry place, away from moisture or the sun. Try to keep the temperature between 15 and 30 degrees Centigrade (59 to 86 F) and ensure the tightness of the containers. Keep them out of the reach of minors, especially if you live with babies or very young children. If, for some reason, you need to throw them away, you should do so in a sealed bag in a garbage container.