Medication Treatment

There are a large number of medications available to treat high blood pressure. Physicians choose the most appropriate medication by taking into consideration age and other health factors involved.

Different groups of antihypertensive medications include:

1. Diuretics
2. Beta Blockers
3. Angiotensin converting enzyme inhibitors (ACE Inhibitors)
4. Angiotensin II Receptor Antagonists (ARBs)
5. Calcium channel blockers (CCBs)
6. Alpha blockers
7. Vasodilators

When the first line (most appropriate) medication is chosen, the dose may need to be increased to a moderate level to bring the blood pressure under control. If the blood pressure is lowered, but continues to remain above the desirable level, a second medication should be added from a different group, rather than the first drug being substituted. The majority of hypertensive patients require combinations of two or more medications for optimum blood pressure control. Many blood pressure medications can be used together with the possible exception of ACE Inhibitors and ARBs.

The advantage of combining medications is:

• it often allows medications to be given at lower doses thereby reducing side effects
• by giving medications from different groups hypertension can be relieved through more than one pathway making treatment more effective.

What are some factors affecting medication choice?

Selection of medication combinations must be individualized for each patient.

Diuretics, Beta-blockers, ACE Inhibitors and ARBs are all good first line anti-hypertensive medications. Calcium Channel blockers can also be used as first line agents, but are more often used in combination with other medications. Age, disease states, cost, side effects, drug interactions, and which combinations are most effective together all influence a physician's choice of medications. For instance, a diuretic or CCB are more effective when combined with a Beta blocker, ACE Inhibitor or ARB than with each other.

The following table shows just a few of the factors affecting choice.

Disease	First Choice	Second Step	Note
Uncomplicated Hypertension	Diuretic Beta Blocker age < 60 ACE Inhibitor ARB or Long Acting CCB	One from another group
Systolic hypertension only	Diruetic Long acting CCB or ARB
Diabetes	ACE inhibitor or ARB	Diuretic Beta blocker or Long Acting CCB
Stable Angina	Beta Blocker	ACE Inhibitor Long Acting CCB
Prior Myocardial Infarction	Beta Blocker ACE Inhibitor
Renal Disease	ACE Inhibitor	Diruetic
Depression			Do not use
Asthma Heart Block			Beta Blockers
Migraines Tremors Rapid Heart Rate	Beta Blockers may be a helpful choice
Bilateral renal artery stenosis			Don not use Ace Inhibitors

Medication Treatment Tips

• Take medications regularly, exactly as prescribed.
• Do not stop medications abruptly without consulting your health care provider. Some antihypertensive medications must be tapered slowly.
• Do not take non-prescription or herbal medications without first consulting your healthcare provider.
• If you forget to take your medication, take it as soon as you remember, unless it is close to the time of your next dose. Do not double up on doses.
• Do not let yourself run out of medications. Get your medication filled a few days early if your pharmacy is closed on weekends or holidays, or if you will be away on vacation.