The BP measurement for some people who have developed high blood pressure can be controlled with the help of lifestyle alterations. Before the beginning of the treatment for blood pressure, it is important to understand the various possible treatment methods that are available to you.
If the person has already high blood pressure or is developing high blood pressure, the changes in the lifestyle can help in lowering the blood pressure. The individuals who are known to have prehypertension have systolic pressure that exists between 120 to 139 mm Hg. These individuals have diastolic pressure that ranges from 80 to 89 mm Hg. The physician who prescribes medications for the patient will also simultaneously ask the person to make changes in his/her lifestyle. The necessity of taking the drugs can be eliminated with the lifestyle changes to manage the high blood pressure. Some of the alterations that have to be done to reduce the blood pressure are maintaining healthy body weight, ceasing to smoke, eating healthy diet that includes vegetables, low fat dairy products and fruits, reducing salt content in the food, limiting the alcohol consumption per day, and doing exercise for at least half an hour per day. Following these steps might help the hypertensive patient to avoid taking high blood pressure drugs. But, if the person is suffering from prehypertension along with heart disease, diabetes and kidney disease, the physician will prescribe drugs that will control the blood pressure of the patient.
Drugs for primary stage hypertension (140/90 and 159/99)
The stage I high blood pressure has the systolic pressure of 140 to 159 mm Hg and the diastolic pressure of 90 to 99mm Hg.
These drugs are called as water pills. The diuretics function by removing more water and sodium from the body and further lower the blood pressure. Along with the lifestyle changes, diuretics will help in controlling the blood pressure.
Thiazide diuretic belongs to the drug type called diuretics. Thiazide diuretics have very few side effects compared to other type of diuretics. The diuretics will provide protection against the medical conditions caused by high blood pressure like heart failure and stroke.
Angiotensin converting enzyme inhibitors
The blood vessels can be widened by avoiding the functioning of the hormone known as angiotensin on the blood vessels. The ACE inhibitors that are frequently prescribed include Lisinopril (Zestril and Prinivil), ramipril (Altace) and captopril (Capoten).
Angiotensin II receptor blockers
This drug helps the blood vessels to relax by inhibiting the angiotensin action. The angiotensin receptor inhibitors that are often prescribed are olmesartan, losartan and valsartan.
These drugs function by inhibiting nerve signals and hormonal signals that travel towards the blood vessels and heart in turn reducing the blood pressure. The beta blockers that are prescribed often include nadolol (corgard), metoprolol (Lopressor, Toprol XL) and penbutolol (Levatol).
Calcium channel blockers
These medications will stop the admission of calcium into the muscular cells present in the heart as well as blood vessels. This action will make the cells to relax and it reduces the blood pressure. The calcium channel inhibitors that are prescribed very often for hypertension are nifedipine (Adalat, Procardia), amlodipine (Norvasc) and diltiazem (Cardizem, Dilacor XR).
The kidneys produce enzyme called renin that begins the sequence of chemical steps which enhances the blood pressure. The renin production speed is reduced by Aliskiren, which decreases the ability of the renin to start the process. The Aliskiren has a risk of causing serious complications like stroke when used along with ACE blockers and ARBs.
Any of the above medications are recommended along with diuretics instead of prescribing diuretics alone because the combination will lower the blood pressure rapidly. The use of drug combinations can reduce the risk of developing the complications due to high blood pressure. If the combination of drugs are used it is also possible to take smaller doses of these drugs, can encounter fewer side effects and also can spend less amount for the treatment. The specific circumstances of the individual will determine the type of combination of the medications that can be used.
Drugs for secondary stage hypertension (greater than 160/100)
In the case of stage II high blood pressure, the systolic pressure will be higher than 160 mmHg and the diastolic pressure will be higher than 100 or 100mmHg. The treatment for this condition might require two blood pressure medications.
Unlike in the case of stage I hypertension where the patient will be prescribed with thiazide diuretic along with life style changes, in stage II hypertension compulsory prescription for the other type drugs along with the diuretics will be given. In case no medication that is mentioned above is able to serve the purpose of lowering the high blood pressure then the physician might prescribe the drugs such as alpha blocker, methyldopa and vasodilator or central acting agent.
In about fewer than half of the cases single drug is found to be sufficient to reach the target blood pressure level. Commonly, two drugs are necessary to bring the blood pressure to the target levels. In one-third of cases three drugs are suggested to make the blood pressure to reach the target levels. It is suggested to take combination of drugs for rapidly reducing the blood pressure so that further complications like arterial damage, kidney failure and heart failure can be prevented.
The best combination of medications
If the patient is not suffering from any other medical problems, then the combination of hypertension medications that are recommended by the UK guidelines are given as under. The treatment for hypertension according to these guidelines includes the combinations of A/C, A+C+D, A+C.
- For the people who are below 55 years of age and are neither Caribbean's nor black Africans, then the treatment suggested for them is giving ACE blockers or ARBs.
- If the people are either Caribbean's or black Africans and they are above 55 years of age, then the treatment has to start with calcium channel blockers. If the blood pressure is not controlled, then ACE inhibitors are used in combination with Calcium channel blockers.
- If the target BP is not reached then it is better to try using ACE inhibitors, calcium channel blockers and diuretics all together.
- The fourth medicine if necessary might include another diuretic, beta blocker and alpha blocker.
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