Treatment of Hypertension, Part 1

The goal of the treatment of hypertension is to reduce blood pressure to normal or optimum levels thereby reducing the risk of serious complications. The treatment approaches used by healthcare professionals include:

• Use of prescription medication
• lifestyle changes

PRESCRIPTION MEDICATION

Several antihypertensive medications are available today for the treatment of hypertension.

Although these medications have been known to induce marked therapeutic responses, their use is not altogether without side effects. It is important to note that combining lifestyle modification and use of prescription medication increases the likelihood of achieving blood pressure control. The antihypertensive medications commonly prescribed by physicians include:

1. Diuretics - the diuretics aid the kidneys in removing salt and water from the body. This results in a reduction of blood volume and consequent reduction of blood pressure. The 3 types of diuretics in use today are:

A. Thiazide diuretics (such as hydrochlorothiazide) have been used to treat hypertension for over three decades. They have a long lasting effect and are particularly indicated in elderly hypertensives. However, these drugs work poorly if liver and kidney functions are compromised. They also deplete potassium stores in the body and increase blood sugar and cholesterol levels. Not indicated for diabetics and persons with gout.

B. Loop diuretics - (such as furosemide) are the most potent diuretics but their effects are not as long lasting as the thiazide diuretics. They are particularly useful for individuals unresponsive to thiazide diuretics. Excessive use of loop diuretics can result in dehydration and depletion of potassium and magnesium levels. Loop diuretics are not indicated for persons with renal failure and producing little or no urine.

C. Potassium sparing diuretics- (such as amiloride and spironolactone )- are weak diuretics and reduce potassium excretion by the kidneys. They tend to increase potassium levels and should be used in combination with other diuretics.

2. Beta receptor antagonists - (such as atenolol and propranolol ) work by reducing the heart rate and the force of contraction of the heart. They also indirectly cause relaxation of blood vessels. Their side effects may include nausea, reduced blood sugar levels, vomiting, depression, confusion and sexual dysfunction. Beta receptor aantagonists (also known as beta blockers) not indicated for persons with asthma, diabetes, heart failure and airway diseases.

3. Calcium channel blockers - (such as nifedipine, amlodipine, and verapamil). Work by causing dilatation (relaxation) of blood vessels. Relaxation of blood vessels has a direct effect of lowering blood pressure. Their side effects may include flushing, dizziness, nausea, headaches, itching, and constipation.

4. Angiotensin converting enzyme (ACE) inhibitors - (such as captopril, lisinopril, enalapril and ramipril). These drugs work by decreasing the production of a certain chemical in the body that could potentially elevate blood pressure. They are particularly useful for persons with diabetes and heart failure. Side effects may include chest pain, cough, headaches, dizziness and nausea. These drugs should be used cautiously in persons with impaired kidney function.

5. Angiotensin ii receptor blockers - (such as losartan and valsartan) these drugs were first discovered 15 years ago and work by blocking the effects of a certain chemical in the body that could potentially cause an increase in blood pressure. They are useful for patients with type 2 diabetes and heart failure. Side effects may include cough, depression, dizziness, nausea and fever.

6. Vasodilators (such as hydralazine, fenoldopam and sodium nitroprusside) - these drugs work by relaxing blood vessels thereby lowering blood pressure. Hydralazine is particularly useful in moderate to severe hypertension, hypertensive crises and hypertension associated with pregnancy. Side effects may include an increased heart rate, nausea, vomiting and headaches.

NOTE: these drugs should be used ONLY after consultation with a health care professional.

Reduction of systolic blood pressure to <>