When reading through these notes, be aware that it is very common for doctors to prescribe a combination of these drugs rather than just one, because in this way, they can keep the dosage of each drug relatively light instead of prescribing a large dose of just one treatment.
Research and empirical evidence has suggested that a combination of relatively small dosages of several different medicines is often far more effective than a large dosage of just one, hence many doctors will adopt this approach.
When you first visit your doctor to seek medical attention for high blood pressure problem, you must always tell them your full medical history, focusing in particular on liver or kidney problems, diabetes, gout, allergies and urinary problems. All of these conditions may have some effect on the medicines that your doctor prescribes, so it is absolutely essential to make sure that they are in possession of a complete medical history before you seek medical treatment for high blood pressure.
Diuretics
Thiazide diuretics are medications that help your kidneys expel sodium and water which in turn helps to reduce blood volume. In many cases, diuretics are often the first medicine that will be prescribed to deal with hypertension because it is very common to find that reducing the amount of fluid in the body is an effective way of reducing blood pressure at the same time.
Drugs of this nature can make you dizzy and lightheaded, particularly when you first start taking them. Blurred vision, a loss of appetite, headaches and a general feeling of weakness and ennui may be encountered, especially in the early days, but these feelings should pass relatively quickly. If they do not do so, you need to report the fact to your doctor as he (or she) may need to change the medication.
Beta blockers
Beta blockers work by reducing the workload on your heart whilst also opening up your blood vessels at the same time. In this way, they cause your heart to beat more slowly and with less force which obviously reduces your blood pressure. For some people, beta blockers on their own are not especially effective for reducing hypertension but they are more effective when taken in combination with diuretics.
There are many different beta blockers that you doctor may prescribe including Acebutolol (Sectral), Bisoprolol (Zebeta), Nadolol (Corgard) and Propranolol (Inderal LA) to name but a few.
In general, all of these medicines have the ability to make you feel dizzy, listless, lightheaded and generally fatigued. As they also reduce your blood pressure, you might also find that you suffer from cold hands, fingers or toes as the blood flow to the extremities of your body gradually decreases with the lowering of your blood pressure.
Less commonly, patients who are taking beta blockers sometimes experience difficulty sleeping, a shortness of breath, depression and a lack of sex drive.
Once again, all of these side-effects should wear off relatively quickly so if they do not do so, you need to consult your medical attendant to seek further attention.
Angiotensin-converting enzyme (ACE) inhibitors
These are medicines that help to relax your blood vessels whilst also making them more flexible by inhibiting the growth of a natural chemical that otherwise restricts blood flow through these vessels by narrowing them. ACE inhibitors are another group of medicines that work best when taken in combination with diuretics rather than on their own.
Another closely related group of medicines are the Angiotensin II receptor blockers which limit the production of Angiotensin II. This is another powerful chemical enzyme which your body produces that tightens the muscles surrounding your blood vessels, thereby constricting them.
Hence, by taking inhibitors that limit the production of both Angiotensin and Angiotensin II, you minimize the risk of your blood vessels being narrowed as they would be if you were not inhibiting the production of these enzymes.
In both cases, your doctor is unlikely to prescribe either of these inhibiting medicines if you are pregnant or if you have suffered (or are still suffering) renal arterial stenosis. Furthermore, anyone else who has previously suffered a strong reaction to ACE inhibitors of any kind is probably best advised to avoid taking them.
For other people, the most common side-effects of taking these inhibitors are coughs, headache, weakness, drowsiness and rashes. In some people, the side-effects can be tasted as normal food or drink tastes become excessively salty or metallic, whilst ACE inhibitors will sometimes reduce blood pressure too far and cause elevated potassium levels.
In all of these situations, should adverse side effects arise, you must seek immediate medical attention.
Renin inhibitors
Renin is a natural chemical enzyme that regulates the mean arterial blood pressure of your body. If you have too much renin being produced, it leads to high blood pressure, so taking a renin inhibitor such as Aliskiren (Tekturna) slows down the production of the enzyme and therefore helps to reduce hypertension.
The drug works by stopping rennin from starting the processes that lead to the increased production of blood. However, as Tekturna is still a relatively new arrival on the market, it is still being studied to ascertain ideal dosages and long-term effects.
For the same reason, the possible adverse side effects of taking the drug are not completely established or understood either although it is suggested that the most common side-effect is likely to be diarrhea, although other people have suffered allergic reactions – swelling in the face and lips – or rashes.
On the flipside of the coin, it is reported on the Medical News Today website that this particular drug might have additional benefits for people whose hypertension is a result of being overweight or obese.
Calcium channel blockers
Calcium channel blockers are an effective treatment for hypertension in older people or those who have difficulty reducing their sodium intake as they work by slowing your heart rate whilst also relaxing the muscles in the blood vessel walls at the same time. Through this combination of effects, calcium channel blockers reduce the amount of blood being pumped around the body whilst also ensuring that restricted blood vessels do not increase pressure either.
Drugs like Amlodipine (Norvasc), Enalapril Maleate-Felodipine ER (Lexxel) and Nisoldipine (Sular) can all cause dizziness, light-headedness and headaches as well as fluid buildup in the legs and intermittent rapid heart rate. In addition, other calcium channel blockers such as Diltiazem (Cardizem SR, Dilacor XR, Taztia or Tiazac) and Verapamil (Calan SR or Isoptin SR) have been known to cause slow heart rates and constipation.
If these are not effective…
When you first visit your medical attendant with a hypertension problem, it is likely that between the two of you, you will set a goal, a level to which you want to bring your blood-pressure numbers down.
In general, it is likely that your doctor will prescribe a combination of the drugs already highlighted in this chapter and that if you choose to use these pharmaceutical chemical-based drugs, you may well reach your objective. If however you do not, there are other drugs that your doctor might describe in an attempt to bring your blood pressure figures down to a level at which you are both satisfied.
These drugs might include alpha blockers which reduce the effect of natural chemicals in the body that would otherwise cause blood vessels to contract or alpha beta blockers such as Carvedilol (Coreg). It has been reported that these drugs may have adverse side effects such as dizziness, diarrhea, dry eyes, depression and tiredness in the case of alpha blockers and nightmares plus panic attacks caused by carvedilol.
Another alternative that your doctor may prescribe are Vasodilators, drugs that work on the muscles in the blood vessel walls to prevent them tightening which would in turn increase blood pressure.
Commonly reported side-effects of taking vasodilators include dizziness, headaches, diarrhea and a loss of appetite. In more extreme cases, these side-effects might extend to chest pains, muscle and joint pain, bloating, fever and a sore throat. In all cases of adverse side-effects, you must always seek medical advice as soon as possible.
In addition, the best known and most commonly prescribed vasodilator Minoxidil may cause an increase in hair growth on the face, head and body. Some people may find troublesome or unpleasant.
If you hit your target… ?
As suggested, when you first consult your medical attendant about your hypertension, it is likely that they will give you a goal, systolic and diastolic numbers to which they want you to reduce your blood pressure to.
If you manage to successfully hit this target, many doctors will suggest that you take an aspirin every day to keep your blood pressure levels down in the future. If you do so, this is unlikely to cause any major problems for the vast majority of people, but you should nevertheless be aware that even the humble, common or garden aspirin can have adverse side-effects, particularly if taken on a long-term basis.
As it is likely that your doctor will expect you to take your aspirin every day for the rest of your life, there could not be a situation which defines ‘long-term basis’ more accurately. You should therefore be aware that long-term use of aspirin has been shown to increase the risk of gastrointestinal bleeding, plus a few people have been known to suffer allergic reactions such as hives, rashes or swelling due to salicylate sensitivity.
Far more rarely, taking aspirin has caused some people to suffer Reye’s syndrome, a potentially fatal condition that causes damage to many organs, particularly the liver and brain.
Whilst suffering an adverse reaction to aspirin is not something that 99% of people will need to concern themselves with, you should nevertheless be aware that there are people who are aspirin intolerant.
To sum up medical treatment for hypertension…
As suggested in this chapter, the majority of medical treatments that might be prescribed to combat hypertension do have potential side-effects.
In most cases, these side-effects are likely to be relatively mild and temporary but this fact is never a guaranteed given. Some people will suffer far more serious adverse side-effects whilst others will find that their side-effects linger considerably longer than expected.
The bottom line is, as with all chemical-based pharmaceuticals, there is always a risk of adverse side-effects ranging from extremely mild – almost unnoticeable – to very severe and those side-effects can be purely temporary or they might last longer than you expected.
It is also extremely pertinent to repeat that none of these medical treatments for high blood pressure deal with the central problem, instead being focused on reducing the severity of the symptoms.
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