When you’re diagnosed with high blood pressure, changes to your diet and fitness regimen might not be enough. Your next option might be medication.
A daily dose of medication might make a big difference toward your health.
“The baseline is 120 over 80. Anyone below that has normal blood pressure,” said Avera Medical Group internal medicine specialist Comfort Agaba, MD, MPH. “If your blood pressure is above that, over an extended period, you should work with a doctor to make changes.” Usually a month’s worth of checking it can give you – and your health care provider – a good look at your blood pressure.
Agaba said long-term higher blood pressure can lead to:
“We will begin treatment with medications, but it always depends on the patient,” Agaba said. “Age and other factors come into the equation, but so do the numbers.”
If your blood pressure is above 180, it’s a medical emergency. If it’s in the 160/100 range, medication can help, but the right medication for you depends on many things, ranging from gender to age, possibility of pregnancy and more.
“It is a puzzle, since not every side effect happens in the same way with different patients,” said Agaba. “Another factor is behavioral health, since some of those medications affect the way blood pressure meds work.”
Agaba said many patients tell her about an ad they read or saw online. It often leads to questions about specific medications. “We always want to look at what is best for you, not what’s being promoted in pharma marketing,” she added.
Treating High Blood Pressure with Medication
High blood pressure is a varying issue, and doctors always develop individualized care for each patient. Each medication has strengths and weaknesses. Options include:
- Water pills: These drugs help remove sodium and water from the body. Sometimes called diuretics, they’re usually among the first medicines used to treat high blood pressure. Your doctor will consider your blood pressure and other conditions, especially ones related to heart and kidney function, before prescribing.
- Beta blockers: This group of drugs slow your heartbeat, and as a result, could reduce blood pressure, since the heart doesn’t have to work as hard. Beta blockers usually work best when combined with other blood pressure drugs.
- ACE inhibitors: Angiotensin-converting enzyme, or ACE inhibitors make blood vessels relax and stop natural chemicals from building up. Those chemicals can shrink blood vessels. ARB inhibitors are like ACE inhibitors, and sometimes in this group. They change how arteries and veins work.
- Calcium channel blockers: Blood vessels have their own muscle; medications like this work to relax those tiny muscles. Some could specifically affect the heart and can slow heartbeat. Other calcium channel blockers affect only blood vessels outside the heart. Usually, this group of meds only has an effect on blood pressure.
- Nitro medications: These fast-acting drugs will lower blood pressure, especially for patients experiencing chest pains.
Keep your provider informed on how treatment is going; high blood pressure can affect the function of your heart, liver and kidneys. You’ll usually take an initial medication for a few months, to see how it affects your blood pressure. Your provider usually won’t add another medication until seeing how you do with the first one.
Other Drugs That Help with Blood Pressure
Other medications are also used to help people control their high blood pressure. The addition of more than one medication can do good things for patients who are not having success with the first.
Some medications include:
- Alpha blockers: These drugs lower the effects of natural chemicals that narrow blood vessels.
- Alpha-beta blockers: Alpha-beta blockers do double duty, with lessening blood vessel narrowing as well as slowing heartbeat.
- Renin inhibitors: Your kidneys make renin, and it can cause chemical changes that lead to increased blood pressure. These meds slow them.
- Vasodilators: These medicines stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing.
“Drug interactions are a threat, so it’s important for us to work closely with the patient and thoroughly understand all medications they take,” said Agaba. This includes medications you don’t take every day, such as Viagra, which can cause serious health problems for patients who take it when using meds for blood pressure, especially nitro medication.
How Doctors Treat Resistant Hypertension
Resistant hypertension is blood pressure that remains above 140/90 despite optimal use of multiple medications. "These patients are more likely to have a secondary cause," Agaba said. "They also face higher risk of end-organ damage." Agaba said step-by-step approaches, such as multiple daily medications including stronger versions already in use, can help against this stubborn form of high blood pressure.
“It’s a step-by-step approach when hypertension is resistant to more common approaches,” she said. “It can be overcome; it just requires more effort from the patient and provider.”
Talk to your primary care provider about your blood pressure. If you don’t have one, you can find a doctor near you for yearly checkups to manage changes in blood pressure.
