Excerpted from "What's New with Your Blood Pressure?", Stroke Connection Magazine September/October 2003 (Science updated July 2008)When diet and exercise aren’t enough to control high blood pressure, doctors prescribe one or more types of medicines. Doctors choose medications carefully to match patients’ profiles.
The major types of high blood pressure medicines include:
- Lower blood pressure by helping the body get rid of excess fluid.
- Generally the doctor’s first choice and the least expensive.
- Often used in combination with other medicines.
- Block adrenaline from binding to heart muscle, lowering the pulse.
- Also used to treat heart disease, migraine headaches and heart palpitations.
- Work much like beta-blockers to reduce adrenaline’s effect on heart muscle.
- Used for other medical conditions such as prostate problems.
Calcium Channel Blockers
- Open blood vessels by reducing the flow of calcium ions into vessel walls, allowing blood to flow more easily.
- Relax your arteries by neutralizing a hormone that constricts vascular walls.
- Help control congestive heart failure, other heart problems and diabetes.
Angiotensin II Receptor Blockers
- Work similarly to ACE inhibitors by blocking angiotensin, but don’t produce a persistent, dry cough, a side effect of ACE inhibitors.
- Open the blood vessels and allows blood to flow more easily
The PROGRESS study showed that an ACE inhibitor called perindopril reduced the rate of ischemic and hemorrhagic stroke by about one-third in patients who’ve already had strokes. On average, systolic blood pressure (top number) went down by 10 to 12 mm Hg and diastolic was reduced by 5 to 6 mm Hg. A combination of indapamide (a diuretic) and perindopril was even more effective.
An NHLBI study that involved more than 42,000 people with hypertension (not just stroke survivors) found that diuretics, the oldest and cheapest high blood pressure medication, were more effective than newer, more expensive drugs.
The study concluded that:
- Because thiazide-type diuretics are more effective and cost less, they should be the drugs of choice for first-step antihypertensive therapy.
- For the unusual circumstance when a patient cannot take a diuretic, calcium channel blockers and ACE inhibitors may be considered.
- Most hypertensive patients require more than one drug. Diuretics should generally be part of the antihypertensive regimen that includes lifestyle changes, such as a modified diet and regular exercise.