When I was a kid my mother used to say that I was ‘about to make her blood pressure go through the roof.’ Technically, I had no idea what she meant; I suspect she didn’t either. But I knew the underlying meaning. She was annoyed or upset and I was the source. These days I have often found myself thinking the same words. It could be news on recent wildfires, climate change issues, Covid numbers and promised vaccines, or just plain politics.
So far, my pressure numbers don’t reflect my attitude. Lucky me. Almost one out of every 3 Americans find they are not controlling blood pressure without meds or a good deal of effort. That means someone close to you is dealing with this issue, a neighbor, family member, spouse or yourself.
Months back, I wrote an article “10 Tips to Make you SMILE about Blood Pressure. Fun & Easy” Part 1 and Part 2. I refer you back to those articles for at-home self-help. At the time I contemplated that down the road I might cover medicinal remedies (anything that goes in your mouth). I am now down the road enough to finish that thought, and cover some conventional and alternative approaches.
As I started to envision the task of discussing convention and alternative remedies, I reached that ‘daunting’ stage that describes many new tasks. I am (maybe obviously) more comfortable with alternative approaches. Still, I felt the need to educate myself more about conventional avenues. It has turned out to be even more painful than I expected. ONEROUS. ARDUOUS. I will have to save a review of alternative remedies for another time – even further down the road.
In the meantime, I am simply sharing with you what I have learned – whittled down as much as possible while still informative. It’s not my specialty, but figured you could learn along with me. Most importantly it allows you to address questions and concerns to your health care provider more clearly.
To start, I want to “cut and paste” a couple elementary points about Blood Pressure (B/P) covered in the previous posts.
“Must Say” Points about Blood Pressure
1. Why is B/P important? Even when it is outrageously high, we feel no symptoms or pain. Yet, if “left unchecked” it can easily lead to stroke… heart attacks…major vision problems… later dementia… and kidney disease.
2. The two numbers can sound confusing, but that’s just medical lingo. What do they mean? Here is the scoop to remember:
Heart pumping (top/high number or systolic)
Heart resting (bottom/low number or diastolic)
3. Typically these days, “norms” have been changed from 140 (systolic) to 150 for people over age 60. Blood pressure rises significantly as we age, and this modification to the acceptable normal reading certainly helps avoid stress and worry. But studies have found that still striving for 130, cuts the risk of heart failure, a non-fatal heart attack or a stroke during a 5 year period by 33%
For those over age 60, and already on meds, this ‘striving’ may not be advised if it means adding another drug. Consider carefully.
Two Concerns Shared by Alternative & Conventional Providers
Sleep Apnea Treatment
Before beginning a conventional remedy (meaning a drug) for high B/P, you should speak to your provider about one other possible situation — the diagnosis and treatment of sleep Apnea. It’s speculated that sleep apnea (interruptions in breathing while sleeping) may cause or exacerbate B/P problems. Treating sleep apnea may, in time, resolve high B/P issues.
Smoking
I was remiss in not addressing smoking in my previous posts. It’s so second-nature to me, realizing that smoking is GOOD FOR NOTHING, that I often overlook it. Whether we are discussing conventional or alternative treatments, it’s a No-No. More strongly, it’s an anathema shared by both types of health care providers.
But WHY include it in this post? Smoking will cause spiking of the B/P, ‘spiking’ being an immediate but temporary increase of both B/P and your heart rate. Additionally, chemicals in tobacco damage the walls of blood vessels (causing vasoconstriction and inflammation). The old term “hardening of the arteries” (damage to the vessels) carries a descriptive label and again affected by tobacco chemical. It also causes higher B/P.
If that is not enough, adults should think of kids around them. Secondhand smoke can affect many of us, but one study showed that children living in homes with smoke had higher blood pressure than those from nonsmoking homes. I appreciate the push to eliminate secondhand smoke. As a child, I could barely breathe in the family car once my mother or father would ‘light up.’
Conventional Approach to B/P
No longer will your health care provider simply put you on a B/P medication without attempts at addressing the problematic condition with life style changes. That is, unless the results of your B/P readings are dangerously high, putting you at serious jeopardy, or there are other special circumstances. But whether you are ‘currently ok’ and attempting to make intentional changes, or already being prescribed medications, your B/P should be monitored regularly. Hey, doesn’t that mean all of us? Yes. And it may be especially true for anyone reading a blog called Aging with Pizzazz.
You can have blood pressure too low. It’s possible. This is particularly true for those on medications. Doesn’t sound scary at first, but your B/P may not be strong enough to pump blood to the brain. And plop! You stand up, get dizzy, fall and fracture a hip. So it IS serious. This low B/P condition is known as orthostatic hypotension and is another good reason for monitoring B/P even when on medication for it (actually, especially then).
Conversely, some OTC medications can raise your B/P enough (maybe 3-6 points) that they can add to the risk of a cardiovascular attack. Surprisingly, aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) can contribute to this rise if taken regularly. NSAIDS also include Motrin, Aleve or Advil. But they aren’t the only problematic OTC purchase. Also watch out for cold medications that contain pseudoephedrine. These can cause dangerous vasoconstriction (narrowing and constricting of blood vessels) explained in the previous posts.
There are numerous B/P lowering drugs; I will briefly explain the categories below. However, as anyone who regularly reads AgingWithPizzazz knows, I do not advise on medication [or ‘advise’ on many products at all.] That’s not just to avoid liability; I am simply not that well-versed on ever-changing conventional medications. I have made every attempt at correct spelling of drugs and brand names, but warn that any error is unintentional and the reader should check beyond this information. So, let this serve as an official disclaimer to say that the post is not a substitute for medical advice from your provider. Still, I will share my overview reference of the many options presented to people for B/P treatment.
It is not uncommon for patients to be prescribed more than one drug for B/P. If you are taking more than one your doc will often choose medications from different classes (to avoid a situation of diminishing returns).
These medications have great benefits for some, especially those in urgent need or without the time or commitment to address problems in some other way. Even allopathic (conventional) providers, take a hard look at life-style issues and other options before having you jump on the drug cart (otherwise known as the band-wagon). But at times, there is no other way.
Side Effects
Chances are you are going to find yourself dealing with side-effects. That’s a trade-off for life-preserving medications. If I were taking any of these (or other) meds, I would keep a log of side-effects. Tracking the frequency and severity of reactions will be helpful for your health care provider in determining if any one drug is best (or bad) for you. Tolerance of each chemical can not be assured for everyone; people respond differently. Thus following your own reactions is a responsibility only you can take on; I highly suggest that it is worth your time.
An Important warning about side-effects or drug interactions. If they persist or create unusual feelings for prolonged periods (although that can mean even minutes if something serious), do NOT simply reduce or stop the drug yourself. Doing so can cause B/P spikes in some people. Definitely call your provider’s office. In the meantime, prepare ahead, before suffering negative reactions. Patient safety information is best reviewed PRIOR to taking a specific medication (especially facts about dosing, drug interactions and side effects), so you can be on alert.
Conventional B/P Medications
I promise I won’t go into these B/P drugs in great detail. Admittedly, this is not just to avoid boredom, but partially out of unfamiliarity and because the chemical information and reactions are formidable. Still, I want to mention a few drugs in each category to offer some broad understanding (about function and side-effects) for the person in your life touched by these choices.
In NO WAY, is this meant to be a complete list or account of all B/P medications, nor a medical primer to learn in detail. I realize that this is longer and drier than most of the issues we cover, but I do hope you will keep it as a general reference to share with others when necessary.
If you or a loved one is considering help on controlling B/P, do some of your own research before talking to your health care provider about the pros and cons.
Different Types of Blood Pressure Medications
Classes of Blood pressure medications include the following (simply follow the link to any category you want to read the overview on):
- Diuretics
- Beta-blockers
- ACE inhibitors
- Angiotensin II receptor blockers
- Calcium channel blockers
- Alpha blockers
- Alpha-2 receptor agonists
- Central agonists
- Peripheral adrenergic inhibitors
- Vasodilators
Diuretic
Often patients will be started on diuretics, which the rest of us call a “water pill.” As the common name implies, ‘water pills’ remove excess water and sodium (salts) from the body. They may be an ‘old’ class of hypertension meds, but still valuable and used widely. An estimated 12% of US adults were taking a diuretic prescription in 2012 (a 1.4% increase from 12 years earlier). Often they are used in combination with other prescription therapies.
Two types of the Diuretic class are most common: Thiazides and Loop diuretics.
Thiazides
Thiazides tend to be used more often than stronger types of diuretics (such as the loop variety). Based on meta-studies, low-dose diuretics seem most reliable for those with a higher prevalence of salt-sensitive hypertension like Blacks, the elderly, obese and many with diabetes. Thus thiazide-type medications are generally the most common and first-line choices of clinicians.
Thiazides reduce cardiac output (technically by decreasing salt absorption, increasing urine fluid loss and thus reducing extracellular fluid and plasma volume). This affects how hard the heart has to work to pump blood around the body. Thiazide has other functions, but lowering B/P is the prime action.
A list of Thiazide diuretics in this most common category (tracked by Drugs.com) includes some of the following:
|
|
The drug is a generic version of the popular sexual support websites stock these products and the most famous promoted in the web as generic substitute for http://cute-n-tiny.com/category/cute-animals/page/70/ cialis without prescription is the Kamagra, a product of Ajanta Pharma Limited – one of the fastest working jellies designed to help men achieve erection within just 15 minutes. Also, he would keep a tab upon the treatment and its subsequent medication. tadalafil overnight shipping is an expensive but extremely effective medicine which has made it a sure shot cure for erectile dysfunction or impotency in men. Unless you never watch TV, it is almost impossible for missing up cialis 40mg 60mg their commercials. Beyond making a purchase via viagra france check.com, “another way to buy both is online.
A typical combination cocktail is Hydrochloothiazide (a thiazide diuretic including brand names above) often used with Lisinopril (an “angiotensin converting enzyme inhibitor” – see later).
Loop Diuretic
Furosemide is one of the most common loop-diuretics, even if not prescribed as much as Thiazide diuretics above. Technically sub-categorized as a “sulfamoylanthranilic-acid derivative”, Furosemide is a “loop diuretic,” preventing too much salt absorption. It’s used to treat more than heart failure, also treating liver disease, certain kidney disorders, and edema (fluid retention). It’s a potent mediation (the active ingredient in Lasix brand), and needs to be supervised carefully.
Loop diuretics like Furosemide can result in profound water and electrolyte depletion and have numerous side effects. Notably, not each of the side-effects is THAT common, and often self-regulating (meaning it may subside on its own). To be sure, even self-regulating side-effects should be recorded in your log. (See these specific side-effects below.)
While complaints about urination are MOST common with diuretics, others noted above must be watched.
An excellent article on the overview of diuretics (first published a couple years ago) is “Diuretics for Hypertension: A Review and Update”
Beta-blockers
Beta-blockers lower B/P by reducing the heart rate (reducing the heart’s workload). The same diuretic mentioned above as part of a drug cocktail can be used with a beta-blocker as well (namely hydrochlorothiazide and the beta-blocker, bisoprolol).
As with any medications, beta-blockers can carry possible side-effects. Aside from special alerts to those with diabetes (and taking insulin) or who are pregnant (or considering pregnancy), below are commonly found problems:
- Asthma-like symptoms
- Cold hands and feet
- Heartbeat slowed
- Insomnia
- Impotence possibility
- Tiredness or depression
—–
—–
For your research efforts, some of the common beta-blockers are listed below, alphabetized by brand name:
- Betapace (generic solotol hydrochloride)
- Blocadren (generic: timolol maleate)
- Cartrol: (generic: carteolol hydrochloride)
- Corgard (generic: nadolol)
- Inderal (generic: propranolol hydrochloride)
- Kerlone (generic: betaxolo)
- Levatol (generic: penbutolol sulfate)
- Lopressor (generic: metoprolol tartrate)
- Sectral (generic: acebutolol)
- Tenormin (generic: atenolol)
- Toprol-XL (generic: metoprolol succinate)
- Visken (generic: pindolol)
- Zebeta (generic: bisoprolol fumarate)
ACE Inhibitors
An ACE inhibitor (or Angiotensin-Converting Enzyme inhibitor) is a type of medication that works to prevent a hormone reaction. It prevents Angiotensin II from being produced (that is a hormone that can cause us problems as it raises blood pressure by narrowing vessels and causing the heart to work harder). ACE Inhibitors are considered prevention to early death from heart attacks, other heart failure or hypertension.
Those who don’t respond well to ACE inhibitors when used alone (particularly patients with Hypertension) are often given a ‘cocktail’ – meaning other drugs are combined with the inhibitor.
Drugs within the ACE inhibitors category are very similar. Not all function in the exact way (specifically how they are converted), but the prominence of this difference has not really been determined. As a practical example of this, if someone suffers from the coughing side-effect, they would likely continue to suffer from coughing if they were changed to a different ACE inhibitor. [Coughing from ARBs in next section is less common.] One way ACE inhibitors differ (and worth a discussion with your doc) is that they vary in how the body eliminates doses of the drug (time of effectiveness).
Examples of ACE inhibitors include:
|
|
ARB (Angiotensin II receptor blockers)
Angiotensin II receptor blockers are potent drugs that also work by blocking the action of angiotensin II (preventing it from binding to receptors on the muscles surrounding blood vessels). It dilates (widens) blood vessels to treat several diseases, including hypertension.
ARBs are somewhat similar to the ACE inhibitors above, but the ACEs prevent the formation of angiotensin II whereas ARBs block the binding of the hormone to muscles or blood vessels.
Since ARB medications have similar benefits as those of ACE inhibitors, the ARBs are often used in their place if a patient is sensitive to ACE inhibitors.
Examples of ARBs which can be reviewed at drugs.com include candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan), losartan (Cozaar), and olmesartan (Benicar).
Neither the newer nor older categories appear more effective
than the others according to literature.
As such, side effects and personal patient reactions rule the day.
Perhaps with a bit of physician preference incorporated into the mix.
(Remember to keep that log of side-effects.)
Calcium Channel Blockers
To understand these drugs we must realize that when calcium enters heart cells it causes stronger and tougher contractions. Decreasing the calcium level means the contraction of the heart muscle would not be as forceful. The goal of this category of drug is to prevent calcium from entering smooth muscle of the heart and related arteries. Ultimately they reduce heart rate and blood pressure.
Possible side-effects (listed alphabetically) include:
- Constipation
- Dizziness
- Headache
- Palpitations
- Swollen ankles
Sample brand and generic names (in alphabetical order) include:
- Amlodipine (brand: Norvasc)
- Diltiazem (brands: Cardizem, Tiazac, others)
- Felodipine (brand: Plendil)
- Isradipine (brands: Dynacirc, DynaCirc CR)
- Nicardipine (brands: Cardene and Cardene (IV or SR)
- Nifedipine (brands: Adalat CC, Procardia)
- Nisoldipine (brands: Sular)
- Verapamil (brands: Calan, Verelan)
Alpha Blockers
Working on a similar mechanism as Calcium Blockers, Alpha Blockers attach themselves to molecules that then act as messengers. They relax the muscle and open vessels to allow for the message reception to smooth muscle and arteries, thus relaxing muscle tone of the vessel walls. This blocking (relaxing blood vessels) leads to an increase in blood flow (and lower pressure). While used for a few different disorders, most often it is prescribed for hypertension.
The most common examples of its brand and generic drugs are: Doxazosin (Cardura), Prazosin (Minipress) and Terazosin (Hytrin).
The most notable side-effects of these drugs are:
- Dizziness
- Fast heart rate
- Orthostatic hypotension (blood pressure drop when you stand up)
Alpha and beta-blockers can be combined and used (in an IV drip) to treat a hypertensive crisis or if the patient is at risk for heart failure. The combination can cause orthostatic hypotension. Two of the generic names of these combined products are carvedilol (brand Coreg) or labetalol-hydrochloride (brands: Normodyne and Trandate).
Alpha-2 Receptor Agonists
With the same goal of decreased B/P in mind, these drugs act on the sympathetic (involuntary) nervous system (affecting the system’s adrenaline-producing portion).
The most common (only?) chemical in this category, Methyldopa is considered a first line antihypertensive drug during pregnancy because adverse effects are infrequent for the pregnant woman or developing fetus. Side-effects are considered limited. The most common possible side effects of Alpha-2 Receptor Agonists are drowsiness or dizziness.
Central Agonists
Central agonists work similarly (but follow a different nerve pathway than alpha or beta blockers to accomplish dropping B/P), by reducing the ability of blood vessels to contract and tense.
These drugs include:
- alpha methyldopa (brand: Aldomet),
- clonidine hydrochloride (brand: Catapres),
- guanabenz acetate (brand: Wytensin),
- guanfacine hydrochloride (brand: Tenex).
Side effects (alphabetically) include possible:
- Anemia
- Constipation
- Drowsiness (or feeling of being sluggish)
- Fever
- Impotence in men
- Mouth dryness – severe
Peripheral Adrenergic Inhibitors
This is not a common category, and not a first-line of defense. As the name implies, this drug category inhibits neurotransmitters in the brain. It then blocks messages sent to constrict smooth muscles (like heart).
Drugs under this category include:
- guandarel (brand: Hylorel),
- guanethidine monosulfate (brand: Ismelin),
- reserpine (brand: Serpasil).
Some noted possible side effects of peripheral adrenergic inhibitors are:
- Diarrhea
- Depression
- Heartburn
- Insomnia
- Sleep disruptions and nightmares
- Stuffy Nose And Congestion
Several of the drugs within this category have warnings different than the others. For example: Guanadrel (Hylorel) and guanethidine (Ismelin) can cause diarrhea. They are also associated with orthostatic hypotension, which can make you dizzy or lightheaded when you get out of bed in the morning. When taking guanethidine, some people complain of faintness when in crowds or outside in the sun. Impotence is another complaint.
Blood Vessel Dilators (vasodilators)
Finally, the last of our categories is the vasodilators. Like other drugs, they cause the blood vessel walls (especially arterioles) to dilate (relax and widen) allowing easier blood flow. The two notable drugs in the category are hydralazine hydrochloride (Brand: Apresoline) and Minoxidil (brand: Loniten). [Yes, that is the same ‘Minoxidil’ as in Rogaine. Not surprisingly, for hair-growth Minoxidil is used topically; as a vasodilator it’s taken orally. You cannot take the hair-product as an oral substitute.]
Side effects of the two drugs are a bit different.
Hydralazine (Apresoline), usually used with other drugs, is known to cause headaches, heart palpitations, joint aches and pains, swelling around temples and eyes. All fairly self-limiting.
Minoxidil, while common for hair-growth is a potent drug taken orally and not usually a first-choice, but used to treat severe high B/P. Notably, it’s sometimes the choice if the patient already has kidney failure. It is known to cause weigh gain (as it causes fluid retention) and (no surprise) hair growth.
FINAL THOUGHT
Whew! I realize that this is a bit more tedious than some of our subjects. For my part, this was not the most fun post to write. For your part, I understand if your eyes glazed over. However, hopefully, it will be here when (and if) you need it.
In the meantime, it should provide you a sufficient overview of conventional medications and how they are used to treat high blood pressure. In turn, that will aid your efforts in taking responsibility to track your side-effects, thus helping your provider help you. Share it with someone for whom you care.
—
Resources:
“Diuretics for Hypertension: A Review and Update” https://academic.oup.com/ajh/article/29/10/1130/2622231
American Heath Association coverage of blood pressure
Medicinenet.com – good source for understandable drug information
—
Picture Credit Title Image by Steve Buissinne from Pixabay
Graphs and charts – original
