Know Your Blood Pressure Medications

It’s estimated that nearly half of American adults—some 100 million men and women—have some degree of high blood pressure, higher than 130/80. That’s the bad news. We know that high blood pressure, also called hypertension, can have no symptoms. Undetected and untreated, it can lead to heart and vascular damage, or even death due to a heart attack or stroke.

High Blood Pressure Is Common—And Treatable

High blood pressure is becoming more common, and in younger people.

“In the past, we would normally think of adults 65 and older being our patient population for hypertension,” said Alicia Topoll, MD, an Indianapolis cardiologist with Franciscan Physician Network Indiana Heart Physicians. “However, we’re seeing high blood pressure in a much younger population—even among 12- to-19-year-olds.”

This increase in high blood pressure, he added, is probably due in large part to the obesity epidemic.

“A higher body mass index (BMI) is correlated with a higher blood pressure,” she said.

But the good news is that high blood pressure is treatable. Not only are there a handful of lifestyle changes a person can make, including weight loss and a low-fat, low-salt diet, but also physicians have a plethora of medications to choose from when writing out prescriptions for patients—in fact, more than 150 of them.

How Docs Decide Which Blood Pressure Medications To Prescribe

Getting the right blood pressure medication to the right patient, however, is based on many factors.

“Anti-hypertensive agents are not created equal,” said Dr. Topoll.

When prescribing medications to treat high blood pressure, physicians must consider several things, including:

• A patient’s health history: Have they already had a heart attack or stroke?
• What about the patient’s anatomy could be causing their hypertension?
• Does the patient have naturally low or high potassium? Does their blood work show us anything else we need to consider?
• What other conditions, or comorbidities, does the patient have? How is their kidney and liver health?

The Hypertension “Work Horses”

To lower blood pressure, medications can either relax blood vessels or muscles around the blood vessels, slow a patient’s heartbeat, or remove excess fluid buildup in the body.

ACE inhibitors and ARBs

The two most common types of medications prescribed are ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers). Both block a stress hormone that “tells” blood vessels to tighten.

“We like to prescribe these for patients who have either had a heart attack in the past or have heart failure,” said Dr. Topoll.

Beta blockers

Beta blockers decrease heart rate, which in turn eases pressure on the heart and blood vessels. They especially benefit patients with atrial fibrillation, the most common arrhythmia among adults.

Diuretics

Diuretics, often called “water pills,” help the kidneys to remove water and salt from the body. Less fluid in the blood vessels reduces the pressure on the blood vessels. These are most helpful for patients with heart failure, said Dr. Topoll.

“Patients who have heart failure tend to have fluid build up in parts of their bodies, and it can be quite debilitating,” she said.

For instance, water that builds up around the lungs can cause pulmonary edema. This makes breathing difficult and is one of the major reasons for hospitalization.

Other Blood Pressure Medications Help Find A Balance

There are several other medications physicians can consider, including calcium channel blockers, vasodilators, and even ones that target brain signals that can cause increased heart rate and tightened blood vessels. But instead of being overwhelming, this large number of choices can be very beneficial for patients when physicians prescribe more than one.

“All medications have side effects,” said Dr. Topoll, “and the higher the dose of one agent, the more likely the patient will have side effects. But if we prescribe two agents at lower dosages, perhaps we can limit some of those.”

Many times, patients going on medications for the first time may report symptoms like fatigue and “brain fog.” It normally takes time for the body to acclimate, she said, which is why it’s important to communicate with your cardiologist so that the two of you can find the right medication balance. And this may take time.

“It’s a bit like calibrating or turning down the thermostat in your house,” Dr. Topoll said. “The body’s adjustment to the new medications doesn’t occur immediately. When your body and organs are used to blood pressures in the 150s and 160s (systolic), even a 10-point drop will take getting used to. So with patients who are very sensitive to these changes, we go slow and steady with medication titration.”

Staying On Track To Lower Blood Pressure

Often, said Dr. Topoll, it takes about two months for a patient to reach a healthy blood pressure and for the body to adjust to the new medications. It’s not uncommon, however, that the cardiologist may change your dose to reduce new side effects that may occur, such as dizziness when standing after lying down. The key is to report issues to your cardiologist so that adjustments can be made.

In addition to medications, of course, key lifestyle issues can lower hypertension. They include significant weight loss, treatment of sleep apnea, and lowering sodium in your diet. Dr. Topoll addresses these and more preventive steps with all her patients.

When it comes to taking pills, however, it’s naturally hard to make this a regular habit. Many patients, said Dr. Topoll, stop taking their medications after a few years. But hypertension doesn’t go away.

“Hypertension is a tough condition because, for most patients, it’s just a number, and most patients don’t really perceive any symptoms with it,” she said. “That’s why it’s called the ‘silent killer.’ Many patients with hypertension come to us after they’ve had a heart attack or stroke. So if you find out that your blood pressure is over 130/80, I urge you to talk to your doctor, look at changes you can make in your diet, and work on increasing cardiovascular activity. While starting medications isn’t the favorite alternative, it can potentially save your life.”