How do medicines for high blood pressure work?
High blood pressure, also known as hypertension, is a common medical condition in Malaysia and all around the world – 30% of Malaysian adults have hypertension; 15.9% of them know they have it, whereas 14.1% of Malaysian adults have hypertension but they are unaware about it!
Having high blood pressure puts you at risk for heart attack, stroke, kidney damage, and other serious problems. Nevertheless, many people do not take it seriously enough because high blood pressure is a silent killer – many high blood pressure patients don’t feel anything until they start to suffer from its complications.
Who needs medicines for high blood pressure?
Hypertension is defined as a persistent elevation of systolic BP of 140mmHg or greater and/or diastolic BP of 90 mmHg or greater. Although you can monitor your own blood pressure using devices, only a doctor can diagnose you with high blood pressure/hypertension.
Depending on the other medical conditions that you might have in addition to hypertension (e.g. type 2 diabetes, kidney disease, other heart conditions), the blood pressure threshold for you may be different. For instance, if you have hypertension AND diabetes alongside with chronic kidney problem, your doctor will aim for a more stringent blood pressure control of less than 130/80mmHg. This is because your risk of developing heart disease is higher when you do have other concurrent medical condition. Hence, it is important to start treatment early and ensure a better blood pressure control.
If you have been diagnosed by a doctor with high blood pressure, chances are you will be started on at least one type of medication. The medication prescribed to you by your doctor for hypertension is aimed to reduce your blood pressure to an optimal level, thus reducing the risk of the aforementioned health problems and even helping you live longer.
Medicines for high blood pressure
In general, there are four major classes of medicines that are used for controlling high blood pressure:
Angiotensin-converting enzyme inhibitors (ACE-I) and Angiotensin II receptor blockers (ARB) [e.g. ACE-I: enalapril, perindopril, captopril, lisinopril. ARB: losartan, valsartan, telmisartan]
Both ACE-I and ARB work in similar ways. There is a compound in our body called angiotensin II that is a powerful vasoconstrictor – it constricts your blood vessels, which raises your blood pressure; it also promotes the retention of sodium, which further increases your blood pressure. ACE-I and ARB lower your blood pressure by blocking angiotensin II from working.
A common side effect of ACE-I is dry cough. If you experience dry cough while taking ACE-I, talk to your doctor and they may switch you to an ARB.
Calcium channel blockers (e.g. amlodipine, felodipine)
Calcium channel blockers (CCB) work in various ways. One of the ways CCB reduces blood pressure is by promoting the relaxation of our blood vessels (vasodilation). If you have high blood pressure and some other heart problems, scientific data shows that CCB is useful in reducing cardiovascular death, major cardiovascular events, stroke, and heart failure.
Beta-blockers (e.g. bisoprolol, carvedilol, metoprolol)
Besides lowering blood pressure, beta blockers help reduce the amount of work the heart has to do. Although it may not be as useful as other medicines in lowering blood pressure, if you have had a heart attack before or have heart failure in addition to high blood pressure, beta-blockers are beneficial.
When people first start taking beta-blockers, they sometimes feel tired. That is just while the body gets used to the medicine. But once the body gets used to beta blockers, the medicines can really help. If your doctor prescribes a beta blocker, give it a little time to start working.
Diuretics (e.g. hydrochlorothiazide, frusemide)
Diuretics are also known as “water pills”, because they make you pee more often. This helps to get rid of fluid in your circulation, thus reducing blood pressure. It is generally safe, but some side effects may occur, such as dizziness, frequent urination, sodium loss, and abnormal blood potassium levels. It is recommended to be taken during the daytime. This is because you will be waking up quite often to pee if it is taken at night time.
Stay on track with your high blood pressure treatment
In most cases, patients with high blood pressure take a combination of those medications above for better blood pressure control. There are many medicines for high blood pressure that actually contain a combination of two different classes of drugs inside them.
During your high blood pressure treatment, you may experience some side effects, such as dizziness, fatigue, and dry cough. If you think the discomfort you’re having is associated with your high blood pressure treatment, talk to your doctor. Do not stop your treatment without consulting your doctor first.
High blood pressure treatments do not include herbs or traditional medicines. Perhaps you have heard about the recently acclaimed superfood sacha inchi (a plant that’s often cultivated for its large, nut-like seeds. These seeds are highly nutritious and may be associated with several health benefits) that can be used for the treatment of high blood pressure, high cholesterol level, and high blood sugar level. Indeed it improves cholesterol levels, increases weight loss, and improves gut health. However, more research in humans is needed to confirm these promising results. Sacha inchi is not a proven treatment option for hypertension. Make sure you talk to your doctor before you start introducing taking any traditional medication or herbs as they may interact with other medications as well.
Medically reviewed by Ashwini Nair, MB BCh BAO.
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References:
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Overview of hypertension in adults - UpToDate. Accessed May 13, 2022. https://www.uptodate.com/contents/overview-of-hypertension-in-adults?search=Overview%20of%20hypertension%20in%20adults&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
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Choice of drug therapy in primary (essential) hypertension - UpToDate. Accessed May 13, 2022. https://www.uptodate.com/contents/choice-of-drug-therapy-in-primary-essential-hypertension?search=Choice%20of%20drug%20therapy%20in%20primary%20(essential)%20hypertension&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
