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High blood pressure, a.k.a 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 the Malaysian adults have hypertension but did not know about it! (Source: National Health and Morbidity Survey 2019)
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.
Hypertension is defined as 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 for having high blood pressure/hypertension. To classify the blood pressure, it must be based on ≥2 properly measured, seated blood pressure readings on each of ≥2 visits with the doctor.
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 systolic BP of 130mmHg or greater and/or diastolic BP of 80 mmHg or greater; AND have diabetes, your doctor might put you on treatment of high blood pressure. This is because with diabetes coming into the picture, your risk of developing heart diseases is even higher than those who are not diabetic, hence treatment should be started even earlier.
If you’ve been diagnosed by a doctor with high blood pressure, chances are you’re taking at least one type of medicine. The medicines your doctor prescribed to you for hypertension reduces your blood pressure to an optimal level, thus reducing the risk of aforementioned health problems and even helping you live longer.
In general, there are four major class of medicines that are used for controlling high blood pressure:
E.g. hydrochlorothiazide (HCTZ), chlorthalidone, 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. Frusemide, in particular, can also be prescribed for another medical condition called heart failure, usually alongside with another diuretics called spironolactone (but spironolactone is rarely used for high blood pressure). Diuretics are generally safe, but some side effects may occur, such as dizziness, frequent urination, sodium loss, and abnormal blood potassium levels.
E.g. ACEI: enalapril, perindopril, captopril, lisinopril. ARB: losartan, valsartan, candesartan
Both ACEI 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. ACEI and ARB lower your blood pressure by blocking angiotensin II from working.
Image credit: Soupvector, CC BY-SA 4.0, via Wikimedia Commons
These medicines have also shown benefits for other medical conditions. Scientific evidence shows that they can prevent or slow down kidney diseases, especially those that have proteinuria (foamy urine as a result of protein leaking into urine). Doctors also often prescribe them for people with diabetes, because people with diabetes have a higher-than-average risk of kidney disease. Similar to diuretics, people with heart failure also take ACE inhibitors and ARBs, and evidence shows that they live longer than people with heart failure who don't.
A common side effect of ACEI is dry cough. If you experience dry cough while taking ACEI, you may consult a doctor to switch you to an ARB.
E.g. amlodipine, felodipine, diltiazem
Calcium channel blockers (CCB) work in various ways. One of the ways CCB reduces blood pressure is 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.
E.g. Bisoprolol, atenolol, 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.
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.
You shouldn’t be too concerned about which class of high blood pressure medicine you should take – leave it to your healthcare provider to figure it out. What you should be focusing on instead is staying on your blood pressure target. Your doctor will inform you of the suitable blood pressure target that you should keep to control the risks and complications high blood pressure may bring.
Throughout 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.
If you struggle to afford the treatment of high blood pressure, speak to your doctor on switching to generic brands. Generic brands cost way less but work similar to original brands of medicines. Read more on generic medicines here.
If you have any questions related to high blood pressure, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.
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Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
UpToDate - Overview of hypertension in adults
UpToDate - Choice of drug therapy in primary (essential) hypertension
CPG Management of Hypertension (5th Edition) 2018
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