We can not emphasize enough the importance of lifestyle management in treating high blood pressure. Avoiding excessive alcohol and tobacco, exercise, diet control, and reduced mental stress all have a profound effect on blood pressure. However, at times adopting these measures is not practical for some people. For example for someone with impaired mobility or a substance use disorder, exercise or avoiding cigarettes respectively may not be possible. In other cases, these measures are just not effective enough to lower blood pressure to the desired target level. In such conditions, treatment with medications is very important since blood pressure needs to be controlled to avoid complications.
There are several different kinds of blood pressure medications available and they work differently to help us achieve our blood pressure targets. Here is a summary of some drug families that are most commonly prescribed for blood pressure management:
1. Diuretics or ‘the water pills’
These medications act on the kidneys, making them retain more water and salt in the urine. The urine is then passed out of the body taking with it the extra salt and water. So, if you are on a diuretic, you are likely to urinate more often than usual and this helps in bringing the blood pressure down. Some examples are hydrochlorothiazide, indapamide, and furosemide.
2. Beta-blockers or ‘the lols’
Beta-blockers primarily act by lowering the heart rate and relaxing the small blood vessels that supply blood to different parts of our body. This makes it easier for the heart to pump blood out to distant parts and thus we see a lowering of blood pressure. Some examples are metoprolol, propranolol, and labetalol, etc. Note that the names always end with ‘lol’.
3. ACE Inhibitors or ‘the prils’
These medications have multiple mechanisms but they mainly act by suppressing the production of a substance called ‘Angiotensin II’. This results in dilatation of blood vessels and decreased aldosterone secretion (which translates into increased excretion of water through urine). If you take a medication that ends with ‘pril’, you may like to know (if you do not already) that it is an ACE inhibitor. Some examples are perindopril, ramipril, and quinapril. Furthermore, they are not only effective in lowering the blood pressure but also in protecting the kidneys.
4. ARBs or ‘the sartans’
The overall effect of these medications is similar to ACE inhibitors but their mode of action is slightly different. Instead of suppressing the production of Angiotensin II, they simply block the action of this substance. The end result is still increased excretion of water and dilatation of blood vessels, but the incidence of certain side effects, such as cough (more common with ACE inhibitors), is lower with ARBs. The names usually end with “sartan,” and that is how you can tell if your blood pressure medication is an ARB. Some examples are candesartan, telmisartan, and valsartan. They also have a kidney protective effect.
These medications exert their effect by acting on the heart rate and relaxing the blood vessels. As a result, the blood pressure goes down. They are also useful in people with certain coexisting heart diseases. Some examples are amlodipine, felodipine, and diltiazem.