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Treatment of high blood pressure

The choice of antihypertensive drugs depends on numerous factors including the presence of coexisting medical conditions, adverse effects and drug interactions.

Commonly used groups of antihypertensives (and the examples of each) are:

Diuretics: chlortalidone and hydrochlorothiazide.

Angiotensin-converting enzyme (ACE) inhibitors: captopril, enalapril and lisinopril.

Angiotensin II Receptor Blockers (ARBs): telmisartan, irbesartan and losartan.

Beta-blockers: atenolol, metoprolol and propranolol.

Calcium channel blockers (CCBs): nifedipine, amlodipine and diltiazem.

Alpha-blockers: doxazosin and prazosin.

In general, clinicians follow the following recommended guidelines while starting pharmacotherapy:4

Patients should be started on a low-dose of the initial medication and the dose should be gradually titrated upward every 1–2 months, depending upon the response to therapy.

Most patients will require two or more antihypertensives at lower doses to achieve the target BP and to lower the adverse effects of the individual drugs in high doses.

Thiazide-type diuretics should be used for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes.

A diuretic or a long-acting CCB may be more effective in elderly patients with isolated systolic hypertension.

An ACE inhibitor should be the initial treatment for hypertension associated with CHF, diabetes mellitus and post-myocardial infarction.

An ARB may be substituted in patients who develop persistent cough subsequent to ACE inhibitor therapy.

A beta-blocker (if not contraindicated) should be prescribed following an acute myocardial infarction.

Written by: healthplus24.com team

Date last updated: January 02, 2014

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