High Blood Pressure (Hypertension)

Medications

Deciding whether to treat high blood pressure with medicine and choosing the best medicine are based mainly on:

• Your blood pressure measurement.
• Whether you have signs of organ damage caused by high blood pressure in other parts of your body, such as an enlarged heart or early damage to your arteries, kidneys, or eyes.
• Whether you have other medical conditions, such as heart disease, diabetes, or kidney or lung disease or risk factors for heart disease, such as diabetes or high cholesterol.
• Whether you think you can be successful in making lifestyle changes.

Doctors may have different opinions about when to start medicines for high blood pressure.

• Lifestyle changes alone may be tried before medicine if you have prehypertension (120–139/ 80–89 millimeters of mercury [mm Hg]) or high blood pressure (140/90 mm Hg), if you do not have other risk factors for heart disease, and if there's no evidence of organ damage.
• Treatment with medicine is often started in addition to lifestyle changes if you have other risk factors for heart disease, if there is evidence of damage to organs, or if you have stage 1 or 2 high blood pressure.

Doctors usually prescribe a single, low-dose medicine first. If blood pressure is not controlled, your doctor may change the dosage or try a different medicine or combination of medicines. It is common to try several medicines before your blood pressure is successfully controlled. Many people need more than one medicine to get the best results. African Americans with blood pressure that is higher than 10 to 15 mm Hg above their goal may need to take a combination of medicines first.¹³ For more information, see:

Should I take medicines for high blood pressure?

Medication Choices

Medication choices include:

• Diuretics.
• ACE inhibitors.
• Angiotensin II receptor blockers (ARBs).
• Beta-blockers.
• Calcium channel blockers.
• Vasodilators.
• Direct renin inhibitors.

All of these medicines are effective for lowering the risk of heart attack and stroke. Treatment for high blood pressure must be highly individualized and based on your risk factors, such as diabetes, smoking, and heart disease. Although one study may recommend a particular medicine as the first line of treatment, it may not be best for you based on your medical condition. What's most important is that you work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you and that you take your medicines regularly as prescribed.

Taking your high blood pressure medicines properly

High blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommend that, for most people, one of the medicines be a thiazide-type diuretic.

If other conditions, such as heart failure or diabetes, are present, ACE inhibitors or ARBs often are used as the first line of therapy because the other medical conditions also may benefit from these medicines. But isolated systolic hypertension may respond best to diuretics alone.

What to Think About

• Your doctor may choose which medicine to give you for high blood pressure based on whether you have any other related conditions. For example, doctors often prescribe ACE inhibitors for people with diabetes or heart failure.
• Some people who develop a cough while taking ACE inhibitors do well with ARBs, which usually do not cause a cough.
• Strategies for treating high blood pressure in pregnant women are quite different. For more information, see the topic Preeclampsia and Hypertension During Pregnancy.
• Some experts believe a combination of medicines, each given in a lower dose, is better for reducing blood pressure than a higher dose of a single medicine. Because the medicines that are combined are given in a lower dose, there may be fewer side effects from the drugs.

Check with your doctor before taking any nonsteroidal anti-inflammatory drugs (NSAIDs) with high blood pressure medicines. NSAIDs may raise blood pressure and lower the effectiveness of blood pressure medicines.

More information How do other medical conditions affect the choice of high blood pressure medications?

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Author:	Robin Parks, MS	Last Updated: April 24, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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