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FDA has approved numerous drugs for treating hypertension. These drugs work in different ways but the end result — reducing blood pressure — is the same.

Some of the most commonly used drugs to treat high blood pressure are:

Diuretics. Sometimes called "water pills," these drugs flush excess water and sodium from the body by increasing urination. This reduces the amount of fluid in the blood and flushes sodium from the blood vessels so that they can open wider, increasing blood flow and thus reducing the blood's pressure against the vessels. Often diuretics are used in combination with other high blood pressure drugs. Types of diuretics include thiazides, such as Diuril (chlorothiazide) and Esidrex (hydrochlorothiazide); potassium-sparing diuretics, such as Aldactone (spironolactone); and loop diuretics, such as Lasix (furosemide).

Beta blockers. These drugs slow the heartbeat by blocking the effect of nerve impulses to the heart and blood vessels, thereby lessening the burden on the heart. Beta blockers include Inderal (propranolol), Lopressor (metoprolol), and Tenormin (atenolol).

ACE (angiotensin-converting enzyme) inhibitors. These inhibit formation of the hormone angiotensin II, which causes blood vessels to narrow, thus increasing blood pressure. ACE inhibitors include Altace (ramipril), Capoten (captopril), and Zestril (lisinopril).

Calcium channel blockers. These prevent calcium from entering the muscle cells of the heart and blood vessels, thus relaxing blood vessels and decreasing blood pressure. Some calcium channel blockers are Procardia (nifedipine), Isoptin (verapamil) and Cardiazem (diltiazem).

Alpha-beta blockers. These combine the actions of alpha blockers, which relax blood vessels, and beta blockers, which slow the heartbeat. The dual effect reduces the amount — and thus pressure — of blood through blood vessels. Alpha-beta blockers include Normodyne and Trandate (both labetalol).

Often, combinations of two drugs from different classes are used to improve the drugs' effectiveness.

Many doctors begin newly diagnosed hypertensive patients with diuretics or beta blockers. The Sixth Report of the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, released by NIH's National Heart, Lung, and Blood Institute in November 1997, recommends diuretics or beta blockers as the first line of treatment. However, based on a patient's situation — for example, use of other medicines — doctors may choose to start treatment with another antihypertensive drug.

Some specifics to JNC's first-line recommendation are noted in the report — for example, it recommends that in African Americans, one of the groups most at risk for hypertension, diuretics alone should be the first agent of choice — provided there are not other conditions that prohibit their use — because of this group's increased sensitivity to salt. For hypertensive people with diabetes or kidney disease, the guidelines recommend that initial drug treatments include ACE inhibitors.

Finding What Works

Like most drugs, blood pressure medicines can have side effects, ranging from the unpleasant — such as skin rash, sleepiness and weight gain — to the severe, including depression, hallucinations, heart dysfunction, and liver disease. Patients who begin a drug treatment and develop symptoms that they did not have before should discuss them with their doctors. With the great variety of medicines, it is likely that another antihypertensive drug or dosage level can help control blood pressure with few or no side effects.

In my mother's 30-year history of high blood pressure, she's switched drugs only a few times or varied the dosages, mainly to gain better control of her blood pressure. But she's never had any qualms about taking the medicine.

"I had a lot of relatives who probably had the same problem I do, but they died early because they didn't have the medicines that they do now," she says. "I'm thankful to have them. I wouldn't be around enjoying the good life that I do."

Who's at Risk?

Those at greater risk for high blood pressure, according to the National Heart, Lung, and Blood Institute, include:

• African Americans
• people with a family history of high blood pressure
• people who drink alcoholic beverages excessively
• people who are physically inactive

In addition, as many as 65 percent of people with diabetes have high blood pressure.

Tags: Hypertension

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.