Antihypertensive Medications
The regulation of blood pressure is a complex system with various control loops and "adjustable screws" that can be targeted with medication. Accordingly, the pharmacological influence on blood pressure reduction is also diverse. The basis of treatment is always the recommended lifestyle change. Lifestyle changes can be sufficient to prevent or at least delay the need for medication in patients with mild hypertension (Grade 1). Furthermore, if antihypertensive medications are still necessary, their effectiveness can be enhanced, thus requiring less medication.
The following measures are recommended:
- Quit smoking
- Reduce alcohol consumption to less than 14 units per week for men and 8 units per week for women (1 unit corresponds to 125 ml of wine or 250 ml of beer).
- Weight reduction in case of overweight
- Regular physical activity - at least 30 minutes on 5-7 days per week.
- Reduce salt intake to less than five grams per day
- Increase consumption of vegetables, fruits, fish, nuts, and unsaturated fatty acids (olive oil). Also, use low-fat dairy products and limit red meat.
- Avoid binge drinking completely
A sufficient, not excessive, potassium intake through food (e.g., fruits, vegetables, legumes) can positively affect blood pressure. However, before resorting to over-the-counter potassium effervescent tablets or similar, please consult your doctor to avoid side effects. This is especially important in cases of kidney disease, as too much potassium should not be supplied in this case. Therefore, a conversation with the doctor is urgently necessary.
Quit smoking
Reduce alcohol
Lose weight
Exercise and movement
Reduce salt
Healthy diet
In cases of significantly high blood pressure values (hypertension Grade II or III) or additional risk factors (such as diabetes), pharmacological therapy is started early.
Antihypertensives blood pressure-lowering medications
Antihypertensives - blood pressure-lowering medications
- Diuretics - water pills
- Beta-blockers
- Calcium antagonists (three groups can be distinguished here)
- ACE inhibitors
- Angiotensin receptor blockers (ARBs)
In most patients, treatment is initiated directly with a combination of 2 substance classes, preferably combined in one tablet.
Monotherapy, meaning treatment with only one substance class, should only be performed in hypertension Grade 1 or selected patients (e.g., very old age). As long as the target blood pressure is not reached, the pharmacological therapy should be intensified. A triple combination therapy is also conceivable.
Diuretics
A thiazide diuretic is often used as a combination medication: Hydrochlorothiazide (HCT). HCT is frequently used in multiple combination therapies and is available in many preparations.
In 2018, it was noted that there may be an increased incidence of skin cancer under therapy with HCT. Nevertheless, the therapy with HCT should not be discontinued without consulting and weighing the risks with the treating physician.
Mechanism of action: Under HCT, there is initially increased excretion of sodium, leading to a decrease in blood volume, and the resistance in smaller vessels decreases. Although sodium excretion and blood volume normalize over time, the blood pressure-lowering effect remains. The most well-known active ingredient in this group is Hydrochlorothiazide.
Beta-blockers
Beta-blockers partially reduce the effects of adrenaline and noradrenaline in the body. Normally, the release of adrenaline or noradrenaline leads to an increase in heart rate and blood pressure via certain beta receptors. By blocking these receptors, beta-blockers cause a decrease in heart rate and blood pressure. The most well-known active ingredients in this group are Bisoprolol, Carvedilol, Metoprolol, Nebivolol, and Propranolol.
Calcium antagonists
Calcium antagonists block the calcium channel at the cell and thus reduce the influx of calcium into the cell interior. In the smooth muscle of our blood vessels, calcium causes constriction of the vessels and leads to an increase in blood pressure to ensure adequate blood flow. Calcium antagonists thus cause relaxation of the smooth muscle in the vessels, resulting in dilation, which leads to a reduction in blood pressure. The most well-known active ingredients in this group are Diltiazem, Nifedipine, and Verapamil.
ACE inhibitors
ACE inhibitors inhibit a specific enzyme (Angiotensin-Converting Enzyme) and thus interfere with a chain of protein transformations. The inhibition leads to less Angiotensin II being formed, which normally causes contraction (tightening) of the vascular muscle. Due to the subsequent dilation of the vessels, blood pressure is reduced. However, the breakdown of a hormone is also inhibited, leading to increased bradykinin in the body. Since bradykinin acts similarly to histamine, this can lead to a range of side effects such as edema (the feared angioedema, which causes swelling of the skin and mucous membranes in the face) and a persistent dry cough. This dry cough, which is completely harmless but can be very bothersome, often leads to discontinuation of the medication. The most well-known active ingredients in this group are Captopril, Enalapril, Fosinopril, Lisinopril, and Ramipril.
Angiotensin receptor blockers
Angiotensin receptor blockers are also called AT1 blockers or Sartans. They do not inhibit the formation of Angiotensin II like ACE inhibitors, but selectively block the Angiotensin II receptor subtype-1 at the site of action (receptor) of Angiotensin II (hence AT1 blockers). Due to the unhindered breakdown of bradykinin, dry irritating cough occurs significantly less frequently than with ACE inhibitors. Angiotensin receptor blockers also cause dilation of the smallest arteries, thereby lowering blood pressure. The most well-known active ingredients in this group are Candesartan, Losartan, Olmesartan, Telmisartan, and Valsartan.
The preferred 2-fold combinations consist of:
The preferred 2-fold combinations consist of:
- ACE inhibitors or ARB, combined with a calcium antagonist or a diuretic.
- Beta-blockers with a diuretic or a substance from another main class, if there is a specific indication for a beta-blocker (e.g., angina pectoris, post-myocardial infarction, heart failure, heart rate control). However, it should be noted that beta-blockers MUST NOT be combined with calcium antagonists of the verapamil and diltiazem type.
The preferred 3-fold combinations consist of:
- ACE inhibitors or ARB + calcium antagonist + diuretic
If blood pressure cannot be normalized even under triple therapy, additional treatment with spironolactone or another diuretic, an alpha-blocker, or a beta-blocker should be considered.
Therapy options for hypertension during pregnancy (pre-existing hypertension, gestational hypertension) are significantly limited. In persistent or severe cases of hypertension during pregnancy, pharmacological therapy may be necessary.
Methyldopa, Labetalol, and calcium channel blockers are the first-choice medications during pregnancy.
The final therapy decision lies with your treating physician.
For more information, please see our article on Hypertension Medications.
Sources:
This article is medically reviewed. Last updated by Sabine Croci (11/2024).
Information on the website and within the app cannot replace a consultation with a doctor, but can certainly complement it.
Information on the website and within the app cannot replace a consultation with a doctor, but can certainly complement it.
