Other Medications for Hypertension Treatment

If it is not possible to adequately control the blood pressure despite multiple combination treatments (triple combo) or due to side effects that lead to discontinuation of medication, the current guidelines recommend adding a mineralocorticoid receptor antagonist or another diuretic, or adding an alpha blocker or beta blocker (this should also be considered during previous therapy stages if appropriate).

Alpha Blockers

These medications primarily act on the alpha-1 receptors and block the effects of adrenaline and noradrenaline. Alpha-1 receptors are mainly found in smooth muscle cells, including in blood vessels and the urinary tract. They cause vasodilation and thus lower blood pressure. They are also prescribed for benign prostatic hyperplasia.

Some beta blockers also have an additional alpha-blocking effect, e.g., Carvedilol.

Side Effects:

Infections of the respiratory and urinary tracts are common with Doxazosin. Symptoms such as headaches, rapid heartbeat, and palpitations, as well as gastrointestinal discomfort, are also observed under this medication.

Please refer to the manufacturer's package insert for additional side effects.

Active Ingredients: Doxazosin (Doxacor, Doxagamma, etc.), Urapidil (Ebrantil, Urapidil)

Renin Inhibitors

Renin Inhibitors: Effect

A renin inhibitor acts relatively early in the renin-angiotensin-aldosterone system. It inhibits the conversion of angiotensinogen to angiotensin I by the enzyme renin.

Renin Inhibitors: Side Effects

Few side effects are observed, and their occurrence is relatively rare.

However, the manufacturer Novartis informed in 2012 after the premature termination of the ALTITUDE study due to interim results about new recommendations for prescribing Aliskiren. According to this, it is recommended not to prescribe Aliskiren-containing medications in combination with ACE inhibitors or angiotensin receptor blockers. For patients with diabetes mellitus or renal impairment, combination therapy with Aliskiren and ACE inhibitors or angiotensin receptor blockers is contraindicated.

Renin Inhibitors: Medications/Products

The active ingredient Aliskiren is marketed under the following product names:

Rasilez, Rasilez HCT

The combination medication Rasilamo (which combined Aliskiren with a calcium antagonist) was withdrawn from the market due to insufficient benefit.

Endothelin Receptor Antagonists (ERA)

Endothelin receptor antagonists are another class of drugs for the treatment of resistant hypertension. However, most preparations are only approved for the treatment of pulmonary arterial hypertension. Only Aprocitentan received approval in the EU in 2024 for the treatment of resistant hypertension.

An endothelin receptor antagonist blocks the binding of endothelin to its receptors (ET_A and ET_B), thereby reducing the vasoconstrictive effect of endothelin. This leads to relaxation of blood vessels and a decrease in blood pressure.

Endothelin Receptor Antagonists: Side Effects

As with most medications, endothelin receptor antagonists can also have side effects. The most common include headaches, edema (fluid retention), and dizziness. It is important for patients to be regularly monitored by their doctor to detect and treat side effects early.

Sources

By Sabine Croci. This article is medically reviewed. Last updated (03/2024).
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