Other medications for treating high blood pressure

If blood pressure remains difficult to control despite multiple combination treatments (triple combo) or if side effects force stopping medication, current guidelines recommend adding a Mineralocorticoid-Rezeptor-Antagonisten or another Diuretikum, or adding an alpha blocker or beta blocker (this can also be considered earlier in treatment if there is a suitable indication). Also, if needed, consider checking the Blutdruck causes and adherence.

Alpha blockers

These drugs mainly act on alpha-1 receptors and block the effects of adrenaline and noradrenaline there. Alpha-1 receptors are found mainly in smooth muscle cells, for example in blood vessels and the urinary tract. They relax blood vessels and thus lower blood pressure. They are also prescribed for benign prostatic enlargement.

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

Side effects:

Doxazosin often causes infections of the respiratory and urinary tracts. Symptoms such as headaches, a fast heartbeat and palpitations, as well as stomach and intestinal complaints, are also observed with this medication.

Please see the manufacturer's package leaflet for other side effects.

Active ingredients: Doxazosin (Doxacor, Doxagamma etc), Urapidil (Ebrantil, Urapidil)

Renin inhibitors

Wirkungsweise Renin-Hemmer zur Blutdrucksenkung

Renin inhibitors: How they work

A renin inhibitor acts relatively early in the reninangiotensinaldosterone system. It already blocks the conversion of angiotensinogen to angiotensin I by the enzyme renin.

Renin inhibitors: Side effects

Few side effects have been observed, and they occur relatively rarely.

However the manufacturer Novartis informed in 2012, after the early termination of the ALTITUDE study due to interim results, about new recommendations for prescribing aliskiren. According to these recommendations, aliskiren-containing medicines should not be prescribed in combination with ACE inhibitors or angiotensin receptor blockers. For patients with diabetes mellitus or impaired kidney function, the combination of aliskiren with ACE inhibitors or angiotensin receptor blockers is contraindicated.

Renin inhibitors: Drugs/Products

The active substance aliskiren is marketed under the following product names:

Rasilez, Rasilez HCT

The combination drug Rasilamo (where aliskiren was combined with a calcium antagonist) was withdrawn from the market due to insufficient benefit.

Endothelin receptor antagonists (ERA)

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

An endothelin receptor antagonist blocks endothelin from binding to its receptors (ETA and ETB), reducing endothelin's vasoconstrictive effect. This leads to relaxation of the blood vessels and a lowering of blood pressure.

Endothelin receptor antagonists: Side effects

As with most medicines, endothelin receptor antagonists can have side effects. The most common are headaches, edema (fluid accumulation), and dizziness. It is important that patients are regularly monitored by their doctor so that side effects can be detected and treated early.

Sources

This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 03/2024).

Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.

We hope you found the article helpful. For good blood pressure control, it's important to take your medications correctly. Our app BloodPressureDB will gladly remind you when to take them. It also keeps track of your medication supply and notifies you in time when you're running low. This feature is fully available in the free version as well. Get the free app now.