Useful High Blood Pressure Medications

The use of combination drug therapy for hypertension is very common. At times, using smaller amounts of one or more agents in combination can minimize side effects while maximizing the anti-hypertensive effect. For example, diuretics, which also can be used alone, are more often used in a low dose in combination with another class of anti-hypertensive medications.

In this the diuretic has fewer side effects while it improves the blood pressure-lowering effect of the other drug. Diuretics also are added to other anti-hypertensive medications when a patient with hypertension also has fluid retention and swelling known as edema. The ACE inhibitors or angiotensin receptor blockers may be useful in combination with most other anti-hypertensive medications. ACE inhibitors and angiotensin receptor blockers have additive effects in treating patients with cardiomyopathies and proteinuria.

Another useful combination is that of a beta-blocker with an alpha-blocker in patients with high blood pressure and enlargement of the prostate gland in order to treat both conditions simultaneously. Caution is necessary; when combining two drugs that both lower the heart rate. For example, adding a beta-blocker to a non-dihydropyridine calcium channel blocker e.g., diltiazem or verapamil needs caution. Patients receiving a combination of these two classes of drugs need to be monitored carefully to avoid an excessively slow heart rate known as bradycardia. Combining alpha and beta-blockers may be beneficial for cardiomyopathies and hypertension. Carvedilol is useful for cardiomyopathies and liberally for hypertension patients.

In a hospital setting, injectable drugs may be used for the emergency treatment of hypertension. The most commonly used agents in this situation are sodium nitroprusside and labetalol . Emergency medical therapy may be needed for patients with severe hypertension. Emergency treatment of hypertension may be necessary in patients with short duration acute congestive heart failure, dissecting aneurysm of the aorta, stroke, and toxemia of pregnancy.

Women with hypertension may become pregnant. These patients have an increased risk of developing preeclampsia or eclampsia of pregnancy. These conditions usually develop during the last three months of pregnancy. In preeclampsia, which can occur with or without pre-existing hypertension, affected women have hypertension, protein loss in the urine and swelling in eclipse (toxemia), convulsions also occur and the hypertension may require very prompt treatment. The foremost goal of treating the high blood pressure in toxemia is to keep the diastolic pressure below 105 mm Hg in order to prevent a brain hemorrhage in the mother.

Hypertension that develops before the 20th week of pregnancy always is due to pre-existing hypertension and not toxemia. High blood pressure that occurs only during pregnancy is generally known as gestational hypertension. It may start late in the pregnancy. These women do not have proteinuria, edema, or convulsions. Gestational hypertension has no ill effects on the mother or the fetus. This form of hypertension becomes normal shortly after delivery. But it may recur with subsequent pregnancies.

The use of medications for hypertension during pregnancy is controversial. The risk of untreated mild to moderate hypertension to the fetus or mother during the relatively brief period of pregnancy probably is not very lethal. Lowering the blood pressure too much can interfere with the flow of blood to the placenta and thereby hinder fetal growth. Hence not all mild or moderate hypertension during pregnancy needs to be treated with medication. If it is treated, however, the blood pressure should be reduced slowly. But it should not be reduced below 140/80.

The anti-hypertensive agents used during pregnancy need to be safe for normal fetal development. The beta-blockers, hydralazine, labetalol, alpha methyldopa and the calcium channel blockers have been advocated as suitable medications for hypertension during pregnancy. Certain other anti-hypertensive medications, however, are not recommended as they are contraindicated during pregnancy. These include the ACE inhibitors, the ARB drugs, and the diuretics. ACE inhibitors may aggravate a diminished blood supply to the uterus and cause kidney dysfunction in the fetus. The ARB drugs may even lead to death of the fetus. Diuretics can cause depletion of the blood volume and so reducer placental blood flow and fetal growth.





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