Medicines for high blood pressure

High blood pressure (hypertension) is a disease that is as widespread as it is underestimated. To avoid complications such as a heart attack, stroke or kidney damage, it is essential to identify and treat high blood pressure in good time. A change in lifestyle with a healthy diet, exercise and abstinence from nicotine is often enough to lower blood pressure below the limit of 140/90 mmHg. 

Drug therapy is the last step

Drug therapy is only necessary if the blood pressure values ​​do not drop despite a healthy lifestyle. Which of the numerous medications for high blood pressure is most suitable depends on many factors and must be decided by the doctor for each patient individually. We have put together an overview of the various antihypertensive drugs for you.

 

High blood pressure: treatment with medication

When treating high blood pressure, there are five main drug groups from which the doctor selects a drug that is suitable for the patient at the beginning of treatment: 

• ACE Inhibitor
• AT1 receptor antagonists
• Beta-Blocker
• calcium antagonists
• Diuretics

Alpha-blockers, aldosterone antagonists or direct vasodilators are sometimes also used. If the medication is ineffective, the doctor can change the product or combine two active ingredients. The drug used to start treatment depends on the severity of the high blood pressure and the patient’s previous illnesses and risk factors. Below, you will find the five most commonly used drug groups in detail. 

ACE inhibitors for high blood pressure

ACE inhibitors block the so-called angiotensin-converting enzyme: This enzyme forms the hormone angiotensin-II, which causes the blood vessels to narrow. ACE inhibitors cause the blood vessels to dilate by reducing the production of angiotensin II, lowering blood pressure.  Drugs that work through this mechanism end in “-pril”, such as ramipril.

 

AT1 receptor antagonists as a tolerable alternative

AT1 receptor antagonists act through the same endocrine system as ACE inhibitors. In contrast to these, however, they do not reduce the formation of angiotensin-II but block the “docking point” (receptor) of the hormone, through which it achieves its vasoconstrictive effect. This lowers blood pressure even though angiotensin-II is still being produced. As a result, specific side effects that occasionally occur when taking ACE inhibitors can be prevented according to the current state of knowledge. AT1 receptor antagonists have the suffix “-sartan” in the drug name. Examples are candesartan or telmisartan.

Beta-blockers: effects on the kidneys and heart

Beta-blockers block specific receptors of adrenaline and norepinephrine. These messenger substances are mainly released in stressful situations and then bind to beta1 receptors in the kidneys. This leads to the release of the enzyme renin, which in turn causes the formation of angiotensin-II and, thus, an increase in blood pressure via several intermediate steps. Beta-blockers prevent this increase in blood pressure by blocking the docking sites for adrenaline and noradrenaline. 

Beta-blockers also block beta-1 receptors in the heart, which cause adrenaline and norepinephrine to increase heart rate, allowing the heart to pump more blood through the circulatory system in less time. Beta-blockers also have a “braking effect” on the heart,  which contributes to lowering blood pressure and relieves the heart. Beta-blockers end in “-lol”, such as bisoprolol or metoprolol.

Calcium antagonists dilate the vessels.

Calcium antagonists inhibit special calcium channels in the vascular muscles, thereby reducing calcium influx into the muscle cells. Due to the reduced calcium concentration, the muscle cells are less able to contract, which leads to the dilation of the vessels and, thus, to a reduction in blood pressure. This is how the calcium antagonists of the so-called nifedipine type work. These drugs end in “-dipine”, such as amlodipine. 

Calcium antagonists such as diltiazem or verapamil form another subgroup. They also affect the heart muscle cells, which leads to a reduced heart rate and heart rate.  On the one hand, diltiazem and verapamil prevent the heart from compensating for the drop in blood pressure by increasing the heart rate. This effect is a dangerous side effect of nifedipine-type drugs, especially in patients with coronary heart disease ( CHD ).

On the other hand, diltiazem and verapamil can also be used against cardiac arrhythmias. 

 

Diuretics: Dehydration in high blood pressure

Diuretics are drugs that promote water excretion through the kidneys and thus have a dehydrating effect. In the case of high blood pressure, so-called thiazide diuretics are used in particular. These drugs block unique transport systems in the kidneys, causing more salt and water to be excreted.

The drainage reduces the blood volume in the vessels and, thus, the blood pressure. In addition, thiazide diuretics open potassium channels in vascular muscle cells, making them less able to contract, which also helps lower blood pressure. An example of a diuretic used for high blood pressure is the drug hydrochlorothiazide.