High blood pressure (hypertension) is a disease that is as widespread as it is underestimated. In order to avoid secondary diseases such as heart attack, stroke or kidney damage, it is important to recognize and treat high blood pressure in time. Often, an adjustment of lifestyle with a healthy diet, exercise and abstaining from nicotine is already sufficient to lower blood pressure below the limit of 140/90 mmHg.
Drug therapy as the final step
Drug therapy becomes necessary only when blood pressure levels do not decrease 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 physician for each patient individually. We have compiled an overview of the various blood pressure-lowering medications for you.
High blood pressure: treatment with medication
In the therapy of high blood pressure, there are five central groups of drugs from which the physician selects a drug suitable for the patient at the beginning of treatment:
- ACE inhibitors
- AT1 receptor antagonists
- Beta-blockers
- Calcium antagonists
- Diuretics
Partially also used alpha-blockers, aldosterone antagonists or direct vasodilators. If the selected drug does not show sufficient effect, the doctor can either change the product or combine two agents. The drug used to start treatment depends on the severity of the hypertension and the patient’s pre-existing conditions and risk factors. The following is a detailed list of the five most commonly used drug groups.
ACE inhibitors for hypertension.
ACE inhibitors block the so-called angiotensin-converting enzyme: this enzyme is involved in the formation of the hormone angiotensin-II, which causes constriction of the blood vessels. ACE inhibitors therefore cause the vessels to dilate by reducing the production of angiotensin-II, thus lowering blood pressure. Agents that work via this mechanism end in “-pril,” such as ramipril.
AT1 receptor antagonists as a tolerable alternative.
AT1 receptor antagonists act through the same hormonal system as ACE inhibitors. Unlike these, however, they do not reduce the formation of angiotensin-II; rather, they block the hormone’s “docking site” (receptor) through which it achieves its vasoconstrictor effect. Thus, blood pressure is lowered even though angiotensin-II continues to be produced. According to current knowledge, this can prevent certain side effects that occasionally occur when taking ACE inhibitors. AT1 receptor antagonists have the suffix “-sartan” in the drug name. Examples include candesartan or telmisartan.
Beta-blockers: action on the kidneys and heart.
Beta-blockers block certain receptors of epinephrine and norepinephrine. These neurotransmitters are released particularly in stressful situations and then bind beta1 receptors on the kidney. This leads to the release of the enzyme renin, which in turn, via several intermediate steps, causes the formation of angiotensin-II and thus an increase in blood pressure. By blocking the docking sites for adrenaline and noradrenaline, beta blockers prevent this increase in blood pressure. In addition, beta-blockers also block beta1 receptors on the heart, through which adrenaline and noradrenaline increase heart rate and cardiac output, so that the heart can pump more blood through the circulation in less time. Beta-blockers therefore also have a “braking effect” on the heart, which also helps to lower blood pressure and additionally relieves the heart. Beta-blockers end in “-lol,” such as bisoprolol or metoprolol.
Calcium antagonists dilate the blood vessels
Calcium antagonists inhibit specific calcium channels in vascular muscle, thereby reducing the influx of calcium into muscle cells. The reduced calcium concentration allows the muscle cells to contract less, causing the vessels to dilate and thus lowering blood pressure. This is how calcium antagonists of the so-called nifedipine type work. These active ingredients end in “-dipine,” such as amlodipine. Calcium antagonists such as diltiazem or verapamil form another subgroup. They have an additional effect on the heart muscle cells, where they lead to reduced cardiac output and a reduction in heart rate.For one thing, diltiazem and verapamil prevent the heart from trying to compensate for the reduction in blood pressure by increasing heart rate. This effect is a dangerous side effect of nifedipine-type drugs, particularly in patients with coronary heart disease (CHD). On the other hand, diltiazem and verapamil can thereby also be used against cardiac arrhythmias.
Diuretics: Drainage for high blood pressure
Diuretics are drugs that promote the excretion of water via the kidneys and thus have a draining effect. In high blood pressure, so-called thiazide diuretics are mainly used. These drugs block special transport systems in the kidneys so that more salt and water are excreted. Drainage reduces the volume of blood in the vessels and thus also blood pressure. In addition, thiazide diuretics open potassium channels in the vascular muscle cells, making them less able to contract, which also helps to lower blood pressure. An example of a diuretic used for hypertension is the active ingredient hydrochlorothiazide.
