Medication

• Diuretics rid the body of extra water and salt. Diuretics are usually the first-line treatment for high blood pressure.
• Beta-blockers block the effects of adrenaline and ease the heart's pumping action.
• Angiotensin converting enzyme (ACE) inhibitorsreduce the production of angiotensin, a chemical that causes arteries to narrow.
• Calcium-channel blockers (CCBs) decrease the contractions of the heart and widen blood vessels.
• Angiotensin-receptor blockers (ARBs) block angiotensin, another chemical that constricts the arteries.
• Vasodilators expand blood vessels.

In about half of patients a single-drug regimen can control mild to moderate hypertension. More severe hypertension often requires a combination of two or more drugs. Each drug has specific benefits, but their effects may vary depending on the individual patient.

Side Effects and Problems in Compliance

One of the most difficult issues that patients face, particularly those with primary hypertension, is that the treatment may make them feel worse than the disease, which usually has no symptoms. Whatever the difficulties, compliance with a drug and lifestyle program is worth the effort. It is very important that patients discuss medication concerns with their doctors. If current blood pressure drugs are causing uncomfortable side effects, the doctor may adjust dosages or combinations.

Withdrawal from Anti-Hypertensive Medications

Patients whose blood pressure has been well-controlled and who are able to maintain a healthy life style may choose to withdraw from medications. They should do so in a step-down manner (gradual reduction) and be monitored regularly. Stopping too quickly can have adverse effects, including serious effects on the heart. The highest success rates are more likely in those who lose weight and reduce sodium intake, in patients who have been treated with a single drug, and in those who have maintained lower systolic blood pressure during treatment. People over 75 years old may have more trouble than younger adults in maintaining normal blood pressure after withdrawal.

Review Date: 12/21/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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