Additional medications sometimes used to treat high BP.
3 min read
Continued from last week!
If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:
Alpha blockers. These medications reduce nerve signals to blood vessels, lowering the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
Beta blockers. These medications reduce the workload on your heart and widen your blood vessels, causing your heart to beat slower and with less force. Beta blockers include acebutolol, atenolol (Tenormin) and others.
Beta blockers aren’t usually recommended as the only medication you’re prescribed, but they may be effective when combined with other blood pressure medications.
Aldosterone antagonists. These drugs also are considered diuretics. Examples are spironolactone and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid buildup, which can contribute to high blood pressure. They may be used to treat resistant hypertension.
Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.
Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
Vasodilators. These medications include hydralazine and minoxidil. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
Central-acting agents. These medications prevent your brain from telling your nervous system to increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.
Treating resistant hypertension. If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension.
You’re also considered to have resistant hypertension if you have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control. If you do, your doctor should investigate the possibility of a secondary cause of the high blood pressure.
Having resistant hypertension doesn’t mean your blood pressure will never get lower. If you and your doctor can determine the cause, a more effective treatment plan can be created to help you meet your goal blood pressure.
Treating resistant hypertension may involve many steps, including:
Changing your high blood pressure medications to determine which combinations and doses work best
Reviewing all the medications you take, including those that you take for other conditions or buy without a prescription
Monitoring your blood pressure at home to see if going to the doctor causes your blood pressure to increase (white coat hypertension)
Making healthy lifestyle changes, such as eating a healthy diet with less salt, maintaining a healthy weight and limiting alcohol
You should always take blood pressure medications as prescribed. Never skip a dose or abruptly stop taking your blood pressure medication. Suddenly stopping certain blood pressure drugs, such as beta blockers, can cause a sharp increase in blood pressure (rebound hypertension).
If you skip doses because you can’t afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don’t change your treatment without your doctor’s guidance.
Potential future treatments
Researchers continue to study catheter-based ultrasound and radiofrequency ablation of the kidney’s sympathetic nerves (renal denervation) as a treatment for resistant hypertension. Early studies showed some benefit, but more-robust studies found that the therapy does not significantly lower blood pressure in people with resistant hypertension. More research is underway to determine what role, if any, this therapy may have in treating hypertension.
