Answer:. High blood pressure, also known as hypertension, is a major medical problem that can cause heart attacks and strokes. Treatment of high blood pressure is necessary to prevent these problems. In addition to weight loss, exercise and limited sodium intake, most patients require at least two types of medicines to help control blood pressure.

There are several classes of blood pressure medicines your doctor may prescribe. Each has different benefits and side effects. Although these medicines come in different doses and strengths, they all work equally well at lowering blood pressure.

The most important factor is to find medicines that effectively control your blood pressure that you can also tolerate. However, your doctor may prescribe a certain medication with extra benefits for your specific medical conditions.

A common class of blood pressure medicines is diuretics, or water pills. Common examples include hydrochlorothiazide (HCTZ) and furosemide. These medicines help kidneys remove excess salt and water from the body, which can lower blood pressure. Diuretics are effective in almost all patients. One common side effect is an increased need to go to the bathroom. These medicines have been around for a long time and are well studied. Most patients taking more than one blood pressure medicine should also be on a diuretic.

Another common class is beta-blockers. These medicines help slow the heart rate and decrease the strength with which the heart contracts. Examples include metoprolol, atenolol, labetalol and propranolol. Common side effects are fatigue, dry mouth and slowed heart rate. These medicines are very useful for patients with a history of heart attack or heart disease.

A newer class of blood pressure medicines is calcium channel blockers. This includes several very different medicines, including verapamil, diltiazem, felodipine, amlodipine and nifedipine. These medicines relax the blood vessels, thus lowering blood pressure. Side effects, which vary depending on the medicine, include ankle swelling, constipation and slowed heart rate. These medicines are very powerful in reducing blood pressure and are particularly useful in African Americans. They can be used along with any other class of blood pressure medicines.

Similar to calcium channel blockers, alpha-blockers also relax blood vessels and lower blood pressure. Doxazosin and terazosin are two commonly prescribed alpha-blockers. These medicines are particularly helpful for men with enlarged prostate glands, called benign prostatic hyperplasia (BPH), because they reduce the need to go to the bathroom. A common side effect is dizziness or lightheadedness, especially when rising from a sitting position.

The newest classes of blood pressure medicines are angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These medicines work to block the creation or function of a powerful hormone that raises blood pressure. There are many types of ACE inhibitors, such as lisinopril, captopril, enalapril, benazepril and fosinopril. Examples of ARBs include losartan, valsartan, irbesartan, candesartan, telmisartan and olmesartan. Both classes are very useful in patients with kidney disease and proteinuria (protein in the urine), as they help protect the kidney from further damage. They also offer special protective effects for patients with congestive heart failure or a weak heart. ARBs have very few side effects but are generally more expensive than ACE inhibitors. Side effects from ACE inhibitors include a chronic, dry cough and, more importantly, angioedema, swelling of the tongue, lips or face. Although angioedema is rare, it can be life threatening and should be reported to your doctor immediately.

Finally, there are a number of other medicines your doctor may prescribe, such as clonidine, hydralazine or minoxidil. Each of these works differently, but all are effective at lowering blood pressure. Clonidine can cause drowsiness, fatigue and dry mouth; hydralazine can cause a rash. Side effects caused by minoxidil include fluid retention, swelling, and increased facial hair growth.

Thus, there are many types and classes of blood pressure medicines. Depending on a number of factors, including your medical conditions, age, race and cost, your physician will come up with a specific plan for you. Each patient is different, and medicines that may help one patient may not be best for others. It is important to work with your physician, because there might be some trial and error involved in selecting the best and most effective medicines. Often times, medicines will need to be stopped due to side effects or because they are not working well enough. However, with continued work and patience, a truly effective combination of medicines can be found for almost every patient. For many patients, this may be just one or two medicines, but other patients may require three or four. Again, the most important issue is to find medicines that work to appropriately control your blood pressure while causing the fewest side effects possible.

Answer provided by Arnold B. Alper Jr., MD, MPH. Dr. Alper graduated from Tulane University School of Medicine in 1995 and is a board certified nephrologist trained at Tulane University Health Sciences Center. For the past four years, he has been an assistant professor in the nephrology and hypertension department of Tulane University School of Medicine. He specializes in hypertension and progression of renal disease.

The American Association of Kidney Patients presents Ask the Doctor, an opportunity for readers to submit kidney related health questions to healthcare professionals who specialize in an area of concern. The answers are not to be construed as a diagnosis and therefore, alterations in current healthcare should not occur until the patient’s physician is consulted.

This article originally appeared in the June/July 2005 issue of Kidney Beginnings: The Magazine, Vol. 4, No. 2.

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