What are the most common blood pressure medications that start with A. How do ACE inhibitors work to lower blood pressure. Are there any side effects associated with alpha blockers. Which angiotensin receptor blockers are most frequently prescribed.

ACE Inhibitors: The First Line of Defense

ACE inhibitors, or Angiotensin-Converting Enzyme inhibitors, are a crucial class of blood pressure medications that begin with the letter A. These drugs work by preventing the body from producing angiotensin II, a hormone that narrows blood vessels and increases blood pressure.

Some common ACE inhibitors include:

• Altace (ramipril)
• Accupril (quinapril)
• Aceon (perindopril)
• Enalapril (Vasotec)

How effective are ACE inhibitors in managing hypertension? Studies have shown that ACE inhibitors can lower systolic blood pressure by 8-12 mmHg and diastolic blood pressure by 5-7 mmHg on average. This reduction can significantly decrease the risk of heart attacks, strokes, and other cardiovascular complications.

Side Effects of ACE Inhibitors

While generally well-tolerated, ACE inhibitors may cause some side effects. These can include:

• Dry cough
• Dizziness
• Elevated potassium levels
• Headache
• Fatigue

Is the dry cough associated with ACE inhibitors dangerous? While annoying, the cough is generally harmless and often subsides over time. However, if it persists or becomes bothersome, your healthcare provider may consider switching you to an alternative medication.

Angiotensin Receptor Blockers (ARBs): The A-Team of Blood Pressure Control

Angiotensin Receptor Blockers, or ARBs, are another class of blood pressure medications that start with A. These drugs work similarly to ACE inhibitors but block the effects of angiotensin II instead of preventing its production.

Common ARBs include:

• Atacand (candesartan)
• Avapro (irbesartan)
• Azilsartan (Edarbi)

How do ARBs compare to ACE inhibitors in terms of efficacy? Studies have shown that ARBs are generally as effective as ACE inhibitors in lowering blood pressure, with the added benefit of fewer side effects, particularly the absence of the persistent dry cough associated with ACE inhibitors.

ARBs and Kidney Protection

Can ARBs provide additional benefits beyond blood pressure control? Research suggests that ARBs may offer kidney protection, especially in patients with diabetes or chronic kidney disease. They can help reduce proteinuria (excess protein in the urine) and slow the progression of kidney damage.

Alpha Blockers: Another A-lister in Hypertension Management

Alpha blockers are yet another class of blood pressure medications that start with A. These drugs work by preventing the hormone norepinephrine from constricting blood vessels, thereby reducing blood pressure.

Common alpha blockers include:

• Alfuzosin (Uroxatral)
• Amlodipine (Norvasc)

Do alpha blockers have any unique advantages? Alpha blockers can be particularly beneficial for men with high blood pressure who also have benign prostatic hyperplasia (BPH), as they can improve urinary symptoms associated with this condition.

Potential Side Effects of Alpha Blockers

What are the most common side effects of alpha blockers? Some patients may experience:

• Dizziness, especially when standing up quickly
• Headache
• Fatigue
• Swelling in the legs and feet

How can these side effects be managed? Starting with a low dose and gradually increasing it can help minimize side effects. It’s also important to rise slowly from a sitting or lying position to prevent dizziness.

Aldosterone Antagonists: The A-plus in Complex Hypertension

Aldosterone antagonists, also known as mineralocorticoid receptor antagonists, are a class of blood pressure medications that can be particularly effective in certain types of hypertension.

The most common aldosterone antagonist is:

• Aldactone (spironolactone)

When are aldosterone antagonists typically prescribed? These medications are often used in cases of resistant hypertension, where blood pressure remains high despite the use of multiple other medications. They can also be beneficial in patients with heart failure or primary aldosteronism.

Monitoring Potassium Levels

Why is it crucial to monitor potassium levels when taking aldosterone antagonists? These medications can cause potassium retention, potentially leading to hyperkalemia (high potassium levels). Regular blood tests are necessary to ensure potassium levels remain within a safe range.

Amlodipine: The Calcium Channel Blocker Starting with A

Amlodipine, while technically a calcium channel blocker, is a widely prescribed blood pressure medication that starts with A. It works by relaxing blood vessels, making it easier for the heart to pump blood.

How effective is amlodipine in managing hypertension? Studies have shown that amlodipine can lower systolic blood pressure by 12-16 mmHg and diastolic blood pressure by 6-9 mmHg on average, making it one of the more potent blood pressure medications available.

Amlodipine and Edema

Is swelling a common side effect of amlodipine? Yes, peripheral edema (swelling in the legs and ankles) is a relatively common side effect of amlodipine. It occurs in about 10-15% of patients and is generally more common in women and older adults.

How can amlodipine-induced edema be managed? In some cases, reducing the dose or switching to a different medication may be necessary. However, lifestyle modifications such as elevating the legs, reducing salt intake, and wearing compression stockings can also help alleviate this side effect.

Aliskiren: The Direct Renin Inhibitor

Aliskiren (brand name Tekturna) is a unique blood pressure medication that starts with A. It belongs to a class called direct renin inhibitors, which work by blocking the enzyme renin, a key player in blood pressure regulation.

How does aliskiren differ from other blood pressure medications? Unlike ACE inhibitors and ARBs, which act later in the renin-angiotensin-aldosterone system, aliskiren targets the very beginning of this pathway. This unique mechanism of action can make it effective in patients who don’t respond well to other medications.

Aliskiren in Combination Therapy

Can aliskiren be used in combination with other blood pressure medications? Yes, aliskiren is often prescribed in combination with other antihypertensive drugs, particularly in patients with difficult-to-control blood pressure. However, it should not be combined with ACE inhibitors or ARBs in patients with diabetes or kidney problems due to an increased risk of adverse effects.

Atenolol: The Beta-Blocker Beginning with A

Atenolol is a beta-blocker that starts with A and is commonly prescribed for hypertension. It works by blocking the effects of adrenaline on the heart, slowing heart rate and reducing the force of heart contractions.

What are the advantages of atenolol over other beta-blockers? Atenolol is cardioselective, meaning it primarily affects the heart rather than other parts of the body. This can result in fewer side effects compared to non-selective beta-blockers.

Atenolol and Exercise

How does atenolol affect exercise capacity? Atenolol, like other beta-blockers, can limit maximum exercise capacity by reducing maximum heart rate. However, it generally doesn’t affect submaximal exercise performance, which is more relevant to daily activities.

Should patients on atenolol avoid exercise? Not at all. Regular exercise is still highly beneficial for patients with hypertension. However, it’s important to be aware that heart rate may not increase as much during exercise, and to use perceived exertion as a guide for exercise intensity instead.

Choosing the Right ‘A’ Medication for Your Blood Pressure

With so many blood pressure medications starting with A, how do healthcare providers choose the right one for a patient? The decision is based on several factors, including:

• The severity of hypertension
• Presence of other medical conditions
• Potential side effects
• Cost and insurance coverage
• Patient preferences and lifestyle

Is it common to try multiple medications before finding the right one? Yes, finding the optimal blood pressure medication or combination of medications often requires some trial and error. It’s a process that requires patience and open communication between the patient and healthcare provider.

The Importance of Medication Adherence

Why is it crucial to take blood pressure medications consistently? Consistent medication use is key to maintaining blood pressure control and reducing the risk of cardiovascular events. Skipping doses or stopping medication without consulting a healthcare provider can lead to rebound hypertension and increased health risks.

How can patients improve their medication adherence? Some strategies include:

• Using pill organizers or smartphone apps to track medications
• Setting reminders for medication times
• Associating medication-taking with daily routines (e.g., brushing teeth)
• Discussing any side effects or concerns with healthcare providers promptly

Lifestyle Modifications: The Perfect Complement to ‘A’ Medications

While medications are often necessary for blood pressure control, lifestyle modifications play a crucial role in managing hypertension. What lifestyle changes can enhance the effectiveness of blood pressure medications?

• Maintaining a healthy weight
• Following a balanced, low-sodium diet (such as the DASH diet)
• Engaging in regular physical activity
• Limiting alcohol consumption
• Quitting smoking
• Managing stress through techniques like meditation or yoga

Can lifestyle changes reduce the need for medication? In some cases, yes. Significant lifestyle modifications can lead to substantial reductions in blood pressure, potentially allowing for lower medication doses or even discontinuation of some medications under medical supervision.

The DASH Diet: A Powerful Tool in Blood Pressure Management

What is the DASH diet, and how effective is it in lowering blood pressure? The Dietary Approaches to Stop Hypertension (DASH) diet is a eating plan designed to lower blood pressure. It emphasizes:

• Fruits and vegetables
• Whole grains
• Lean proteins
• Low-fat dairy products
• Limited saturated fats and added sugars

Studies have shown that the DASH diet can lower systolic blood pressure by 8-14 mmHg, a reduction comparable to that achieved by some blood pressure medications.

Monitoring Blood Pressure at Home: A Key to Successful Treatment

Regular blood pressure monitoring at home is an important part of managing hypertension, especially when starting new medications or adjusting doses. How often should patients measure their blood pressure at home?

For most patients, measuring blood pressure twice daily (morning and evening) for a week before each doctor’s appointment can provide valuable information. Some healthcare providers may recommend more frequent measurements, especially when initiating or changing treatment.

Choosing a Home Blood Pressure Monitor

What features should patients look for in a home blood pressure monitor? Key considerations include:

• Accuracy (look for devices validated by organizations like the Association for the Advancement of Medical Instrumentation)
• Cuff size (proper fit is crucial for accurate readings)
• Ease of use
• Memory function to store readings
• Ability to connect to smartphones or share data with healthcare providers

Is it necessary to bring the home blood pressure monitor to doctor’s appointments? Yes, it’s a good idea to bring your home monitor to appointments periodically. This allows your healthcare provider to check its accuracy and ensure you’re using it correctly.

The Future of Blood Pressure Medications: What’s on the Horizon?

While current blood pressure medications, including those starting with A, are effective for many patients, research into new treatments continues. What emerging therapies show promise in hypertension management?

• Dual-acting ARB-neprilysin inhibitors: These combination drugs have shown potential in treating resistant hypertension.
• Endothelin receptor antagonists: Currently used for pulmonary hypertension, these drugs are being studied for broader use in hypertension.
• Vaccines targeting angiotensin II: Early research suggests these could provide long-lasting blood pressure control with infrequent dosing.
• Gene therapy: Targeting genes involved in blood pressure regulation could offer new treatment options in the future.

How soon might these new treatments be available? While some of these therapies are in advanced clinical trials, it typically takes several years for new medications to complete testing and gain regulatory approval. However, the field of hypertension management continues to evolve, offering hope for improved treatments in the coming years.

Personalized Medicine in Hypertension Treatment

How might personalized medicine impact the use of blood pressure medications in the future? Advances in genetic testing and biomarker identification could allow for more tailored treatment approaches. This could involve:

• Predicting which medications will be most effective for individual patients based on their genetic profile
• Identifying patients at higher risk for specific side effects
• Developing new medications targeted at specific genetic variants associated with hypertension

While personalized medicine in hypertension treatment is still in its early stages, it holds promise for improving treatment outcomes and minimizing side effects in the future.

Types of Blood Pressure Medications

Prescription blood pressure drugs come in many classes

Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs.

Overviews of the classes of blood pressure medications

Summaries of some of the major types of commonly prescribed cardiovascular medications are provided here.

• For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
• If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information.
• It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
• Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician

The classes of blood pressure medications include:

Diuretics

Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies.

Some noted possible side effects from diuretics:

• Some of these drugs may decrease your body’s supply of the mineral potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. If your doctor recommends it, you could prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic. Diuretics such as amiloride (Midamar)*, spironolactone (Aldactone)* or triamterene (Dyrenium)* are called “potassium sparing” agents. They don’t cause the body to lose potassium. They might be prescribed alone, but are usually used with another diuretic. Some of these combinations are Aldactazide*, Dyazide*, Maxzide* or Moduretic*.
• Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn’t common and can be managed by other treatment.
• People with diabetes may find that diuretic drugs increase their blood sugar level. A change in medication, diet, insulin or oral anti-diabetic dosage corrects this in most cases.
• Impotence may occur.

Beta-blockers

Beta-blockers reduce the heart rate, the heart’s workload and the heart’s output of blood, which lowers blood pressure.

Some noted possible side effects of beta-blockers:

• Insomnia
• Cold hands and feet
• Tiredness or depression
• Slow heartbeat
• Symptoms of asthma
• Impotence may also occur
• If you have diabetes and you’re taking insulin, have your responses to therapy monitored closely.
• If you have been prescribed beta-blockers, consult your healthcare provider prior to conception if you are considering pregnancy or if there is a chance you could become pregnant. If you discover that you are pregnant consult your healthcare provider as soon as possible to determine the safest medication for you at this time.

ACE inhibitors

Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.

Some noted possible side effects of ACE inhibitors:

• Skin rash
• Loss of taste
• Chronic dry, hacking cough
• In rare instances, kidney damage
• Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you’re taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately. These drugs have been shown to be dangerous to both mother and baby during pregnancy. They can cause low blood pressure, severe kidney failure, excess potassium (hyperkalemia) and even death of the newborn.

Angiotensin II receptor blockers

These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow. Angiotensin needs a receptor- like a chemical “slot” to fit into or bind with- in order to constrict the blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood vessels stay open and blood pressure is reduced.

Some noted possible side effects of Angiotensin II receptor blockers:

• May cause occasional dizziness.
• ARBs should not be used during pregnancy. Medications that act directly on the renin-angiotensin system can cause injury or even death to a developing fetus. When pregnancy is detected, consult your healthcare professional as soon as possible.

Calcium channel blockers

This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts’ contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.

Some noted possible side effects of calcium channel blockers:

• Palpitations
• Swollen ankles
• Constipation
• Headache
• Dizziness

Alpha blockers

These drugs reduce the arteries’ resistance, relaxing the muscle tone of the vascular walls.

Some noted possible side effects of alpha blockers:

Alpha-2 Receptor Agonists

These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system. Methyldopa is considered a first line antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.

Some noted possible side effects of Alpha-2 Receptor Agonists:

• Methyldopa can cause drowsiness or dizziness

Combined alpha and beta-blockers

Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.

A noted possible side effect of combined alpha and beta-blockers:

• May cause a drop in blood pressure when you stand up

Central agonists

Central agonists also help decrease the blood vessels’ ability to tense up or contract. The central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of blood pressure reduction.

Some noted possible side effects of central agonists:

• Alpha methyldopa (Aldomet)* may produce a greater drop in blood pressure when you’re in an upright position (standing or walking), and it may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.
• Clonidine (Catapres)*, guanabenz (Wytensin)* or guanfacine (Tenex)* may produce severe dryness of the mouth, constipation or drowsiness. If you’re taking any of these drugs, don’t stop suddenly because your blood pressure may rise quickly to dangerously high levels.

Peripheral adrenergic inhibitors

These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles from getting the “message” to constrict. These drugs are rarely used unless other medications don’t help.

Some noted possible side effects of peripheral adrenergic inhibitors:

• Reserpine may cause a stuffy nose, diarrhea or heartburn. These effects aren’t severe, and no treatment is required other than to change the dosage. If you have nightmares or insomnia or get depressed, tell your doctor immediately.
• Guanadrel (Hylorel)* or guanethidine (Ismelin)* may cause some diarrhea, which may persist in some people. This side effect usually becomes less of a problem if you continue treatment. These drugs reduce blood pressure more when you stand. Consequently, you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions and if they persist for more than a minute or two, contact your doctor. He/she may instruct you to reduce or omit the next dose of the medication.
• When taking guanethidine, don’t stand in the hot sun or at a social gathering if you begin to feel faint or weak. These activities cause low blood pressure and fainting. Male patients may experience impotence. Contact your doctor if either of these side effects occurs.

Blood vessel dilators (vasodilators)

Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.

Some noted possible side effects of vasodilators:

• Hydralazine (Apresoline)* may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn’t usually used by itself.
• Minoxidil (Loniten)* is a potent drug that’s usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.

† Used in severe cases or when kidney failure is present.

Types of Blood Pressure Medications

Prescription blood pressure drugs come in many classes

Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs.

Overviews of the classes of blood pressure medications

Summaries of some of the major types of commonly prescribed cardiovascular medications are provided here.

• For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
• If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information.
• It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
• Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician

The classes of blood pressure medications include:

Diuretics

Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies.

Some noted possible side effects from diuretics:

• Some of these drugs may decrease your body’s supply of the mineral potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. If your doctor recommends it, you could prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic. Diuretics such as amiloride (Midamar)*, spironolactone (Aldactone)* or triamterene (Dyrenium)* are called “potassium sparing” agents. They don’t cause the body to lose potassium. They might be prescribed alone, but are usually used with another diuretic. Some of these combinations are Aldactazide*, Dyazide*, Maxzide* or Moduretic*.
• Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn’t common and can be managed by other treatment.
• People with diabetes may find that diuretic drugs increase their blood sugar level. A change in medication, diet, insulin or oral anti-diabetic dosage corrects this in most cases.
• Impotence may occur.

Beta-blockers

Beta-blockers reduce the heart rate, the heart’s workload and the heart’s output of blood, which lowers blood pressure.

Some noted possible side effects of beta-blockers:

• Insomnia
• Cold hands and feet
• Tiredness or depression
• Slow heartbeat
• Symptoms of asthma
• Impotence may also occur
• If you have diabetes and you’re taking insulin, have your responses to therapy monitored closely.
• If you have been prescribed beta-blockers, consult your healthcare provider prior to conception if you are considering pregnancy or if there is a chance you could become pregnant. If you discover that you are pregnant consult your healthcare provider as soon as possible to determine the safest medication for you at this time.

ACE inhibitors

Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.

Some noted possible side effects of ACE inhibitors:

• Skin rash
• Loss of taste
• Chronic dry, hacking cough
• In rare instances, kidney damage
• Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you’re taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately. These drugs have been shown to be dangerous to both mother and baby during pregnancy. They can cause low blood pressure, severe kidney failure, excess potassium (hyperkalemia) and even death of the newborn.

Angiotensin II receptor blockers

These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow. Angiotensin needs a receptor- like a chemical “slot” to fit into or bind with- in order to constrict the blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood vessels stay open and blood pressure is reduced.

Some noted possible side effects of Angiotensin II receptor blockers:

• May cause occasional dizziness.
• ARBs should not be used during pregnancy. Medications that act directly on the renin-angiotensin system can cause injury or even death to a developing fetus. When pregnancy is detected, consult your healthcare professional as soon as possible.

Calcium channel blockers

This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts’ contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.

Some noted possible side effects of calcium channel blockers:

• Palpitations
• Swollen ankles
• Constipation
• Headache
• Dizziness

Alpha blockers

These drugs reduce the arteries’ resistance, relaxing the muscle tone of the vascular walls.

Some noted possible side effects of alpha blockers:

Alpha-2 Receptor Agonists

These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system. Methyldopa is considered a first line antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.

Some noted possible side effects of Alpha-2 Receptor Agonists:

• Methyldopa can cause drowsiness or dizziness

Combined alpha and beta-blockers

Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.

A noted possible side effect of combined alpha and beta-blockers:

• May cause a drop in blood pressure when you stand up

Central agonists

Central agonists also help decrease the blood vessels’ ability to tense up or contract. The central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of blood pressure reduction.

Some noted possible side effects of central agonists:

• Alpha methyldopa (Aldomet)* may produce a greater drop in blood pressure when you’re in an upright position (standing or walking), and it may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.
• Clonidine (Catapres)*, guanabenz (Wytensin)* or guanfacine (Tenex)* may produce severe dryness of the mouth, constipation or drowsiness. If you’re taking any of these drugs, don’t stop suddenly because your blood pressure may rise quickly to dangerously high levels.

Peripheral adrenergic inhibitors

These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles from getting the “message” to constrict. These drugs are rarely used unless other medications don’t help.

Some noted possible side effects of peripheral adrenergic inhibitors:

• Reserpine may cause a stuffy nose, diarrhea or heartburn. These effects aren’t severe, and no treatment is required other than to change the dosage. If you have nightmares or insomnia or get depressed, tell your doctor immediately.
• Guanadrel (Hylorel)* or guanethidine (Ismelin)* may cause some diarrhea, which may persist in some people. This side effect usually becomes less of a problem if you continue treatment. These drugs reduce blood pressure more when you stand. Consequently, you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions and if they persist for more than a minute or two, contact your doctor. He/she may instruct you to reduce or omit the next dose of the medication.
• When taking guanethidine, don’t stand in the hot sun or at a social gathering if you begin to feel faint or weak. These activities cause low blood pressure and fainting. Male patients may experience impotence. Contact your doctor if either of these side effects occurs.

Blood vessel dilators (vasodilators)

Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.

Some noted possible side effects of vasodilators:

• Hydralazine (Apresoline)* may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn’t usually used by itself.
• Minoxidil (Loniten)* is a potent drug that’s usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.

† Used in severe cases or when kidney failure is present.

Types of Blood Pressure Medications

Prescription blood pressure drugs come in many classes

Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs.

Overviews of the classes of blood pressure medications

Summaries of some of the major types of commonly prescribed cardiovascular medications are provided here.

• For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
• If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information.
• It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
• Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician

The classes of blood pressure medications include:

Diuretics

Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure. They are often used in combination with additional prescription therapies.

Some noted possible side effects from diuretics:

• Some of these drugs may decrease your body’s supply of the mineral potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. If your doctor recommends it, you could prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic. Diuretics such as amiloride (Midamar)*, spironolactone (Aldactone)* or triamterene (Dyrenium)* are called “potassium sparing” agents. They don’t cause the body to lose potassium. They might be prescribed alone, but are usually used with another diuretic. Some of these combinations are Aldactazide*, Dyazide*, Maxzide* or Moduretic*.
• Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn’t common and can be managed by other treatment.
• People with diabetes may find that diuretic drugs increase their blood sugar level. A change in medication, diet, insulin or oral anti-diabetic dosage corrects this in most cases.
• Impotence may occur.

Beta-blockers

Beta-blockers reduce the heart rate, the heart’s workload and the heart’s output of blood, which lowers blood pressure.

Some noted possible side effects of beta-blockers:

• Insomnia
• Cold hands and feet
• Tiredness or depression
• Slow heartbeat
• Symptoms of asthma
• Impotence may also occur
• If you have diabetes and you’re taking insulin, have your responses to therapy monitored closely.
• If you have been prescribed beta-blockers, consult your healthcare provider prior to conception if you are considering pregnancy or if there is a chance you could become pregnant. If you discover that you are pregnant consult your healthcare provider as soon as possible to determine the safest medication for you at this time.

ACE inhibitors

Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.

Some noted possible side effects of ACE inhibitors:

• Skin rash
• Loss of taste
• Chronic dry, hacking cough
• In rare instances, kidney damage
• Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you’re taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately. These drugs have been shown to be dangerous to both mother and baby during pregnancy. They can cause low blood pressure, severe kidney failure, excess potassium (hyperkalemia) and even death of the newborn.

Angiotensin II receptor blockers

These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow. Angiotensin needs a receptor- like a chemical “slot” to fit into or bind with- in order to constrict the blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood vessels stay open and blood pressure is reduced.

Some noted possible side effects of Angiotensin II receptor blockers:

• May cause occasional dizziness.
• ARBs should not be used during pregnancy. Medications that act directly on the renin-angiotensin system can cause injury or even death to a developing fetus. When pregnancy is detected, consult your healthcare professional as soon as possible.

Calcium channel blockers

This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts’ contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.

Some noted possible side effects of calcium channel blockers:

• Palpitations
• Swollen ankles
• Constipation
• Headache
• Dizziness

Alpha blockers

These drugs reduce the arteries’ resistance, relaxing the muscle tone of the vascular walls.

Some noted possible side effects of alpha blockers:

Alpha-2 Receptor Agonists

These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system. Methyldopa is considered a first line antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.

Some noted possible side effects of Alpha-2 Receptor Agonists:

• Methyldopa can cause drowsiness or dizziness

Combined alpha and beta-blockers

Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.

A noted possible side effect of combined alpha and beta-blockers:

• May cause a drop in blood pressure when you stand up

Central agonists

Central agonists also help decrease the blood vessels’ ability to tense up or contract. The central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of blood pressure reduction.

Some noted possible side effects of central agonists:

• Alpha methyldopa (Aldomet)* may produce a greater drop in blood pressure when you’re in an upright position (standing or walking), and it may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.
• Clonidine (Catapres)*, guanabenz (Wytensin)* or guanfacine (Tenex)* may produce severe dryness of the mouth, constipation or drowsiness. If you’re taking any of these drugs, don’t stop suddenly because your blood pressure may rise quickly to dangerously high levels.

Peripheral adrenergic inhibitors

These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles from getting the “message” to constrict. These drugs are rarely used unless other medications don’t help.

Some noted possible side effects of peripheral adrenergic inhibitors:

• Reserpine may cause a stuffy nose, diarrhea or heartburn. These effects aren’t severe, and no treatment is required other than to change the dosage. If you have nightmares or insomnia or get depressed, tell your doctor immediately.
• Guanadrel (Hylorel)* or guanethidine (Ismelin)* may cause some diarrhea, which may persist in some people. This side effect usually becomes less of a problem if you continue treatment. These drugs reduce blood pressure more when you stand. Consequently, you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions and if they persist for more than a minute or two, contact your doctor. He/she may instruct you to reduce or omit the next dose of the medication.
• When taking guanethidine, don’t stand in the hot sun or at a social gathering if you begin to feel faint or weak. These activities cause low blood pressure and fainting. Male patients may experience impotence. Contact your doctor if either of these side effects occurs.

Blood vessel dilators (vasodilators)

Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.

Some noted possible side effects of vasodilators:

• Hydralazine (Apresoline)* may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn’t usually used by itself.
• Minoxidil (Loniten)* is a potent drug that’s usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.

† Used in severe cases or when kidney failure is present.

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List of High Blood Pressure (Hypertension) Medications (214 Compared)

10 Common High Blood Pressure Medications

High blood pressure—or hypertension—occurs when blood flows through your blood vessels with too much force. If you have high blood pressure, you’re one of about 85 million American adults who also have it. However, many people do not even know they have high blood pressure because there are usually no obvious symptoms. This fact is why high blood pressure gets the name “silent killer.” It can lead to life-threatening complications, such as heart attack and stroke, without warning signs.

If your doctor diagnoses high blood pressure, you will probably need to make some lifestyle changes. However, medication for consistent blood pressure control is a vital part of treatment.

Classes of Blood Pressure Medications

Drugs that treat high blood pressure are known as antihypertensives. There are many so-called “classes” of antihypertensives and many drugs within each class. This results in a large number of drugs doctors can use to treat high blood pressure. To assist doctors in choosing treatment, they follow guidelines and recommendations from experts in the field.

Commonly prescribed classes of hypertension medications include:

• Thiazide diuretics. These drugs work by increasing the amount of fluid the body eliminates through urination. A lot of people call diuretics “water pills.” By also reducing your body’s volume of blood, pressure on the artery walls decreases. Common side effects of diuretics are increased urination, thirst, dizziness, and sensitivity to sunlight.

• Calcium channel blockers. This class relaxes blood vessels and decreases heart rate. Possible side effects include heart palpitations, ankle swelling, constipation, headache, and dizziness.

• ACE (angiotensin-converting enzyme) inhibitors. These drugs block an enzyme to reduce the body’s amount of angiotensin. Less angiotensin helps relax blood vessels. Common side effects of ACE inhibitors are skin rash and a dry cough.

• Angiotensin II receptor blockers. This class directly blocks angiotensin to relax blood vessels. Common side effects are dizziness and lightheadedness, especially when standing up from a seated position.

• Beta blockers. These drugs block adrenalin, lower blood pressure by decreasing your heart rate and the force of each beat.

When choosing among these classes, your doctor will consider many factors, including your other health conditions and your race. For example, African American people benefit most from starting treatment with a thiazide diuretic or a calcium channel blocker, studies show. However, someone with diabetes may benefit more from using an ACE inhibitor.

After starting treatment, your doctor will regularly monitor your blood pressure. It may be necessary to adjust the dose, change drugs, or add a second drug to control your blood pressure. Your doctor can choose this second drug from any of the first-line classes. In some cases, your doctor may need to consider another antihypertensive class, such as beta blockers.

Common Medications for High Blood Pressure

Within each class of antihypertensive drug, your doctor has more choices to make. Some classes contain just a few drug options. Others, such as ACE inhibitors, include many drugs. Finding the right choice for you may involve some trial and error. Here is a summary of 10 drugs commonly prescribed for high blood pressure:

1. Amlodipine (Norvasc) is a calcium channel blocker. You usually take it once a day. Most people find once daily dosing to be convenient and easy to remember. Amlodipine is also a treatment for angina.

2. Benazepril (Lotensin) is an ACE inhibitor. At low doses, you usually take it once a day. Your doctor may recommend splitting higher doses to twice a day.

3. Chlorthalidone (Hygroton) is a thiazide diuretic. The usual dose is once a day with food, preferably breakfast. It also treats fluid retention from conditions like heart failure.

4. Enalapril (Vasotec) is an ACE inhibitor. For high blood pressure, you usually take it once a day. It is also a treatment for heart failure.

5. Hydrochlorothiazide (Hydrodiuril, Microzide) is a thiazide diuretic. It comes as a capsule or tablet you typically take once a day. Like other thiazide diuretics, it also treats fluid retention, or edema.

6. Irbesartan (Avapro) is an angiotensin II receptor blocker. The usual dose is once daily. It is also a treatment for kidney problems in people with type 2 diabetes.

7. Lisinopril (Prinivil, Zestril) is an ACE inhibitor. It is also a drug you usually take once a day. Lisinopril is also a treatment for heart failure.

8. Losartan (Cozaar) is an angiotensin II receptor blocker. In most cases, the dose is once a day. Doctors also use it to decrease the risk of stroke in people with an enlarged heart.

9. Metoprolol (Lopressor, Toprol XL) is a beta blocker. It comes in both an immediate-release and an extended-release form. It also helps lower the risk of repeat heart attacks and treats angina and congestive heart failure.

10. Valsartan (Diovan) is an angiotensin II receptor blocker. It is also a treatment for heart failure and to improve survival after a heart attack. For high blood pressure, you usually take it once a day.

There are many other options available for treating high blood pressure. If you are experiencing side effects or are otherwise not happy with your current medicine, talk with your doctor. It may be possible to try a different drug and get better results. Healthy lifestyle habits also help lower blood pressure. Doctors prescribe regular physical activity and a low-salt diet to compliment the effect of your blood pressure medication.

Medications Used to Treat High Blood Pressure

*Classification only requires one of the listed criteria to be present.

If there is a difference between the systolic pressure (top number) and diastolic blood pressure (bottom number), the higher one determines the stage.

Deciding When Medication Is Needed

Doctors generally use a stepwise approach to managing hypertension in their patients. For the vast majority of people, the goal of treatment is to achieve a blood pressure of less than 120/80 mmHg.

Step 1 involves engaging in lifestyle modifications that have been shown to reduce blood pressure. These include adopting a heart-healthy diet, losing weight (if needed), participating in regular exercise, and so on.

These changes may be implemented alone, but may or may not be sufficient to manage your condition. Given this, they may also be used in combination with one or more high blood pressure medications.

The initiation of a single anti-hypertensive medication is reasonable in adults with stage 1 hypertension and a BP goal <130/80 mm Hg.

However, if you have stage 2 hypertension and your average blood pressure is more than 20 mmHg above goal, your doctor may recommend combination drug therapy.

Deciding whether or not to start medication for your high blood pressure requires a thoughtful discussion with your doctor. In some cases, the decision is obvious. For example, medication is strongly advised if a patient has hypertension and another medical condition, like type 2 diabetes mellitus.

That said, other cases are less straightforward. For example, if you are over the age of 75, the potential risks of taking medication may not outweigh the potential benefits.

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Drug Types and Choices in Treatment

If you and your doctor decide that taking a medication for your hypertension is the best approach, then the next step is choosing which one (or more) to start.

There are five major categories of medications that have been proven effective in treating hypertension:

Combination therapy would involve taking two anti-hypertensive medications, each from a different drug category.

Verywell / JR Bee

Generally speaking, drugs from each of these classes tend to work equally well in controlling hypertension. That said, individuals may respond quite differently. Doctors have no way of predicting this ahead of time, so they and patients must settle for an educated trial-and-error approach.

In “guessing” on the best initial single drug to try, most experts now recommend beginning either with calcium channel blockers and ARB/ACE inhibitors. While there are no hard and fast rules about which drugs to use in which people, there are certain tendencies that are useful in selecting single-drug therapy.

For instance, African American patients tend to do better with thiazide diuretics or calcium channel blockers. In addition, patients with certain medical conditions may benefit from one drug versus another.

For example, individuals with hypertension who also have diabetes or chronic kidney disease with albuminuria (when a person’s urine contains high levels of the protein albumin) are generally prescribed an ACE inhibitor or an ARB (if an ACE inhibitor is not tolerated).

Likewise, having a particular medical condition may sway a doctor away from prescribing a certain anti-hypertensive medication. For example, ACE inhibitors are contraindicated in people with a history of angioedema or in women who are pregnant.

Most Common Hypertension Drugs

It is not possible to list every high blood pressure medication here, but the following list is reasonably complete. The brand name(s) of each drug is listed first, followed by the generic name.

Diuretics

Diuretics (“water pills”) increase the amount of sodium and water excreted into the urine by the kidneys. It is thought that diuretics lower blood pressure mainly by reducing the volume of fluid in the blood vessels.

Examples of diuretics commonly used for hypertension:

• Thalidone, also sold as Tenoretic and Clorpres, (chlorthalidone)
• HydroDiuril, also sold as Microzide and Esidrix (hydrochlorothiazide)
• Lozol (indapamide)

Diuretics less commonly used for hypertension include:

• Diamox (acetazolamide)
• Zaroxolyn, also sold as Mykrox (metolazone)
• Midamor (amiloride hydrochloride)
• Bumex (bumetanide)
• Edecrin (ethacrynic acid)
• Lasix (furosemide)
• Aldactone (spironolactone)
• Demadex (torsemide)
• Dyrenium (triamterene)

Calcium Channel Blockers

Calcium channel blockers can reduce blood pressure by dilating the arteries and, in some cases, reducing the force of the heart’s contractions.

Examples of calcium channel blockers include:

• Norvasc (amlodipine)
• Cardizem, also sold as Dilacor and Tiazac, (diltiazem)
• Plendil (felodipine)
• DynaCirc (isradipine)
• Cardene (nicardipine)
• Procardia XL, also sold as Adalat CC, (nifedipine)
• Sular (nisoldipine)
• Verelan, also sold as Calan, (verapamil)

ARBs

The angiotensin II receptor blockers (so-called ARBs) also reduce blood pressure by dilating the arteries. ARBs are generally thought of as superior to ACE inhibitors due to better efficacy and fewer adverse effects.

Options include:

• Atacand (candesartan)
• Avapro (irbesartan)
• Cozaar (losartan)
• Micardis (telmisartan)
• Diovan (valsartan)

ACE Inhibitors

The angiotensin-converting enzyme inhibitors (ACE inhibitors) can lower blood pressure by dilating the arteries.

Popular ACE inhibitors include:

• Lotensin (benazepril)
• Capoten (captopril)
• Vasotec, also sold as Vaseretic (enalapril)
• Monopril (fosinopril)
• Prinivil, also sold as Zestril (lisinopril)
• Univasc (moexipril)
• Accupril (quinapril)
• Altace (ramipril)
• Mavik (trandolapril)

Beta-Blockers

Beta-blockers are no longer considered a first-line, single-drug therapy for hypertension unless a patient has ischemic heart disease, heart failure, or arrhythmias. These drugs block the effect of adrenaline on the cardiovascular system, slow the heart rate, and reduce stress on the heart and the arteries.

Some beta-blockers include:

• Sectral (acebutolol)
• Bystolic (nebivolol)
• Tenormin (atenolol)
• Kerlone (betaxolol)
• Zebeta, also sold as Ziac (bisoprolol)
• Cartrol (carteolol)
• Coreg (carvedilol)
• Normodyne, also sold as Trandate (labetalol)
• Lopressor, also sold as Toprol (metoprolol)
• Corgard (nadolol)
• Levatol (penbutolol)
• Inderal, Inderal LA (propranolol)
• Blocadren (timolol)

Less Commonly Used Hypertension Drugs

These options may be considered in certain circumstances, but are less commonly used:

• Catapres (clonidine)
• Cardura (doxazosin)
• Wytensin (guanabenz)
• Tenex (guanfacine)
• Apresoline (hydralazine hydrochloride)
• Aldomet (methyldopa)
• Minipress (prazosin)
• Serpasil (reserpine)
• Hytrin (terazosin)

Combination Drugs for Hypertension

Several clinical trials have been conducted that offer substantial guidance in choosing appropriate combination therapy for hypertension.

The best scientific evidence (from the ACCOMPLISH trial) suggests that clinical outcomes (including the risk of stroke, heart attack, and cardiovascular death) are most improved with combination therapy when a long-acting calcium channel blocker is used together with an ACE inhibitor or an ARB. So, today most doctors will try this combination first.

If the blood pressure remains elevated with combination therapy using a calcium channel blocker plus an ACE inhibitor or ARB drug, a thiazide drug will usually be added as a third drug. And if this combination still fails to control the blood pressure, a fourth drug (usually spironolactone, a non-thiazide diuretic) may be added.

The vast majority of patients with hypertension will achieve successful therapy long before a third or fourth drug needs to be considered. The rare individual who fails to respond adequately to this kind of combination therapy should be referred to a hypertension specialist.

Numerous combination drugs have been marketed for hypertension, and it is almost impossible to keep track of new ones that come along, or old ones that fade away.

The following list includes most of the commonly prescribed combination drugs used for hypertension:

• Moduretic (amiloride and hydrochlorothiazide)
• Lotrel (amlodipine and benazepril)
• Tenoretic (atenolol and chlorthalidone)
• Lotensin HCT (benazepril and hydrochlorothiazide)
• Ziac (bisoprolol and hydrochlorothiazide)
• Capozide (captopril and hydrochlorothiazide)
• Vaseretic (enalapril and hydrochlorothiazide)
• Lexxel (felodipine and enalapril)
• Apresazide (hydralazine and hydrochlorothiazide)
• Prinzide, also sold as Zestoretic (lisinopril and hydrochlorothiazide)
• Hyzaar (losartan and hydrochlorothiazide)
• Aldoril (methyldopa and hydrochlorothiazide)
• Lopressor HCT (metoprolol and hydrochlorothiazide)
• Corzide (nadolol and bendroflumethiazide)
• Inderide (propranolol and hydrochlorothiazide)
• Aldactazide (spironolactone and hydrochlorothiazide)
• Dyazide, also sold as Maxide (triamterene and hydrochlorothiazide)
• Tarka (verapamil extended-release and trandolapril)

Interestingly, research has found that combining anti-hypertensive drugs has a significantly greater effect (about five times greater) on lowering a person’s blood pressure than simply doubling the dose of a single agent.

Avoiding Adverse Effects

Any of the drugs used to treat hypertension has the potential of causing problems. And when choosing the best drug regimen for treating a person with hypertension, it is critical to find a drug (or drugs) that not only effectively reduces blood pressure, but that is also well tolerated.

In general, lower doses of blood pressure medicine are as effective as higher doses and cause fewer side effects.

While each of the myriads of hypertension drugs has its own individual side effect profile, for the most part, the potential adverse effects of these drugs are related to their category.

The major category-related adverse effects are:

• Thiazide diuretics: Hypokalemia (low potassium levels), frequent urination, worsening of gout
• Calcium channel blockers: Constipation, swelling of the legs, headache
• ACE inhibitors: Cough, loss of sense of taste, hyperkalemia (elevated potassium levels)
• ARBs: Allergic reactions, dizziness, hyperkalemia
• Beta-blockers: Worsening of dyspnea in people with chronic obstructive pulmonary disease (COPD) or asthma; sexual dysfunction; fatigue; depression; worsening of symptoms in people with peripheral artery disease

With so many drugs to choose from, it is rare that a doctor will ask a person with hypertension to tolerate significant adverse effects.

A Word From Verywell

Hypertension is an extremely common medical problem that can have severe consequences if not treated adequately. However, with so many treatment options, you should expect your doctor to find a therapeutic regimen that will greatly decrease your risk of a bad outcome from hypertension—without disrupting your everyday life. If you are experiencing any troublesome side effects, be sure to talk to your doctor about finding a treatment regimen that you can tolerate better.

Heart attack

Symptoms of a heart attack

Common signs and symptoms of a heart attack include:

• Chest pain or discomfort (angina pectoris) may present with a feeling of tightness, tightness, fullness, or pain in the center of the chest. With a heart attack, pain usually lasts for a few minutes and may increase and decrease in intensity.
• Discomfort in the upper body, including arms, neck, back, jaw, or abdomen.
• Difficulty breathing.
• Nausea and vomiting.
• Cold sweat.
• Dizziness or fainting.
• Women are less likely to have chest pain.

Emergency treatment for heart attack

The American Heart Association and the American College of Cardiology recommend:

• If you think you are having a heart attack, call (03) right away. After calling (03), you need to chew an aspirin tablet. Be sure to inform the paramedic about this, then an additional dose of aspirin is not required.
• Angioplasty, also called percutaneous coronary intervention (PCI), is a procedure that must be performed within 90 minutes of the onset of a heart attack. Patients suffering from a heart attack must be transported to a hospital equipped to perform PCI.
• Fibrinolytic therapy should be given within 30 minutes of a heart attack if the center performing PCI is not available. The patient should be transferred to the PCI unit without delay.

Secondary prevention of heart attack

Additional preventive measures are needed to help prevent another heart attack. Before discharge, you need to discuss with your inpatient doctor:

• Control of blood pressure and cholesterol levels (statins, ACE inhibitors, beta-blockers are prescribed at discharge).
• Aspirin and the antiplatelet drug clopidogrel (Plavix), which many patients must take on a regular basis.Prasugrel (Effient) is a new drug that can be used as an alternative to clopidogrel for patients.
• Cardiac rehabilitation and regular exercise.
• Weight normalization.
• Smoking cessation.

Introduction

The heart is a complex organ of the human body. Throughout life, it constantly pumps blood, supplying oxygen and vital nutrients to all body tissues through the arterial network.To accomplish this strenuous task, the heart muscle itself needs a sufficient amount of oxygenated blood, which is delivered to it through the network of coronary arteries. These arteries carry oxygen-rich blood to the muscular wall of the heart (myocardium).

A heart attack (myocardial infarction) occurs when blood flow to the heart muscle is blocked, tissue is deprived of oxygen and part of the myocardium dies.

Ischemic heart disease is the cause of heart attacks.Coronary artery disease is the end result of atherosclerosis, which interferes with coronary blood flow and reduces the delivery of oxygenated blood to the heart.

Heart attack

Heart attack (myocardial infarction) is one of the most serious outcomes of atherosclerosis. It can happen for two reasons:

• If a crack or rupture develops in an atherosclerotic plaque. Platelets are trapped in this area for sealing and a blood clot (thrombus) forms.A heart attack can occur if a blood clot completely blocks the passage of oxygen-rich blood to the heart.
• If an artery becomes completely blocked due to a gradual increase in atherosclerotic plaque. A heart attack can occur if insufficient oxygen-rich blood passes through this area.

Angina pectoris

Angina, the main symptom of coronary artery disease, is usually perceived as chest pain.There are two types of angina pectoris:

• stable angina pectoris. This is predictable chest pain that can usually be managed with lifestyle changes and certain medications, such as low doses of aspirin and nitrates.
• unstable angina. This situation is much more serious than stable angina and is often an intermediate stage between stable angina and heart attack. Unstable angina is part of a condition called acute coronary syndrome.

Acute coronary syndrome

Acute coronary syndrome (ACS) is a severe and sudden heart condition that, with the necessary intensive treatment, does not turn into a full-blown heart attack. Acute coronary syndrome includes:

• unstable angina. Unstable angina is a potentially serious condition in which chest pain is persistent but blood tests do not show markers of heart attack.
• myocardial infarction without ST segment elevation (not Q-myocardial infarction).Diagnosed when blood tests and ECGs reveal a heart attack that does not capture the full thickness of the heart muscle. The damage to the arteries is less severe than with a major heart attack.

Patients diagnosed with acute coronary syndrome (ACS) may be at risk of heart attack. Doctors analyze the patient’s medical history, various tests, and the presence of certain factors that help predict which ACS patients are most at risk of developing a more serious condition.The severity of chest pain alone does not necessarily indicate the severity of the heart injury.

Risk factors

The risk factors for heart attack are the same as the risk factors for coronary heart disease. These include:

Age

The risk of coronary heart disease increases with age. About 85% of people who die from cardiovascular disease are over 65 years of age. In men, on average, the first heart attack develops at the age of 66.

Floor

Men are at a greater risk of developing coronary artery disease and heart attacks at an earlier age than women.The risk of cardiovascular disease in women increases after menopause, and they begin to suffer from angina more than men.

Genetic factors and family inheritance

Several genetic factors increase the likelihood of developing risk factors such as diabetes, high cholesterol, and high blood pressure.

Race and ethnicity

African Americans have the highest risk of heart disease due to their high incidence of high blood pressure, diabetes and obesity.

Medical prerequisites

Obesity and metabolic syndrome. Excessive fat storage, especially around the waist, can increase the risk of heart disease. Obesity also contributes to the development of high blood pressure, diabetes, which affect the development of heart disease. Obesity is especially dangerous when it is part of metabolic syndrome, a pre-diabetic condition associated with heart disease. This syndrome is diagnosed when three of the following conditions are present:

• Abdominal obesity.
• Low HDL cholesterol.
• High triglyceride levels.
• High blood pressure.
• Insulin resistance (diabetes or prediabetes).

Elevated cholesterol levels. Low-density lipoprotein (LDL) is the “bad” cholesterol responsible for many heart problems. Triglycerides are another type of lipids (fatty molecules) that can be harmful to the heart. High density lipoprotein cholesterol (HDL) is the “good” cholesterol that helps protect against heart disease.Doctors analyze a “total cholesterol” profile, which includes measurements of LDL, HDL, and triglycerides. The ratios of these lipids can affect the risk of developing cardiovascular disease.

High blood pressure. High blood pressure (hypertension) is associated with the development of coronary artery disease and heart attack. Normal blood pressure figures are below 120/80 mm Hg. High blood pressure is generally considered to be blood pressure greater than or equal to 140 mmHg. (systolic) or greater than or equal to 90 mm Hg.Art. (diastolic). Prehypertension is blood pressure with numbers 120 – 139 systolic or 80 – 89 diastolic, it indicates an increased risk of developing hypertension.

Diabetes. Diabetes, especially for people whose blood sugar levels are not well controlled, significantly increases the risk of developing cardiovascular disease. In fact, heart disease and strokes are the leading causes of death in people with diabetes. People with diabetes also have a high risk of developing hypertension and hypercholesterolemia, bleeding disorders, kidney disease, and nerve dysfunctions, all of which can lead to heart damage.

Lifestyle factors

Reduced physical activity. Exercise has a number of effects that benefit the heart and circulation, including cholesterol and blood pressure levels and weight maintenance. People who are sedentary are almost twice as likely to have heart attacks as people who exercise regularly.

Smoking. Smoking is the most important risk factor for cardiovascular disease.Smoking can raise blood pressure, disrupt lipid metabolism, and make platelets very sticky, increasing the risk of blood clots. Although heavy smokers are at the greatest risk, people who smoke as little as three cigarettes a day have a high risk of blood vessel damage, which can lead to impaired blood supply to the heart. Regular exposure to secondhand smoke also increases the risk of heart disease in nonsmokers.

Alcohol. Drinking alcohol in moderation (one glass of dry red wine a day) can help raise your “good” cholesterol (HDL) levels.Alcohol can also prevent blood clots and inflammation. In contrast, drunkenness harms the heart. In fact, cardiovascular disease is the leading cause of death for alcoholics.

Diet. Diet can play an important role in protecting the heart, especially by reducing dietary sources of trans fat, saturated fat, and cholesterol, and limiting salt intake, which contributes to high blood pressure.

NSAIDs and COX-2 inhibitors