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.

Compare Current High+Blood+Pressure Drugs and Medications with Ratings & Reviews

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

All non-steroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, are a risk factor for the heart.NSAIDs and COX-2 inhibitors may increase the risk of death in patients who have had a heart attack. The risk is greatest at higher doses.

NSAIDs include over-the-counter drugs such as ibuprofen (Advil, Motril) and prescription drugs such as diclofenac (Cataflam, Voltaren). Celecoxib (Celebrex), a COX-2 inhibitor that is available in the United States, has been associated with cardiovascular risks such as heart attack and stroke. Patients who have had heart attacks should consult their doctor before taking any of these medications.

The American Heart Association recommends that patients who have or are at risk of heart disease primarily use non-drug methods of pain relief (eg, physical therapy, exercise, weight loss to reduce stress on joints, and heat or cold therapy). If these methods do not work, patients should take low doses of acetaminophen (Tylenol) or aspirin before using NSAIDs, and the COX-2 inhibitor celecoxib (Celebrex) should be used last.

Forecast

Heart attacks can be fatal, become chronic, or lead to complete recovery. The long-term prognosis for life expectancy and quality of life after a heart attack depends on its severity, the damage to the heart muscle, and the preventive measures taken thereafter.

Patients who have had a heart attack have a higher risk of having another heart attack. Although there are no tests that can predict whether another heart attack will occur, patients themselves can avoid another heart attack by following a healthy lifestyle and adhering to treatment.Two thirds of patients who have had a heart attack do not take the necessary steps to prevent it.

A heart attack also increases the risk of other heart problems, including abnormal heart rhythms, heart valve damage, and stroke.

People at greatest risk. A heart attack is always more serious in some people, such as:

• Elderly.
• People with heart disease or multiple risk factors for cardiovascular disease.
• People with heart failure.
• People with diabetes.
• People on continuous dialysis.
• Women are more likely to die of a heart attack than men. The risk of death is highest in young women.

Factors that occur during a heart attack that increase the severity.

The presence of these conditions during a heart attack can contribute to a worsening prognosis:

• Arrhythmias (heart rhythm disturbances).Ventricular fibrillation is a dangerous arrhythmia and one of the leading causes of early death from heart attack. Arrhythmias are more likely to occur within the first 4 hours of a heart attack and are associated with high mortality. However, patients who are successfully treated have the same long-term prognosis as patients without arrhythmias.
• Cardiogenic shock. This very dangerous situation is associated with very low blood pressure, decreased urinary output, and metabolic disturbances. Shock occurs in 7% of heart attacks.
• Heart block, the so-called atrioventricular (AV) block, is a condition in which the electrical conduction of nerve impulses to the muscles in the heart is slowed down or interrupted. Although heart block is dangerous, it can be effectively treated with a pacemaker and rarely causes any long-term complications in surviving patients.
• Heart failure. The damaged heart muscle is unable to pump the blood necessary for the tissues to function.Patients experience fatigue, shortness of breath, and fluid retention in the body.

Symptoms

Heart attack symptoms can vary. They may come on suddenly and be severe, or they may progress slowly, starting with mild pain. Symptoms can differ between men and women. Women are less likely than men to have classic chest pain, they are more likely to experience shortness of breath, nausea or vomiting, back pain and jaw pain.

Common signs and symptoms of heart attack include:

• Chest pain.Chest pain or discomfort (sore throat) is the main symptom of a heart attack and can be felt as a feeling of tightness, tightness, fullness, or pain in the center of the chest. Patients with coronary artery disease who have stable angina often experience chest pain that lasts a few minutes and then goes away. With a heart attack, pain usually lasts more than a few minutes and may go away but then return.
• Upper body discomfort. People who are experiencing a heart attack may feel discomfort in their arms, neck, back, jaw, or stomach.
• Difficulty breathing may be accompanied by chest pain or no pain.
• Nausea and vomiting.
• Cold sweat.
• Dizziness or fainting.

The following symptoms are less common with a heart attack:

• Sharp pain when breathing or coughing.
• Pain that is mainly or only in the middle or lower abdomen.
• Pain that can be caused by touch.
• Pain that can be caused by movement or pressing on the chest wall or arm.
• Pain that is constant and lasts for several hours (do not wait several hours if you suspect that a heart attack has begun).
• Pain that is very short and lasts for a few seconds.
• Pain that spreads to the legs.
• However, these signs do not always rule out serious heart disease.

Painless ischemia

Some people with severe coronary artery disease may not have angina. This condition is known as painless ischemia. It is a dangerous condition because patients do not have alarming symptoms of heart disease. Some studies show that people with painless ischemia have a greater risk of complications and mortality than those with angina pain.

What to do in case of a heart attack

People who are experiencing symptoms of a heart attack should follow these steps:

• For patients with angina pectoris – take one dose of nitroglycerin (a tablet under the tongue or in an aerosol form) when symptoms appear.Then another dose every 5 minutes, up to three doses, or until pain decreases.
• Call (03) or dial the local emergency number. This should be done first if three doses of nitroglycerin do not relieve chest pain. Only 20% of heart attacks occur in patients with previously diagnosed angina. Therefore, anyone who develops symptoms of a heart attack should contact emergency services.
• The patient should chew aspirin (250 – 500 mg), which should be reported to the arrived emergency service, since an additional dose of aspirin in this case does not need to be taken.
• A patient with chest pain should be transported immediately to the nearest emergency room, preferably by ambulance. Traveling on your own is not recommended.

Diagnostics

When a patient with chest pain is admitted to the hospital, the following diagnostic steps are taken to identify heart problems and, if present, their severity:

• The patient should inform the doctor about any symptoms that may indicate heart problems or possibly other serious medical conditions.
• Electrocardiogram (ECG) – a record of the electrical activity of the heart. It is a key tool for determining if chest pains are related to heart problems and, if so, how severe they are.
• Blood tests reveal an increase in the levels of certain factors (troponins and CPK-MB), which indicate heart damage (the doctor will not wait for results before starting treatment, especially if he suspects a heart attack).
• Imaging techniques, including echocardiography and perfusion scintigraphy, help rule out a heart attack if you have any questions.

Electrocardiogram (ECG)

An electrocardiogram (ECG) measures and records the electrical activity of the heart, the ECG waves correspond to the contraction and relaxation of certain structures in different parts of the heart. Certain waves on the ECG are named with the corresponding letters:

• R. P-waves are associated with atrial contractions (two chambers in the heart that receive blood from the organs).
• QRS. The complex is associated with ventricular contractions (the ventricles are the two main pumping chambers in the heart.)
• T and U. These waves accompany ventricular contractions.

Doctors often use terms such as PQ or PR interval. This is the time it takes for the electrical impulse to travel from the atria to the ventricles.

ST segment elevation and Q wave definition are the most important in the diagnosis and treatment of heart attack.

ST segment elevation: Heart attack. Elevation of the ST segment is an indicator of a heart attack. It indicates that the artery of the heart is blocked and the heart muscle is damaged to its full thickness.Q-myocardial infarction (myocardial infarction with ST-segment elevation) develops.

However, ST elevation does not always mean that the patient is having a heart attack. Inflammation of the bursa (pericarditis) is another cause of ST segment elevation.

Without ST segment elevation: angina pectoris and acute coronary syndrome.

A depressed or horizontal ST segment suggests conduction abnormalities and cardiovascular disease, even if no angina is present at present.ST segment changes occur in about half of patients with various heart diseases. However, in women, ST segment changes can occur without heart problems. In such cases, laboratory tests are needed to determine the extent of damage to the heart, if any. Thus, one of the following conditions may develop:

• Stable angina (blood test or other test results do not show any major problems and chest pain disappears).During this period, in 25 – 50% of people with angina pectoris or painless ischemia, normal ECG values ​​are recorded.
• Acute coronary syndrome (ACS). It requires intensive treatment until it turns into a massive heart attack. ACS includes either unstable angina or myocardial infarction without ST-segment elevation (not Q-myocardial infarction). Unstable angina is a potentially serious event with persistent chest pain, but blood tests do not reveal markers of heart attack.In non-Q myocardial infarction, blood tests detect a heart attack, but the damage to the heart is less severe than in a full-blown heart attack.

Echocardiogram (ECHOKG)

An echocardiogram is a non-invasive technique that uses ultrasound to visualize the heart. It is possible to determine the damage and mobility of areas of the heart muscle. Echocardiography can also be used as an exercise test to detect the location and extent of damage to the heart muscle during illness or shortly after hospital discharge.

Radionucleide methods (stress test with thallium)

Allows to visualize the accumulation of radioactive tracers in the heart area. They are usually given intravenously. This method allows you to evaluate:

• Severity of unstable angina when less expensive diagnostic methods are not effective.
• Severity of chronic coronary heart disease.
• Success of surgery for coronary heart disease.
• Whether a heart attack has occurred.
• Localization and degree of damage to the heart muscle during illness or shortly after discharge from the hospital after suffering a heart attack.

The procedure is non-invasive. It is a reliable method for a variety of severe heart conditions and can help determine if damage is due to a heart attack. The radioactive isotope thallium (or technetium) is injected into the patient’s vein. It binds to red blood cells and travels with the blood through the heart.The isotope can be traced to the heart using special cameras or scanners. Images can be synchronized with ECG. The test is performed at rest and during exercise. If damage is detected, the image is retained for 3 or 4 hours. Damage caused by a heart attack will persist on re-scans, and damage caused by angina will be leveled.

Angiography

Angiography is invasive. It is used for patients with angina pectoris confirmed by stress tests or other methods and for patients with acute coronary syndrome.Procedure progress:

• A narrow tube (catheter) is inserted into an artery, usually an arm or leg, and then passed through the vessels to the coronary arteries.
• A contrast agent is injected through a catheter into the coronary arteries and a recording is made.
• This results in images of the coronary arteries showing obstructions to blood flow.

Biological markers

When heart cells are damaged, they release various enzymes and other substances into the bloodstream.Elevated levels of these markers of heart damage in the blood or urine can help identify a heart attack in patients with severe chest pain and help guide treatment. Tests like these are often done in the emergency room or hospital if a heart attack is suspected. Most commonly identified markers:

• troponins. Cardiac troponin T and I proteins are released when the heart muscle is damaged. These are the best diagnostic signs of heart attacks.They can help diagnose and confirm the diagnosis in patients with ACS.
• myocardial creatine kinase (CPK-MB). CPK-MB is a standard marker, but its sensitivity is less than that of troponin. Elevated levels of CPK-MB can be observed in people without heart disease.

Treatment

Treatments for heart attack and acute coronary syndrome include:

• Oxygen therapy.
• Relief of pain and discomfort with the use of nitroglycerin or morphine.
• Correction of arrhythmia (abnormal heart rhythm).
• Blocking further blood clotting (if possible) using aspirin or clopidogrel (Plavix) and anticoagulants such as heparin.
• The opening of the artery in which the cow flow has been disturbed should be made as soon as possible by performing angioplasty or with the help of drugs that dissolve the blood clot.
• Beta blockers, calcium channel blockers, or angiotensin-converting enzyme inhibitors are prescribed to improve the function of the heart muscle and coronary arteries.

Immediate actions

The same for patients with both ACS and heart attack.

Oxygen. It is usually given through a tube into the nose or through a mask.

Aspirin. The patient is given aspirin if it has not been taken at home.

Medicines for relieving symptoms:

• Nitroglycerin. Most patients will receive nitroglycerin both during and after a heart attack, usually under the tongue. Nitroglycerin lowers blood pressure and dilates blood vessels, increasing blood flow to the heart muscle.Nitroglycerin is sometimes given intravenously (recurrent angina, heart failure, or high blood pressure).
• Morphine. Morphine not only relieves pain and reduces anxiety, but also dilates blood vessels, increasing the flow of blood and oxygen to the heart. Morphine can lower blood pressure and make it easier for the heart. Other drugs can be used as well.

Removal of obstruction of coronary circulation: emergency angioplasty or thrombolytic therapy

In a heart attack, clots form in the coronary arteries that obstruct coronary flow.Removal of clots in the arteries should be done as soon as possible, this is the best approach to improve survival and reduce the amount of damage to the heart muscle. Patients should be admitted to specialized medical centers as quickly as possible.

Standard medical and surgical procedures include:

• Angioplasty, also called percutaneous coronary intervention (PCI), is the preferred procedure for emergency opening of arteries.Angioplasty should be performed promptly for patients with a heart attack, preferably within 90 minutes of arriving at the hospital. In most cases, a stent is placed in the coronary artery, which creates an internal scaffold and improves the patency of the coronary artery.
• Thrombolytics dissolve the clot and are the standard drugs used to open arteries. Thrombolytic therapy should be given within 3 hours of symptom onset. Patients who are admitted to a hospital unable to perform PCI should receive thrombolytic therapy and be transferred to a PCI center without delay.
• Coronary artery bypass grafting (CABG) is sometimes used as an alternative to PCI.

Thrombolytics

Thrombolytic or fibrinolytic drugs are recommended as an alternative to angioplasty. These drugs dissolve the clot, or blood clot, that is responsible for blocking an artery and causing cardiovascular death.

Generally speaking, thrombolysis is considered a good choice for patients with myocardial infarction in the first 3 hours. Ideally, these medications should be given within 30 minutes of arriving at the hospital unless angioplasty is being performed.Other situations where thrombolytics are used:

• The need for long-term transportation.
• Long period of time before PCI.
• Failure of PCI.

Thrombolytics should be avoided or used with great caution in the following patients after a heart attack:

• In patients over 75 years old.
• If symptoms persist for more than 12 hours.
• Pregnant women.
• People who have recently suffered an injury (especially a head injury) or surgery.
• People with exacerbation of peptic ulcer disease.
• Patients who have undergone long-term cardiopulmonary resuscitation.
• When taking anticoagulants.
• Patients who have suffered a major loss of cows.
• Stroke patients.
• Patients with uncontrolled high blood pressure, especially when the systolic pressure is above 180 mm.Hg

Standard thrombolytic drugs are recombinant tissue plasminogen activators (TAP): Alteplase (Actelise) and Reteplase (Retalize), as well as the new tenecteplase (Metalize). A combination of antiplatelet and anticoagulant therapy is also used to prevent clot enlargement and the formation of a new one.

Rules for the administration of thrombolytics. The sooner thrombolytics are given after a heart attack, the better. Thrombolytics are most effective during the first 3 hours.They can still help up to 12 hours after a heart attack.

Complications. Hemorrhagic stroke usually occurs on the first day and is the most serious complication of thrombolytic therapy, but fortunately this rarely occurs.

Revascularization procedures: angioplasty and bypass surgery

Percutaneous coronary intervention (PCI), also called angioplasty, and coronary artery bypass grafting are standard surgeries to improve coronary blood flow.These are known as revascularization surgeries.

• Emergency angioplasty / PCI is a standard procedure for heart attacks and must be performed within 90 minutes of its onset. Studies have shown that balloon angioplasty and stenting are not able to prevent heart complications in patients when they are performed 3 to 28 days after a heart attack.
• Coronary artery bypass grafting is usually used as elective surgery, but can sometimes be performed after a heart attack, with unsuccessful angioplasty or thrombolytic therapy.It is usually performed over several days to allow the heart muscle to heal.
  Most patients are suitable for thrombolytic therapy or angioplasty (although not all centers are equipped for PCI).

Angioplasty / PCI includes the following steps:

• A narrow catheter (tube) is inserted into the coronary artery.
• The vessel lumen is restored when a small balloon is inflated (balloon angioplasty).
• After deflation of the balloon, the vessel lumen increases.
• To keep the lumen of an artery open for a long time, a device called a coronary stent is used – an expandable metal mesh tube that is implanted into an artery during angioplasty. The stent can consist of bare metal, or it can be coated with a special drug that is slowly released into the adjacent wall of the vessel.
• The stent restores the vessel lumen.

Complications occur in about 10% of patients (about 80% of them during the first day). Best results are achieved in hospitals with experienced staff. Women who undergo angioplasty after a heart attack have a higher risk of death than men.
Restenosis after angioplasty. Narrowing after angioplasty (restenosis) can occur within a year after surgery and requires a repeat of the PCI procedure.

Drug eluting stents that are coated with sirolimus or paclitaxel may help prevent restenosis.They may be better than a bare metal stent for patients who have had a heart attack, but they can also increase the risk of blood clots.

It is very important for patients with drug-eluting stents to take aspirin and clopidogrel (Plavix) for at least 1 year after stenting to reduce the risk of blood clots. Clopidogrel, like aspirin, helps prevent platelets from sticking together. If, for some reason, patients are unable to take clopidogrel along with aspirin after angioplasty and stenting, bare metal stents should be implanted without drug coating.Prasugrel is a newer alternative to clopidogrel.

Coronary bypass surgery (CABG). It is an alternative to angioplasty in patients with severe angina pectoris, especially those with two or more occluded arteries. This is a very aggressive procedure:

• The chest opens and blood is pumped using a heart-lung machine.
• During the main stage of the operation, the heart stops.
• Bypassing the closed sections of the arteries, shunts are sewn, which are taken during the operation from the patient’s leg, or from the arm and chest. Thus, blood flows to the heart muscle through shunts bypassing the closed sections of the arteries.

Mortality in CABG after a heart attack is significantly higher (6%) than when the operation is performed as planned (1-2%). How and when it should be used after a heart attack remains controversial.

Treatment of patients with shock or heart failure

Seriously ill patients with heart failure or who are in a state of cardiogenic shock (it includes a decrease in blood pressure and other disorders) are intensively treated and monitored: they give oxygen, inject fluids, regulate blood pressure, dopamine, dobutamine and other drugs are used.

Heart failure. Furosemide is administered intravenously. Patients may also be given nitrates and ACE inhibitors if there is no sharp drop in blood pressure when indicated. Thrombolytic therapy or angioplasty may be done.

Cardiogenic shock. The intra-aortic balloon counterpulsation (IABP) procedure can help patients with cardiogenic shock when used in combination with thrombolytic therapy. A balloon catheter is used that inflates and descends into the aorta during certain phases of the cardiac cycle, thus increasing blood pressure.Also, an angioplasty procedure can be performed.